Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
Complex and plausible patho-physiological mechanisms are discussed by the authors with regards to significant variation in normal body temperature and the risk of increased mortality with elevated temperature (1).
But there could be a simpler explanation for the increased mortality and raised temperature noted particularly in African- American women attending an emergency department. Did the authors adjust the mortality data for insurance coverage and economic deprivation based on patients’ home zip code? (2).
Socio-economic deprivation and lack of insurance coverage could have been responsible for the observed increased mortality with the raised temperature being a mere surrogate marker for undiagnosed medical comorbidities .(3).
1. Obermeyer Ziad, Samra Jasmeet K, Mullainathan Sendhil. Individual differences in normal body temperature: longitudinal big data analysis of patient records BMJ 2017; 359 :j5468. doi: https://doi.org/10.1136/bmj.j5468
2. Haider AH, Chang DC, Efron DT, Haut ER, Crandall M, Cornwell EE 3rd. Race and insurance status as risk factors for trauma mortality. doi: 10.1001/archsurg.143.10.945.
3. Duron VP, Monaghan SF, Connolly MD, Gregg SC, Stephen AH, Adams CA Jr, Cioffi WG, Heffernan DS. Undiagnosed medical comorbidities in the uninsured: a significant predictor of mortality following trauma. J Trauma Acute Care Surg. 2012 Nov;73(5):1093-8; doi: 10.1097/TA.0b013e31826fc844.