JMIR Publications

ABSTRACT

Background:

Climate change threatens population health through temperature extremes, air pollution, and altered infectious disease patterns. Emergency departments are sensitive indicators of climate-related health impacts; however, comprehensive multicenter investigations integrating meteorological factors, air quality, and infectious disease surveillance across different healthcare provision levels remain scarce in Germany, particularly in maritime climate regions.

Objective:

To characterize the impact of meteorological factors, air quality, and infectious disease dynamics on emergency department presentations across multiple healthcare facilities and care provision levels in northern Germany over an 11-year period.

Methods:

This retrospective, multicenter, observational study will examine emergency department presentations across four facilities representing different care provision levels in the greater Lübeck area and southeastern Schleswig-Holstein, Germany, from January 2014 to December 2024. Clinical data, including ICD-coded diagnoses, patient demographics, and temporal information, will be linked with meteorological data from the German Weather Service, air quality measurements from state environmental monitoring, and infectious disease surveillance from the Robert Koch Institute. The primary outcomes will be daily emergency department visits overall and stratified by disease category (cardiovascular, respiratory, psychiatric, infectious, renal, neurological, and surgical/traumatic). Distributed lag non-linear models will be used to characterize temperature-health relationships, accounting for delayed and non-linear effects, and adjusted for temporal trends, seasonality, and infectious disease incidence. Subgroup analyses will be used to identify vulnerable populations by age, sex, and socioeconomic status.

Results:

Data collection commenced in January 2025 and is expected to be completed by February 2026. We anticipate analyzing over 1,000,000 emergency department presentations across the four participating facilities over the 11-year study period. First results are expected to be submitted for publication in late 2026.

Conclusions:

This study will quantify climate-health relationships in an understudied maritime climate context, identify vulnerable populations, and inform evidence-based climate adaptation strategies for emergency healthcare systems. The findings will contribute to the development of early warning systems, public health preparedness, and healthcare capacity planning in the face of accelerating climate change.