High ambient temperature and child emergency and hospital visits in New York City

Background: Emerging literature has documented heat-related impacts on child health, yet few studies have evaluated the effects of heat among children of different age groups and comparing emergency department (ED) and hospitalisation risks. Objectives: To examine the differing associations between high ambient temperatures and risk of ED visits and hospitalisations among children by age group in New York City (NYC). Methods: We used New York Statewide Planning and Research Cooperative System (SPARCS) data on children aged 0–18 years admitted to NYC EDs (n = 2,252,550) and hospitals (n = 228,006) during the warm months (May-September) between 2005 and 2011. Using a time-stratified, case-crossover design, we estimated the risk of ED visits and hospitalisations associated with daily maximum temperature (Tmax) for children of all ages and by age group. Results: The average Tmax over the study period was 80.3°F (range 50°, 104°F). Tmax conferred the greatest risk of ED visits for children aged 0–4, with a 6-day cumulative excess risk of 2.4% (95% confidence interval [CI] 1.7, 3.0) per 13°F (ie interquartile range) increase in temperature. Children and adolescents 5–12 years (0.8%, 95% CI 0.1, 1.6) and 13–18 years (1.4%, 95% CI 0.6, 2.3) are also sensitive to heat. For hospitalisations, only adolescents 13–18 years had increased heat-related risk, with a cumulative excess risk of 7.9% (95% CI 2.0, 14.2) per 13°F increase in Tmax over 85°F. Conclusions: This urban study in NYC reinforces that young children are particularly vulnerable to effects of heat, but also demonstrates the sensitivity of older children and adolescents as well. These findings underscore the importance of focussing on children and adolescents in targeting heat illness prevention and emergency response activities, especially as global temperatures continue to rise.