Records analysis, eight years of admissions

Public health poster

A public health poster has to state one finding a passer by can repeat, show the data behind it, and end with what a service should change. This A0 portrait example reports a fictional analysis of eight years of city records: emergency admissions in people 65 and over rose 14.2 per cent on nights when the minimum stayed above 22.1 degrees. It carries a one line key finding, a background block, labelled methods, one five band chart, one stat block, a discussion and four takeaways.

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BU
Night time temperature and emergency admissions in older adults: eight years of city records
N. Haddad ¹, E. Barlow ¹ ², C. Iwu ²
1 School of Population Health, Brightwater University · 2 Coastal City Public Health Unit
Above a night minimum of 22.1 degrees, emergency admissions in people 65 and over rose 14.2 per cent.
BACKGROUND
A hot day is survivable if the night that follows it is cool, because the body sheds the heat load while asleep. When the night stays warm the load carries over, and it is that carry over rather than the peak itself that the physiology literature associates with cardiovascular strain in older adults. Warning systems have mostly not followed. This city, like most in the region, triggers on forecast daytime maximum, a figure that is easy to communicate and easy to forecast. Whether it is the right figure is an empirical question that can be answered from records this city already holds, and answering it costs nothing but the analysis. Eight years of admissions and hourly temperature from a station six kilometres from the centre is enough to test it. The question is not whether heat kills, which is settled, but which number a public health unit should watch on a Thursday afternoon when it decides whether to open cooling centres for the weekend.
METHODS
Data. All 81,400 emergency admissions age 65 and over, 2017 to 2024, city hospital register.
Exposure. Hourly dry bulb temperature from the airport station, 6 km from the city centre, no gaps over 3 hours.
Model. Quasi-Poisson distributed lag non-linear model, lags 0 to 10 days, adjusted for season and day of week.
Change point. Segmented regression on night minimum, bootstrap confidence interval over 2,000 resamples.
Sensitivity. Repeated with humidity, with a second weather station, and excluding the 2020 lockdown months.
Under 1818 to 2020 to 2222 to 24Over 2400.350.71.051.4
Figure 1. Relative risk by night minimum band: under 18, 18 to 20, 20 to 22, 22 to 24 and over 24 degrees.
Source: city hospital admissions register and airport station, 2017 to 2024.
RESULTS
Above a night minimum of 22.1 degrees admissions rose 14.2% (95% CI 9.8 to 18.7), and above 24 degrees the rise was 28%. The change point at 22.1 degrees (95% CI 21.4 to 22.9) was stable across every sensitivity analysis we ran. The effect peaked at lag three and was gone by lag eight, which is consistent with a cumulative load rather than an immediate collapse. Cardiovascular and respiratory admissions accounted for 71% of the excess, and falls for a further 9%. Adding the daytime maximum to the model changed the night coefficient by less than 2% and did not improve fit, so on these records the night figure carries the signal on its own. The change requires no new data collection, only a different figure read from a forecast the city already receives, and no change to how the warning itself is issued or communicated.
14.2%
more admissions on hot nights
95% CI 9.8 to 18.7
DISCUSSION
A trigger built on the night minimum would have issued 31 warnings across the study period rather than 19, and would have covered 84% of the excess admissions rather than 52%. The extra warnings are not free, since a warning issued too often is ignored, but twelve extra nights across eight years is a modest cost for that coverage. This is one city with one weather station and a temperate coastal climate, so the threshold itself should not be copied. The method can be: any city with an admissions register and an hourly station can run this analysis on data it already holds, and should before it sets a threshold. Night time minimum predicts emergency admissions in older adults better than daytime maximum in this city, and a warning threshold set at 22 degrees would have covered most of the excess.
Admissions up 14.2% above a 22.1 degree night
Effect peaks at three days, gone by eight
Daytime maximum adds nothing to the model
Night trigger covers 84% of excess, not 52%
REFERENCES
1.Gasparrini A, et al. Lancet 2015;386(9991):369-375.
2.Royé D, et al. Environ Res 2021;196:110412.
3.Murage P, Hajat S, Kovats RS. Lancet Planet Health 2017;1(3):e97-e106.

Block by block

What each block on the board is for, in the order a reader walks it.

