Abstract：
BACKGROUND: Given the anticipated increase in ambient temperature due to climate change, the hazardous effects of heat on health have been extensively studied; however, its impact on people with intellectual disability, autism, and mental illness is largely unknown. We aimed to estimate the association between heat and hospitalisation through the emergency department (ED) among people with these mental disorders.
METHODS: In this nationwide study, we used data from the National Health Insurance Database (NHID) of the National Health Insurance Service, the single universal insurer in South Korea, the claims data for which is based on the ICD-10. We included individuals with identified intellectual disability, autism, and mental disorders (including schizophrenia, bipolar disorder, recurrent depressive disorder, schizoaffective disorder and persistent obsessive-compulsive disorder, Tourette\'s disorder, and narcolepsy) and we established two control groups of people without these disorders: one including 1 million systematically sampled individuals, and one matched to the cohort based on sex, age, and income group. Data on hospital admission via the ED were obtained from the NHID, including the primary cause of admission and corresponding medical costs, for the warm season (June-September) of the period 2006-2021. We used the Google Earth Engine with the ERA5-Land dataset to collect data on the daily mean temperature. We applied a time-stratified case-crossover design using a distributed lag non-linear model and performed a conditional logistic regression. The risk ratio was estimated as the odds ratio (OR) with calculated odds at the 99th percentile temperature compared with that at the local 75th percentile temperature. We did not include people with lived experience of mental illness in this study.
RESULTS: Of the 456 946 people with intellectual disability, autism, or mental disorder in the NHID records, 99 845 were admitted to the ED, including 59 821 (59·9%) males and 40 024 (40·1%) females, and including 29 192 people with intellectual disability, 1428 people with autism, and 69 225 people with mental disorders. We were not able to collect data on ethnicity. The mean age at ED admission was 42·1 years (SD 17·9, range 0-102) for people with intellectual disability, 18·6 years (SD 10·4, range 1-72) for people with autism, and 50·8 years (SD 11·9, range 2-94) for people with mental disorders. The heat OR (odds at the 99th percentile vs 75th percentile of temperature) of ED admission was 1·23 (95% CI 1·11-1·36) for intellectual disability, 1·06 (0·68-1·63) for autism, and 1·20 (1·12-1·29) for mental disorders. People with intellectual disability, female individuals, people living in rural areas, or those with a low-income status were at increased risk of ED admission due to heat. The risk of ED admission due to genitourinary diseases was higher than that from other causes. Annual increase in medical costs attributable to heat among people with intellectual disability, autism, and mental disorders was US$ 224 970 per 100 000 person-years (95% empirical CI 139 784-305 770).
CONCLUSIONS: People with intellectual disability, autism, and mental disorders should be included in groups considered at a high-risk for heat exposure, and heat adaptation policies should be implemented with consideration of these groups and their needs.
BACKGROUND: The National Research Foundation of Korea, Korean Ministry of Environment, and Korean Ministry of Education.
UNASSIGNED: For the Korean translation of the abstract see Supplementary Materials section.
METHODS: In this nationwide study, we used data from the National Health Insurance Database (NHID) of the National Health Insurance Service, the single universal insurer in South Korea, the claims data for which is based on the ICD-10. We included individuals with identified intellectual disability, autism, and mental disorders (including schizophrenia, bipolar disorder, recurrent depressive disorder, schizoaffective disorder and persistent obsessive-compulsive disorder, Tourette\'s disorder, and narcolepsy) and we established two control groups of people without these disorders: one including 1 million systematically sampled individuals, and one matched to the cohort based on sex, age, and income group. Data on hospital admission via the ED were obtained from the NHID, including the primary cause of admission and corresponding medical costs, for the warm season (June-September) of the period 2006-2021. We used the Google Earth Engine with the ERA5-Land dataset to collect data on the daily mean temperature. We applied a time-stratified case-crossover design using a distributed lag non-linear model and performed a conditional logistic regression. The risk ratio was estimated as the odds ratio (OR) with calculated odds at the 99th percentile temperature compared with that at the local 75th percentile temperature. We did not include people with lived experience of mental illness in this study.
RESULTS: Of the 456 946 people with intellectual disability, autism, or mental disorder in the NHID records, 99 845 were admitted to the ED, including 59 821 (59·9%) males and 40 024 (40·1%) females, and including 29 192 people with intellectual disability, 1428 people with autism, and 69 225 people with mental disorders. We were not able to collect data on ethnicity. The mean age at ED admission was 42·1 years (SD 17·9, range 0-102) for people with intellectual disability, 18·6 years (SD 10·4, range 1-72) for people with autism, and 50·8 years (SD 11·9, range 2-94) for people with mental disorders. The heat OR (odds at the 99th percentile vs 75th percentile of temperature) of ED admission was 1·23 (95% CI 1·11-1·36) for intellectual disability, 1·06 (0·68-1·63) for autism, and 1·20 (1·12-1·29) for mental disorders. People with intellectual disability, female individuals, people living in rural areas, or those with a low-income status were at increased risk of ED admission due to heat. The risk of ED admission due to genitourinary diseases was higher than that from other causes. Annual increase in medical costs attributable to heat among people with intellectual disability, autism, and mental disorders was US$ 224 970 per 100 000 person-years (95% empirical CI 139 784-305 770).
CONCLUSIONS: People with intellectual disability, autism, and mental disorders should be included in groups considered at a high-risk for heat exposure, and heat adaptation policies should be implemented with consideration of these groups and their needs.
