Private vs. public emergency visits for mental health due to heat: An indirect socioeconomic assessment of heat vulnerability and healthcare access, in Curitiba, Brazil.

Autor: Corvetto JF; Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany. Electronic address: julia.corvetto@uni-heidelberg.de., Helou AY; Laboratory of Chemical Neuroanatomy, Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, SP, Brazil., Kriit HK; Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany; Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden., Federspiel A; Private Psychiatric Hospital Meiringen, 3860 Meiringen, Switzerland., Bunker A; Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany., Liyanage P; Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany., Costa LF; Hospital Psiquiátrico Porto Seguro, Curitiba, Brazil., Müller T; Private Psychiatric Hospital Meiringen, 3860 Meiringen, Switzerland; Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000, Bern 60, Switzerland., Sauerborn R; Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany.
Jazyk: angličtina
Zdroj: The Science of the total environment [Sci Total Environ] 2024 Jul 15; Vol. 934, pp. 173312. Date of Electronic Publication: 2024 May 16.
DOI: 10.1016/j.scitotenv.2024.173312
Abstrakt: Few studies have explored the influence of socioeconomic status (SES) on the heat vulnerability of mental health (MH) patients. As individual socioeconomic data was unavailable, we aimed to fill this gap by using the healthcare system type as a proxy for SES. Brazilian national statistics indicate that public patients have lower SES than private. Therefore, we compared the risk of emergency department visits (EDVs) for MH between patients from both healthcare types. EDVs for MH disorders from all nine public (101,452 visits) and one large private facility (154,954) in Curitiba were assessed (2017-2021). Daily mean temperature was gathered and weighed from 3 stations. Distributed-lag non-linear model with quasi-Poisson (maximum 10-lags) was used to assess the risk. We stratified by private and public, age, and gender under moderate and extreme heat. Additionally, we calculated the attributable fraction (AF), which translates individual risks into population-representative burdens - especially useful for public policies. Random-effects meta-regression pooled the risk estimates between healthcare systems. Public patients showed significant risks immediately as temperatures started to increase. Their cumulative relative risk (RR) of MH-EDV was 7.5 % higher than the private patients (Q-Test 26.2 %) under moderate heat, suggesting their particular heat vulnerability. Differently, private patients showed significant risks only under extreme heat, when their RR became 4.3 % higher than public (Q-Test 6.2 %). These findings suggest that private patients have a relatively greater adaptation capacity to heat. However, when faced with extreme heat, their current adaptation means were potentially insufficient, so they needed and could access healthcare freely, unlike their public counterparts. MH patients would benefit from measures to reduce heat vulnerability and access barriers, increasing equity between the healthcare systems in Brazil. AF of EDVs due to extreme heat was 0.33 % (95%CI 0.16;0.50) for the total sample (859 EDVs). This corroborates that such broad population-level policies are urgently needed as climate change progresses.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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