Rongbin Xu|Qi Zhao|Micheline de Sousa Zanotti Stagliorio Coélho|Paulo Hilário Nascimento Saldiva|Michael J. Abramson|Shanshan Li|Hyewon Lee
Socioeconomic level and associations between heat exposure and all-cause and cause-specific hospitalization in 1,814 Brazilian cities: A nationwide case-crossover study
Binzhou University|Binzhou Medical University|Monash University|Monash University|Universidade de São Paulo|Universidade de São Paulo|Monash University|Monash University|Monash University|Binzhou University|Binzhou Medical University
background heat exposure increase global warming linked increased risk range types causespecific hospitalizations however little known socioeconomic disparities vulnerability heat aimed evaluate whether socioeconomic disparities vulnerability heatrelated allcause causespecific hospitalization among brazilian cities methods findings collected daily hospitalization weather data hot season cityspecific 4 adjacent hottest months year 20002015 1814 brazilian cities covering 784 brazilian population timestratified casecrossover design modeled quasipoisson regression distributed lag model used estimate cityspecific heathospitalization association metaanalysis used synthesize cityspecific estimates according different socioeconomic quartiles levels included 49 million hospitalizations 585 female median interquartile range age 333 198557 years cities lower middle income lmi upper middle income umi high income hi according world banks classification every 5c increase daily mean temperature hot season associated 51 95 ci 4457 p 0001 37 3340 p 0001 26 1734 p 0001 increase allcause hospitalization respectively intercity socioeconomic disparities association strongest children adolescents 019 years increased allcause hospitalization risk every 5c increase 95 ci 99 87111 p 0001 lmi cities versus 52 4163 p 0001 hi cities disparities particularly evident hospitalization due certain diseases including ischemic heart disease increase causespecific hospitalization risk every 5c increase 95 ci 56 02 118 p 0060 lmi cities versus 05 21 31 p 0717 hi cities asthma 37 0371 p 0031 versus 64 121 03 p 0041 pneumonia 80 56104 p 0001 versus 38 1165 p 0005 renal diseases 96 62131 p 0001 versus 49 1880 p 0002 mental health conditions 172 84268 p 0001 versus 55 14 130 p 0121 neoplasms 31 0755 p 0011 versus 01 21 20 p 0939 disparities similar stratifying cities socioeconomic indicators urbanization rate literacy rate household income main limitations lack data personal exposure temperature citylevel analysis assess intracity individuallevel socioeconomic disparities could exclude confounding effects unmeasured variables conclusions less developed cities displayed stronger associations heat exposure allcause hospitalizations certain types causespecific hospitalizations brazil may exacerbate existing geographical health socioeconomic inequalities changing climate