Background: While literature on the overall health burden of high temperature exposures on children continues to grow, little is known about whether children with chronic diseases are particularly vulnerable to the adverse health impacts of extreme heat.

Methods: We used New York Statewide Planning and Research Cooperative System (SPARCS) data on children aged 0-18 years admitted to emergency department and hospitals during the warm months (May-September) from 2005 to 2011. We identified children with specific chronic diseases or conditions that plausibly enhance susceptibility to heat (i.e., asthma, obesity, cerebral palsy, cystic fibrosis, sickle cell disease, sickle cell trait, and mental health disorders). We also identified children with a complex chronic condition (CCC) defined using the Feudtner classification scheme. We used a time-stratified, case-crossover design and conditional logistic regression models, adjusted for mean daily relative humidity, to derive estimates of excess risk of pediatric admissions associated with daily maximum temperature (Tmax).

Results: There were 2,480,556 pediatric cases in New York City during the study period; 90.8% (n = 2,252,550) occurred in emergency departments; chronic conditions appeared in 0.1% (sickle cell trait) up to 8.3% (asthma). The average Tmax was 80.3F (range 50F-104F). While we found an increase in overall pediatric admissions associated with Tmax, we found decreased risks among children with some specific categories of chronic conditions, including asthma, obesity, and mental health disorders. For children with CCC, temperature was associated with increased admissions when considering only the summer months. Conclusions: We found that children with chronic conditions show a complex pattern of risk of healthcare utilization. With further replication, our findings can help inform preparedness of the health system for prevention measures.

Key Take Away Points

• We found a complex pattern of risk between daily maximum temperatures and ED hospital admissions for children with chronic conditions in New York City during warm seasons between 2005 and 2011.

• Children’s susceptibility to heat varied by the chronic condition, timeframe, and healthcare utilization type.

• While we found an increase in overall pediatric admissions associated with heat, we found decreased risks associated with high temperatures among children with some specific categories of chronic conditions including asthma and obesity.

• When considering ED visits and hospitalizations separately, children with sickle cell trait had increased risk of ED visit and children with mental health disorder diagnoses had increased risk of hospitalization.

Author Biography

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Research reported in this publication was supported by the National Institute of Environmental Health Sciences (R01ES030717). The funder/sponsor did not participate in the work.