热浪与分娩做法:巴西产房极端温度的影响

Journal of Development Economics · 2026 · [{"name": "Rafael Parfitt", "affiliation": ["Fundação de Apoio à Universidade Federal de São Paulo", "Research Institute of Medical Climatology and Rehabilitation"]}, {"name": "Nícolas Goulart", "affiliation": ["Fundação de Apoio à Universidade Federal de São Paulo"]}]

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。我们将基于卫星的气温记录与高维固定效应设计相结合，研究产科病房中的分娩实践与服务提供者配置如何随短期气温波动而变化。我们发现，极端高温与由医生主导分娩的概率下降相关，并伴随由护士主导分娩的相应增加，同时剖宫产率下降。在由医生接生的分娩中，极端高温日与临产前剖宫产的可能性上升相关，这与热应激下转向更快手术程序的倾向相一致。我们未发现对以Apgar评分衡量的即时新生儿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中的临床决策与任务配置，揭示了气候压力影响医疗服务提供的一条运作渠道。

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.