Heatwaves, medications, and heat-related hospitalization in older Medicare beneficiaries with chronic conditions.
Abstract
<h4>Background</h4>Heatwaves kill more people than floods, tornadoes, and earthquakes
combined and disproportionally affect older persons and those with chronic conditions.
Commonly used medications for chronic conditions, e.g., diuretics, antipsychotics
disrupt thermoregulation or fluid/electrolyte balance and may sensitive patients to
heat. However, the effect of heat-sensitizing medications and their interactions with
heatwaves are not well-quantified. We evaluated effects of potentially heat-sensitizing
medications in vulnerable older patients.<h4>Methods</h4>US Medicare data were linked
at the zip code level to climate data with surface air temperatures for June-August
of 2007-2012. Patients were Medicare beneficiaries aged ≥65 years with chronic conditions
including diabetes, dementia, and cardiovascular, lung, or kidney disease. Exposures
were potentially heat-sensitizing medications including diuretics, anticholinergics,
antipsychotics, beta blockers, stimulants, and anti-hypertensives. A heatwave was
defined as ≥2 days above the 95th percentile of historical zip code-specific surface
air temperatures. We estimated associations of heat-sensitizing medications and heatwaves
with heat-related hospitalization using self-controlled case series analysis.<h4>Results</h4>We
identified 9,721 patients with at least one chronic condition and heat-related hospitalization;
42.1% of these patients experienced a heatwave. Heatwaves were associated with an
increase in heat-related hospitalizations ranging from 21% (95% CI: 7% to 38%) to
33% (95% CI: 14% to 55%) across medication classes. Several drug classes were associated
with moderately elevated risk of heat-related hospitalization in the absence of heatwaves,
with rate ratios ranging from 1.16 (95% CI: 1.00 to 1.35) to 1.37 (95% CI: 1.14 to
1.66). We did not observe meaningful synergistic interactions between heatwaves and
medications.<h4>Conclusions</h4>Older patients with chronic conditions may be at heightened
risk for heat-related hospitalization due to the use of heat-sensitizing medications
throughout the summer months, even in the absence of heatwaves. Further studies are
needed to confirm these findings and also to understand the effect of milder and shorter
heat exposure.
Type
Journal articleSubject
HumansHeat Stress Disorders
Hospitalization
Risk Factors
Climate
Environmental Exposure
Aged
Aged, 80 and over
Medicare
United States
Female
Male
Permalink
https://hdl.handle.net/10161/22255Published Version (Please cite this version)
10.1371/journal.pone.0243665Publication Info
Layton, J Bradley; Li, Wenhong; Yuan, Jiacan; Gilman, Joshua P; Horton, Daniel B;
& Setoguchi, Soko (2020). Heatwaves, medications, and heat-related hospitalization in older Medicare beneficiaries
with chronic conditions. PloS one, 15(12). pp. e0243665. 10.1371/journal.pone.0243665. Retrieved from https://hdl.handle.net/10161/22255.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Wenhong Li
Associate Professor of Climate
Dr. Li's research interests focus primarily on climate dynamics, land-atmosphere interaction,
hydroclimatology, and climate modeling. Her current research is to understand how
the hydrological cycle changes in the current and future climate and their impacts
on the ecosystems, subtropical high variability and change, unforced global temperature variability,
and climate and health issues.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info