BACKGROUND: The National Research Foundation of Korea, Korean Ministry of Environment, and Korean Ministry of Education.
UNASSIGNED: For the Korean translation of the abstract see Supplementary Materials section.
摘要：
背景：鉴于气候变化导致的环境温度预期升高，热量对健康的危害已被广泛研究；然而，它对智障人士的影响，自闭症,精神疾病在很大程度上是未知的。我们旨在通过急诊科（ED）评估这些精神障碍患者的热量与住院之间的关联。
方法：在这项全国性的研究中，我们使用了国家健康保险服务的国家健康保险数据库（NHID）的数据，韩国的单一万能保险公司，索赔数据基于ICD-10。我们包括了有智力残疾的人，自闭症,和精神障碍（包括精神分裂症，双相情感障碍,复发性抑郁障碍,分裂情感障碍和持续性强迫症，图雷特障碍,和发作性睡病），我们建立了两个没有这些疾病的对照组：一个包括100万系统采样的个体，其中一个根据性别与队列相匹配，年龄,和收入组。通过急诊室住院的数据来自NHID，包括入院的主要原因和相应的医疗费用，为2006-2021年的温暖季节（6月至9月）。我们使用GoogleEarthEngine和ERA5-Land数据集收集每日平均温度数据。我们使用分布滞后非线性模型应用了时间分层的案例交叉设计，并进行了条件逻辑回归。风险比估计为比值比（OR），计算出的比值在第99百分位温度与当地第75百分位温度的比值。在这项研究中，我们没有包括有精神疾病生活经历的人。
结果：在456946名智障人士中，自闭症,或者NHID记录中的精神障碍，99845被允许进入急诊室，包括59821名(59·9%)男性和40024名(40·1%)女性，包括29192名智障人士，1428名自闭症患者,和69225名精神障碍患者。我们无法收集有关种族的数据。智力残疾患者的ED入院平均年龄为42·1岁（SD17·9，范围0-102），自闭症患者为18·6年（SD10·4，范围1-72），精神障碍患者为50·8岁（SD11·9，范围2-94）。智力残疾的ED入院热OR（第99百分位数与第75百分位数的几率）为1·23（95％CI1·11-1·36），1·06（0·68-1·63）自闭症，和1·20（1·12-1·29）用于精神障碍。有智力残疾的人,女性个体,生活在农村地区的人们，或低收入人群因高温导致ED入院风险增加.泌尿生殖系统疾病导致ED入院的风险高于其他原因。智力残疾人士因发热导致的医疗费用每年增加，自闭症,精神障碍为每10万人年224970美元(95%经验CI139784-305770).
结论：智障人士，自闭症,和精神障碍应包括在被认为是热暴露的高风险人群中，热适应政策的实施应考虑到这些群体及其需求。
背景：韩国国家研究基金会，韩国环境部，韩国教育部。
■有关摘要的韩语翻译，请参见补充材料部分。
方法：在这项全国性的研究中，我们使用了国家健康保险服务的国家健康保险数据库（NHID）的数据，韩国的单一万能保险公司，索赔数据基于ICD-10。我们包括了有智力残疾的人，自闭症,和精神障碍（包括精神分裂症，双相情感障碍,复发性抑郁障碍,分裂情感障碍和持续性强迫症，图雷特障碍,和发作性睡病），我们建立了两个没有这些疾病的对照组：一个包括100万系统采样的个体，其中一个根据性别与队列相匹配，年龄,和收入组。通过急诊室住院的数据来自NHID，包括入院的主要原因和相应的医疗费用，为2006-2021年的温暖季节（6月至9月）。我们使用GoogleEarthEngine和ERA5-Land数据集收集每日平均温度数据。我们使用分布滞后非线性模型应用了时间分层的案例交叉设计，并进行了条件逻辑回归。风险比估计为比值比（OR），计算出的比值在第99百分位温度与当地第75百分位温度的比值。在这项研究中，我们没有包括有精神疾病生活经历的人。
结果：在456946名智障人士中，自闭症,或者NHID记录中的精神障碍，99845被允许进入急诊室，包括59821名(59·9%)男性和40024名(40·1%)女性，包括29192名智障人士，1428名自闭症患者,和69225名精神障碍患者。我们无法收集有关种族的数据。智力残疾患者的ED入院平均年龄为42·1岁（SD17·9，范围0-102），自闭症患者为18·6年（SD10·4，范围1-72），精神障碍患者为50·8岁（SD11·9，范围2-94）。智力残疾的ED入院热OR（第99百分位数与第75百分位数的几率）为1·23（95％CI1·11-1·36），1·06（0·68-1·63）自闭症，和1·20（1·12-1·29）用于精神障碍。有智力残疾的人,女性个体,生活在农村地区的人们，或低收入人群因高温导致ED入院风险增加.泌尿生殖系统疾病导致ED入院的风险高于其他原因。智力残疾人士因发热导致的医疗费用每年增加，自闭症,精神障碍为每10万人年224970美元(95%经验CI139784-305770).
结论：智障人士，自闭症,和精神障碍应包括在被认为是热暴露的高风险人群中，热适应政策的实施应考虑到这些群体及其需求。
背景：韩国国家研究基金会，韩国环境部，韩国教育部。
■有关摘要的韩语翻译，请参见补充材料部分。