Title band and key finding line
The title names the exposure, the population and the span of records. Three authors sit under it over two affiliations, a university school of population health and the city public health unit. Below them the billboard line gives the result in one sentence: above a night minimum of 22.1 degrees, emergency admissions in people 65 and over rose 14.2 per cent. That line is what this layout exists for, and it is what a reader takes away from across the room.
Background
The longest block on the board explains why a warm night matters more than a hot day: the body sheds the heat load while asleep, and when the night stays warm the load carries over. It then names the practical gap, that warning systems trigger on the daytime maximum, and frames the question as a decision a unit makes on a Thursday afternoon. On your board, cut it to four sentences; the key finding line has already done the persuading.
Methods as a labelled protocol
Five labelled entries. Data: all 81,400 emergency admissions age 65 and over, 2017 to 2024, from the city hospital register. Exposure: hourly dry bulb temperature from the airport station 6 km from the centre. Model: a quasi Poisson distributed lag non linear model over lags 0 to 10 days, adjusted for season and day of week. Change point: segmented regression with a bootstrap over 2,000 resamples. Sensitivity: humidity, a second station, and the 2020 lockdown months excluded.
Figure 1, risk by night minimum band
Five vertical bars of relative risk, pooled over lags 0 to 10, rising from about 1.00 in the coolest band to about 1.03, then 1.14 and 1.28 in the two warmest. The last two match the 14.2 and 28 per cent rises in the results text. Each bar carries its band label on the axis, and the caption spells out all five bands again for a reader who starts there. The source line names the admissions register and the airport station for 2017 to 2024.
Results and the stat block
The results give the 14.2 per cent rise with its interval of 9.8 to 18.7, a 28 per cent rise above 24 degrees, the change point interval of 21.4 to 22.9, an effect that peaks at lag three and is gone by lag eight, and the share of the excess that was cardiovascular and respiratory, 71 per cent, or falls, 9 per cent. Adding the daytime maximum moved the night coefficient by under 2 per cent. The stat block prints 14.2% with the label more admissions on hot nights and its interval underneath.
Discussion
A trigger on the night minimum would have issued 31 warnings over the eight years rather than 19 and covered 84 per cent of the excess admissions rather than 52. The discussion prices that honestly: twelve extra warning nights is a modest cost, but a warning issued too often gets ignored. It then limits itself to one city, one station and a temperate coastal climate, and says the method transfers while the threshold does not.
Takeaways and references
Four checked points repeat the result in the shortest possible form: the 14.2 per cent rise, the three day peak, the daytime maximum adding nothing, and 84 per cent coverage against 52. Three references follow in journal style, which is the most this layout holds. Check each citation against the published paper before you print, since a reference is the one block a specialist will look up.
How to adapt this board
Keep the key finding line to one sentence carrying the effect and the threshold. Keep the admissions count in the Data entry, all five bands in the caption and the real data custodian in the source line. Let the discussion alone carry the closing conclusion sentence, as here, so the results block stays on the numbers. The model description is what another analyst would need to rebuild the work, so keep it exact.

What makes this board work

One sentence carries the poster

The key finding line holds the effect, the threshold and the population in one sentence directly under the authors. A passer by who reads nothing else leaves with the finding, and the stat block beneath repeats the number with its interval for anyone who stops.

The rival explanation is tested

Adding the daytime maximum to the model moved the night coefficient by under 2 per cent and did not improve fit. Showing that the obvious rival fails is more convincing than showing your own variable works, and it is the sentence a heat researcher will look for.

It ends in a decision, not a finding

Thirty one warnings instead of nineteen, covering 84 per cent of excess admissions instead of 52. Public health work is judged on what changes, so the discussion converts the model into the trigger a unit would set and names what that trigger would cost.

Questions people ask

What goes on a public health poster?

The population and period, the data source, the analysis, the effect with its interval, and what a service should do differently. An analysis with no implication reads as unfinished to this audience. This board puts the effect in a key finding line and a stat block, and ends its discussion on a warning trigger a unit could adopt.

How do I show a threshold effect?

Give the change point with its confidence interval in the text, then chart risk across bands of the exposure so a reader can see the shape rather than trust one cut point. This board does both: the interval of 21.4 to 22.9 degrees in the results, and five bars that stay flat before climbing in the two warmest bands.

Should I list sensitivity analyses?

Name them in one methods entry and say in the results whether the finding held. This board lists humidity, a second weather station and a lockdown exclusion, then says the change point was stable across all three. The full output belongs in a supplement behind a printed link, because nobody reads model tables standing in an aisle.

Can this analysis be repeated in another city?

The method transfers and the threshold does not. A city with an admissions register and an hourly weather station can rerun the model on its own records, but a 22 degree trigger copied into a hotter or drier climate would be wrong. On a reused board, change every number, the station description and the climate caveat together.

How should a public health poster credit its data source?

Name the custodian, the dataset, the years and the approval that allowed its use, in the figure source line and in the methods. This board names the hospital register in methods and again in the figure source line, with the airport station and the years. A reviewer from the data custodian will look for their name first.

Why chart relative risk by band rather than as a curve?

Bands read at a distance and match how a warning threshold is set, as a number a forecast crosses. A fitted curve is more faithful to the model, but its confidence band cannot be drawn by the poster chart block, which has no error bars. Print the band edges in the caption so each bar has a label a reader can quote.

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