This study related daily intensive care unit (ICU) admissions among AOK insurance members to atmospheric data, 2009 to 2023. Quasi-Poisson generalised additive models were fitted by disease, age and sex in eleven human-bioclimatic regions of Germany. Admissions averaged 2,526 per 100,000 insured persons per year, and 74.3% of patients were aged 60 or over. Sea-level pressure was significant in 29.3% of models, tropical nights in 18.3%, summer days in 17.8% and ozone in 15.6%. Models explained on average only 10% of weighted deviance, and at most 49% for NSTEMI in the East German Lowlands. The design is observational and shows associations only, and the low explained deviance limits what the models account for.
Why it is interesting: ICUs run with little spare capacity, which the authors give as the reason to study atmospheric links to admissions. Pressure and heat were linked to admissions more often than pollutants, with heat links commoner in men and older people.
Abstract — the authors' own words, CC BY
Introduction
Atmospheric conditions under climate change constitute an increasing health burden and raise pressure on health care systems. Intensive care units (ICUs) are particularly vulnerable due to their low buffer capacity and high utilization rates. This study aimed to examine the association between atmospheric exposures and ICU admissions for intensive care relevant diseases across Germany. Methods
We analyzed daily time-series data on ICU admissions from AOK health insurances and atmospheric data in the period 2009 to 2023. Using principal component analysis, we clustered Germany into eleven human-bioclimatic regions. For each atmospheric predictor, the optimal time lag was selected, and disease-specific predictor sets were defined while accounting for multiple testing. In each region, we fitted quasi-Poisson generalized additive models to estimate disease-specific ICU admission risks associated with atmospheric exposures. Models were stratified by age ( Results
Over the 15-year study period, on average 2,526 ICU admissions per 100,000 AOK insured persons per year were recorded in Germany (44% women, 74.3% aged ≥60 years). Pressure-related variables were most frequently associated with ICU admissions (p ≤ 0.05). Sea-level pressure demonstrated a significant association in 29.3% of the models. Heat-related variables, including tropical nights (18.3%) and summer days (17.8%), were significantly associated with ICU admissions in Germany. Among air pollutants, ozone showed the highest proportion of significant associations (15.6%). Significant associations for heat-related atmospheric variables were observed more frequently among men and persons ≥60 years. Mean model performance across all models was 10% WED. The models for ICU admissions due to myocardial infarction (NSTEMI) in the East German Lowlands demonstrated the best model performance (WED: 49%). Discussion
Atmospheric factors were associated with ICU admissions, and these associations differed by region, disease, and age-sex group. Pressure- and heat-related factors were the most relevant atmospheric factors. These findings indicate that atmospheric factors have the potential to adversely impact intensive health care preparedness and delivery.
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