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Private vs. public ...
Private vs. public emergency visits for mental health due to heat : an indirect socioeconomic assessment of heat vulnerability and healthcare access, in Curitiba, Brazil
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- Corvetto, Julia F. (author)
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany
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- Helou, Ammir Y. (author)
- Laboratory of Chemical Neuroanatomy, Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, SP, Sao Paulo, Brazil
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- Kriit, Hedi Katre (author)
- Umeå universitet,Avdelningen för hållbar hälsa,Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany
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- Federspiel, Andrea (author)
- Private Psychiatric Hospital Meiringen, 3860 Meiringen, Switzerland
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- Bunker, Aditi (author)
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany
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- Liyanage, Prasad (author)
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany
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- Costa, Luis Felipe (author)
- Hospital Psiquiátrico Porto Seguro, Curitiba, Brazil
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- Müller, Thomas (author)
- Private Psychiatric Hospital Meiringen, 3860 Meiringen, Switzerland; Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000, Bern, Switzerland
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- Sauerborn, Rainer (author)
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany
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(creator_code:org_t)
- Elsevier, 2024
- 2024
- English.
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In: Science of the Total Environment. - : Elsevier. - 0048-9697 .- 1879-1026. ; 934
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Abstract
Subject headings
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)
Keyword
- Attributable risk
- Climate change
- Dlnm
- Emergency department visits
- Extreme heat
- Mental disorder
- Private health care
- Psychiatric disorder
- Public health care
- Socioeconomic status
Publication and Content Type
- ref (subject category)
- art (subject category)
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