在一个大型医疗索赔数据库中观察到的与高温有关的健康风险关联的普遍性,该数据库的对象是购买了商业医疗保险的患者。

IF 4.7 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Epidemiology Pub Date : 2024-11-01 Epub Date: 2024-08-09 DOI:10.1097/EDE.0000000000001781
Chad W Milando, Yuantong Sun, Yasmin Romitti, Amruta Nori-Sarma, Emma L Gause, Keith R Spangler, Ian Sue Wing, Gregory A Wellenius
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引用次数: 0

摘要

背景:极端的环境温度与较高的疾病和死亡风险有着明确的联系。Optum Labs Data Warehouse (OLDW) 是美国商业健康保险或医疗保险优势患者医疗索赔数据库,已被用于量化与高温有关的健康影响。据我们所知,投保人群的结果是否可以推广到更广泛的人群中,尚未有文献记载。我们试图解决这一问题,研究对象为 2012 年至 2019 年期间加利福尼亚州的美国人口:我们研究了急诊科(ED)每日就诊率和住院就诊率的变化情况,包括所有原因、与高温相关的结果、肾脏疾病、精神/行为障碍、心血管疾病和呼吸系统疾病。OLDW 是加州投保人健康数据的来源,而更广泛人群的健康数据则来自加州医疗保健获取和信息部 (HCAI)。我们将极端高温天气定义为最高气温超过特定县 97.5th 百分位数的 2 天或更多天中的任何一天,并采用时空分层病例交叉设计来评估和比较高温对健康的影响:不同数据集的平均就诊率各不相同。然而,在所有病因(发病率比值比 (rIRR) = 0.989; 95% 置信区间 (CI) = 0.973, 1.011)、热相关原因(rIRR = 1.080;95% CI = 0.999,1.168)、肾病(rIRR = 0.963;95% CI = 0.718,1.292)和精神疾病(rIRR = 1.098;95% CI = 1.004,1.201)。住院病人的比率也相似:这项工作提供的证据表明,OLDW 仍可作为估计极端高温对健康影响的资源。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Generalizability of Heat-related Health Risk Associations Observed in a Large Healthcare Claims Database of Patients with Commercial Health Insurance.

Background: Extreme ambient heat is unambiguously associated with a higher risk of illness and death. The Optum Labs Data Warehouse (OLDW), a database of medical claims from US-based patients with commercial or Medicare Advantage health insurance, has been used to quantify heat-related health impacts. Whether results for the insured subpopulation are generalizable to the broader population has, to our knowledge, not been documented. We sought to address this question, for the US population in California from 2012 to 2019.

Methods: We examined changes in daily rates of emergency department encounters and in-patient hospitalization encounters for all-causes, heat-related outcomes, renal disease, mental/behavioral disorders, cardiovascular disease, and respiratory disease. OLDW was the source of health data for insured individuals in California, and health data for the broader population were gathered from the California Department of Health Care Access and Information. We defined extreme heat exposure as any day in a group of 2 or more days with maximum temperatures exceeding the county-specific 97.5th percentile and used a space-time-stratified case-crossover design to assess and compare the impacts of heat on health.

Results: Average incidence rates of medical encounters differed by dataset. However, rate ratios for emergency department encounters were similar across datasets for all causes [ratio of incidence rate ratios (rIRR) = 0.989; 95% confidence interval (CI) = 0.969, 1.009], heat-related causes (rIRR = 1.080; 95% CI = 0.999, 1.168), renal disease (rIRR = 0.963; 95% CI = 0.718, 1.292), and mental health disorders (rIRR = 1.098; 95% CI = 1.004, 1.201). Rate ratios for inpatient encounters were also similar.

Conclusions: This work presents evidence that OLDW can continue to be a resource for estimating the health impacts of extreme heat.

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来源期刊
Epidemiology
Epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.70
自引率
3.70%
发文量
177
审稿时长
6-12 weeks
期刊介绍: Epidemiology publishes original research from all fields of epidemiology. The journal also welcomes review articles and meta-analyses, novel hypotheses, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.
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