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Original research
Understanding current and projected emergency department presentations and associated healthcare costs in a changing thermal climate in Adelaide, South Australia
  1. Berhanu Yazew Wondmagegn1,2,3,
  2. Jianjun Xiang1,4,
  3. Keith Dear1,
  4. Susan Williams1,
  5. Alana Hansen1,
  6. Dino Pisaniello1,
  7. Monika Nitschke5,
  8. John Nairn6,
  9. Ben Scalley7,
  10. Alex Xiao8,
  11. Le Jian8,
  12. Michael Tong1,
  13. Hilary Bambrick9,
  14. Jonathan Karnon10,
  15. Peng Bi1
  1. 1 Public Health, The University of Adelaide, Adelaide, South Australia, Australia
  2. 2 Public Health, Swan Hill Rural City Council, Swan Hill, Victoria, Australia
  3. 3 Environmental Health Science, Haramaya University, Dire Dawa, Ethiopia
  4. 4 Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, China
  5. 5 South Australian Department of Health and Wellbeing, Adelaide, South Australia, Australia
  6. 6 Australian Bureau of Meteorology, Adelaide, South Australia, Australia
  7. 7 Department of Health, Metropolitan Communicable Disease Control, Perth, Western Australia, Australia
  8. 8 Department of Health, Epidemiology Branch, Perth, Western Australia, Australia
  9. 9 School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
  10. 10 School of Public Health, Flinders University, Adelaide, South Australia, Australia
  1. Correspondence to Professor Peng Bi, Public Health, The University of Adelaide, Australia, Adelaide, South Australia, Australia;{at}


Background Exposure to extreme temperatures is associated with increased emergency department (ED) presentations. The resulting burden on health service costs and the potential impact of climate change is largely unknown. This study examines the temperature-EDs/cost relationships in Adelaide, South Australia and how this may be impacted by increasing temperatures.

Methods A time series analysis using a distributed lag nonlinear model was used to explore the exposure–response relationships. The net-attributable, cold-attributable and heat-attributable ED presentations for temperature-related diseases and costs were calculated for the baseline (2014–2017) and future periods (2034–2037 and 2054–2057) under three climate representative concentration pathways (RCPs).

Results The baseline heat-attributable ED presentations were estimated to be 3600 (95% empirical CI (eCI) 700 to 6500) with associated cost of $A4.7 million (95% eCI 1.8 to 7.5). Heat-attributable ED presentations and costs were projected to increase during 2030s and 2050s with no change in the cold-attributable burden. Under RCP8.5 and population growth, the increase in heat-attributable burden would be 1.9% (95% eCI 0.8% to 3.0%) for ED presentations and 2.5% (95% eCI 1.3% to 3.7%) for ED costs during 2030s. Under the same conditions, the heat effect is expected to increase by 3.7% (95% eCI 1.7% to 5.6%) for ED presentations and 5.0% (95% eCI 2.6% to 7.1%) for ED costs during 2050s.

Conclusions Projected climate change is likely to increase heat-attributable emergency presentations and the associated costs in Adelaide. Planning health service resources to meet these changes will be necessary as part of broader risk mitigation strategies and public health adaptation actions.

  • public health
  • climate
  • environmental exposure
  • health services research
  • risk assessment

Data availability statement

Data may be obtained from a third party and are not publicly available. Not applicable.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Not applicable.

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  • Contributors BYW: methodology, data analyses, visualisation and writing-original draft and final manuscript. JX: methodology, data analyses, visualisation, project administration, supervision and writing-reviewing and editing. SW and MT: methodology, data analyses, visualisation, project administration and writing-reviewing and editing. KD: conceptualisation, funding acquisition, methodology, data analyses, visualisation and writing-reviewing and editing. DP: methodology, supervision and writing-reviewing and editing. MN, JN, BS, AX and LJ: methodology, funding acquisition, data acquisition and writing-reviewing and editing. AH, HB and JK: conceptualisation, funding acquisition, methodology and writing-reviewing and editing. PB: conceptualisation, funding acquisition, methodology, project administration, supervision and writing-reviewing and editing. PB: guarantor of the manuscript.

  • Funding The results reported herein correspond to specific aims of grant APP1145239 to investigator PB from the National Health and Medical Research Council.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.