The Association Between Ambient Temperature and Snakebite in Georgia, USA: A Case-Crossover Study

• Type of Material: Article
• Authors: Mariah Landry, Emory University; Rohan D Souza, Emory University; Shannon Moss, Emory University; Howard Chang, Emory University; Stefanie Ebelt, Emory University; Lawrence Wilson, Emory University; Noah Scovronick, Emory University
• Language: English
• Date: 2023-07-01
• Publisher: Wiley Periodicals LLC on behalf of American Geophysical Union
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1029/2022GH000781
• Title of Journal or Parent Work: GeoHealth
• Volume: 7
• Issue: 7
• Start Page: e2022GH000781
• End Page: e2022GH000781
• Keywords: ecology; climate change; epidemiology; snakebite; temperature
• Research Categories: Environmental Sciences; Biology, Biostatistics; Health Sciences, Public Health; Biology, General

Abstract

The World Health Organization has identified snakebite envenoming as a highest priority neglected tropical disease, yet there is a dearth of epidemiologic research on environmental risk factors, including outdoor temperature. Temperature may affect snakebites through human behavior or snake behavior; snakes are ectotherms, meaning outdoor temperatures influence their internal body temperature and thus their behavior. Here we investigate the relationship between short-term temperature and snakebites in Georgia, one of the most biodiverse US states in terms of herpetofauna. We acquired emergency department (ED) visit data for Georgia between 1 January 2014 and 31 December 2020. Visits for venomous and non-venomous snakebites were identified using diagnosis codes. For comparison, we also considered visits for non-snake (e.g., insects, spiders, scorpions) envenomation. Daily meteorology from the Daymet 1 km product was linked to patient residential ZIP codes. We applied a case-crossover design to estimate associations of daily maximum temperature and snakebite ED visits. During the 7-year study period, there were 3,908 visits for venomous snakebites, 1,124 visits for non-venomous bites and 65,187 visits for non-snake envenomation. Across the entire period, a 1°C increase in same-day maximum temperature was associated with a 5.6% (95%CI: 4.0–7.3) increase in the odds of venomous snakebite and a 5.8% (95%CI: 3.0–8.8) increase in non-venomous snakebite. Associations were strongest in the spring. We also observed a positive and significant (p < 0.05) association for non-snake envenomation, albeit slightly smaller and more consistent across seasons compared to those for snakebites.