Increased Emergency Department Medical Imaging: Association with Short-Term Exposures to Ambient Heat and Particulate
Kate Hanneman1, Omar Taboun1, Anish Kirpalani1
1From the Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (K.H., A. Kirpalani, B.E.W., J.A., H.S., A. Kielar, M.P.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital, University Health Network and Sinai Health System, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2 (K.H., H.P., H.S., A. Kielar, M.P.); Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (O.T.); Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada (A. Kirpalani); Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada (B.E.W., J.A.); Departments of Environmental Health (S.D.) and Biostatistics (R.C.N.), Harvard T. H. Chan School of Public Health, Boston, Mass; Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada (J.C.); and Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.).
None:
Background Climate change adversely affects human health, resulting in higher demand for health care services. However, the impact of climate-related environmental exposures on medical imaging utilization is currently unknown. Purpose To determine associations of short-term exposures to ambient heat and particulate air pollution with utilization of emergency department medical imaging. Materials and Methods In this retrospective time-stratified case-crossover study, daily imaging utilization counts from four emergency departments were linked to local daily environmental data-including fine particulate matter with 2.5-µm or smaller aerodynamic diameter (PM2.5) and ambient temperature-over 10 years (January 2013 to December 2022). Conditional Poisson regression models were used to evaluate the associations between daily imaging utilization and environmental exposures on the same day and each of the 7 days preceding imaging, lag days 0-7, controlling for day of the week, month, and year. Moving averages of mean daily PM2.5 and temperature were calculated to account for lagged exposure effects. Imaging counts were also stratified by modality (CT, radiography, US, and MRI). Results In an analysis of 1 666 420 emergency department imaging studies, a rise of 10 °C in the 2-day moving average of mean daily temperature and a rise of 10 μg/m3 in the 3-day moving average of mean daily PM2.5 were associated with overall imaging utilization increases of 5.1% (incidence rate ratio [IRR], 1.051; 95% CI: 1.045, 1.056) and 4.0% (IRR, 1.040; 95% CI: 1.035, 1.046), respectively. Heat exposure days (mean temperature >20 °C) and air pollution exposure days (mean PM2.5 >12 μg/m3) were associated with same-day excess absolute risk of 5.5 and 6.4 imaging studies per 1 million people at risk per day, respectively. Heat exposure days and air pollution exposure days were associated with increased utilization of radiography (excess relative risk, 2.7% [P < .001] and 2.1% [P < .001], respectively) and CT (excess relative risk, 2.0% [P = .001] and 2.7% [P < .001]) but not US (P = .14 and P = .14) or MRI (P = .70 and P = .65). Conclusion Short-term exposures to ambient heat and particulate air pollution were associated with increased utilization of radiography and CT but not US or MRI. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Vosshenrich in this issue.
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