Heatwaves and delivery practices: The effects of extreme temperature in Brazilian maternity wards
中文摘要
本文利用2008年至2019年间巴西公立医院约2500万例分娩的数据，考察极端高温如何影响医疗服务提供。我们将基于卫星的温度记录与高维固定效应研究设计相结合，考察产科病房的分娩实践和医护人员配置如何随短期温度波动而变化。我们发现，极端高温与医生主导分娩概率的降低相关，护士主导分娩相应增加，同时剖宫产率也有所下降。在医生主导的分娩中，极端炎热天数与临产前剖宫产可能性上升相关，这与热应激下转向更快速手术操作的趋势一致。以阿普加评分衡量，我们未发现极端高温对新生儿即时健康存在可检测的影响。总体而言，这些结果表明，温度冲击重塑了产科病房的临床决策与任务分配，揭示了气候压力影响医疗服务提供的一条运营渠道。
Abstract
This paper examines how extreme heat affects healthcare delivery, using data on around 25 million births in Brazilian public hospitals between 2008 and 2019. Combining satellite-based temperature records with a high-dimensional fixed-effects design, we study how delivery practices and provider allocation vary with short-run temperature fluctuations in maternity wards. We find that extreme heat is associated with a lower probability that deliveries are led by physicians and a corresponding increase in nurse-led births, alongside a decline in cesarean section rates. Among physician-attended deliveries, extremely hot days are associated with a higher likelihood of pre-labor cesarean sections, consistent with shifts toward faster procedures under thermal stress. We find no detectable effects on immediate neonatal health as measured by Apgar scores. Together, these results suggest that temperature shocks reshape clinical decision-making and task allocation in maternity wards, revealing an operational channel through which climate stress affects healthcare delivery.