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Background: The health impacts of heatwaves are a growing public health concern with the frequency, intensity, and duration of heatwaves increasing with global climate change. However, little is known about the healthcare costs and the attributable morbidity associated with heatwaves Objective This study aims to examine the relationship between heatwaves and costs of emergency department (ED) presentations, and to quantify heat-attributable burden during the warm seasons of 2014–2017, in Adelaide, South Australia. Methods: Daily data on ED presentations and associated costs for the period 2014–2017 were obtained from the South Australian Department of Health and Wellbeing. Heatwave intensity was determined using the excess heat factor (EHF) index, obtained from the Australian Bureau of Meteorology. A distributed lag non-linear model (DLNM) was used to quantify the cumulative risk of heatwave-intensity over a lag of 0–7 days on ED presentations and costs. Effects of heatwaves were estimated relative to no heatwave. The number of ED presentations and costs attributable to heatwaves was calculated separately for two EHF severity categories (low-intensity and severe/extreme heatwaves). Subgroup analyses by disease-diagnosis groups and age categories were performed. Results: For most disease diagnosis and age categories, low-intensity and severe heatwaves were associated with higher rates of ED presentations and costs. We estimated a total of 1161 (95% empirical confidence interval (eCI): 342, 1944) heatwave-attributable all-cause ED presentations and associated healthcare costs (thousands) of AU$1020.3 (95% eCI: 224.9, 1804.7) during the warm seasons of 2014–2017. The heat-related illness was the disease category contributing most to ED presentations and costs. Age groups 0–14 and ≥ 65 years were most susceptible to heat. Conclusions: Heatwaves produced a statistically significant case-load and cost burden to the ED. Developing tailored interventions for the most vul

Increasing temperature and its impact on population health is an emerging significant public health issue in the context of climate change in Australia. While previous studies have primarily focused on risk assessment, very few studies have evaluated heat-attributable emergency department (ED) visits and associated healthcare costs, or projected future health and economic burdens. This study used a distributed lag non-linear model to estimate heat attributable ED visits and associated healthcare costs from 13 hospitals in Perth, Western Australia, and to project the future healthcare costs in 2030s and 2050s under three climate change scenarios - Representative Concentration Pathways (RCPs)2.6, RCP4.5 and RCP8.5. There were 3697 ED visits attributable to heat (temperatures above 20.5 C) over the study period 2012-2019, accounting for 4.6% of the total ED visits. This resulted in AU$ 2.9 million in heat-attributable healthcare costs. The number of ED visits projected to occur in the 2030s and 2050s ranges from 5707 to 9421 under different climate change scenarios, which would equate to AU$ 4.6-7.6 million in heat associated healthcare costs. The heat attributable fraction for ED visits and associated healthcare costs would increase from 4.6% and 4.1% in 2010s to 5.0%-6.3% and 4.4%-5.6% in 2030s and 2050s, respectively. Future heat attributable ED visits and associated costs will increase in Perth due to climate change. Excess heat will generate a substantial population health challenge and economic burdens on the healthcare system if there is insufficient heat adaptation. It is vital to reduce greenhouse gas emissions, develop heat-related health interventions and optimize healthcare resources to mitigate the negative impact on the healthcare system and population health in the face of climate change.

Background: A growing number of studies have investigated the effect of increasing temperatures on morbidity and health service use. However, there is a lack of studies investigating the temperature-attributable cost burden. Objectives: This study examines the relationship of daily mean temperature with hospital admissions, length of hospital stay (LoS), and costs; and estimates the baseline temperature-attributable hospital admissions, and costs and in relation to warmer climate scenarios in Adelaide, South Australia. Method: A daily time series analysis using distributed lag non-linear models (DLNM) was used to explore exposure-response relationships and to estimate the aggregated burden of hospital admissions for conditions associated with temperatures (i.e. renal diseases, mental health, diabetes, ischaemic heart diseases and heat-related illnesses) as well as the associated LoS and costs, for the baseline period (2010–2015) and different future climate scenarios in Adelaide, South Australia. Results: During the six-year baseline period, the overall temperature-attributable hospital admissions, LoS, and associated costs were estimated to be 3915 cases (95% empirical confidence interval (eCI): 235, 7295), 99,766 days (95% eCI: 14,484, 168,457), and AU$159 million (95% eCI: 18.8, 269.0), respectively. A climate scenario consistent with RCP8.5 emissions, and including projected demographic change, is estimated to lead to increases in heat-attributable hospital admissions, LoS, and costs of 2.2% (95% eCI: 0.5, 3.9), 8.4% (95% eCI: 1.1, 14.3), and 7.7% (95% eCI: 0.3, 13.3), respectively by mid-century. Conclusions: There is already a substantial temperature-attributable impact on hospital admissions, LoS, and costs which are estimated to increase due to climate change and an increasing aged population. Unless effective climate and public health interventions are put into action, the costs of treating temperature-related admissions will be high.

The association between heat and diseases has been extensively reported. However, its associated healthcare costs and attributable fraction due to heat were scarcely explored. The aim of this study was to estimate hospitalisation costs attributable to heat in Sydney, and to project future costs under climate change scenarios. Using a distributed lag nonlinear model, this study estimated heat-attributable hospitalisation costs in Sydney; and using 2010–2016 data as baseline, future costs for 2030s and 2050s were estimated under three climate change scenarios depending on greenhouse gas emissions - Representative Concentration Pathway (RCP)2.6, RCP4.5, and RCP8.5. Higher temperatures were found to be associated with increased hospitalisation costs. About 8–9% of the total hospitalisation costs were attributable to heat. The total costs attributable to heat over the baseline period 2010–2016 were estimated to be AU$252 million, with mental health hospitalisation making the largest contribution. Hospitalisation costs are estimated to increase substantially to AU$387–399 million in the 2030s, and AU$506–570 million by mid-century under different climate change scenarios. Urgent action is required to reduce heat-attributable illness in our communities, particularly for mental health conditions. Relevant preparations including healthcare workforce capacity building and resource allocation are needed to deal with these challenges in the context of climate change.