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Ribeiro MR, Lima MVM, Ilacqua RC, Savoia EJL, Alvarenga R, Vittor AY, Raimundo RD, Laporta GZ. Amazon Wildfires and Respiratory Health: Impacts during the Forest Fire Season from 2009 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:675. [PMID: 38928922 PMCID: PMC11204220 DOI: 10.3390/ijerph21060675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
The Brazilian Amazon, a vital tropical region, faces escalating threats from human activities, agriculture, and climate change. This study aims to assess the relationship between forest fire occurrences, meteorological factors, and hospitalizations due to respiratory diseases in the Legal Amazon region from 2009 to 2019. Employing simultaneous equation models with official data, we examined the association between deforestation-induced fires and respiratory health issues. Over the studied period, the Legal Amazon region recorded a staggering 1,438,322 wildfires, with 1,218,606 (85%) occurring during August-December, known as the forest fire season. During the forest fire season, a substantial portion (566,707) of the total 1,532,228 hospital admissions for respiratory diseases were recorded in individuals aged 0-14 years and 60 years and above. A model consisting of two sets of simultaneous equations was constructed. This model illustrates the seasonal fluctuations in meteorological conditions driving human activities associated with increased forest fires. It also represents how air quality variations impact the occurrence of respiratory diseases during forest fires. This modeling approach unveiled that drier conditions, elevated temperatures, and reduced precipitation exacerbate fire incidents, impacting hospital admissions for respiratory diseases at a rate as high as 22 hospital admissions per 1000 forest fire events during the forest fire season in the Legal Amazon, 2009-2019. This research highlights the urgent need for environmental and health policies to mitigate the effects of Amazon rainforest wildfires, stressing the interplay of deforestation, climate change, and human-induced fires on respiratory health.
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Affiliation(s)
- Maura R. Ribeiro
- Graduate Program in Health Sciences, FMABC Medical School University Center, Santo André 09060-870, SP, Brazil; (M.R.R.); (R.C.I.); (R.D.R.)
- Laboratory of Study Design and Scientific Writing, FMABC Medical School University Center, Santo André 09060-870, SP, Brazil
| | - Marcos V. M. Lima
- Health Surveillance Department, Acre State Secretary of Health, Rio Branco 69914-220, AC, Brazil;
| | - Roberto C. Ilacqua
- Graduate Program in Health Sciences, FMABC Medical School University Center, Santo André 09060-870, SP, Brazil; (M.R.R.); (R.C.I.); (R.D.R.)
| | - Eriane J. L. Savoia
- Environmental Health Department, FMABC Medical School University Center, Santo André 09060-870, SP, Brazil; (E.J.L.S.); (R.A.)
| | - Rogerio Alvarenga
- Environmental Health Department, FMABC Medical School University Center, Santo André 09060-870, SP, Brazil; (E.J.L.S.); (R.A.)
| | - Amy Y. Vittor
- Department of Medicine, Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611, USA;
| | - Rodrigo D. Raimundo
- Graduate Program in Health Sciences, FMABC Medical School University Center, Santo André 09060-870, SP, Brazil; (M.R.R.); (R.C.I.); (R.D.R.)
- Laboratory of Study Design and Scientific Writing, FMABC Medical School University Center, Santo André 09060-870, SP, Brazil
| | - Gabriel Z. Laporta
- Graduate Program in Health Sciences, FMABC Medical School University Center, Santo André 09060-870, SP, Brazil; (M.R.R.); (R.C.I.); (R.D.R.)
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Wilgus ML, Merchant M. Clearing the Air: Understanding the Impact of Wildfire Smoke on Asthma and COPD. Healthcare (Basel) 2024; 12:307. [PMID: 38338192 PMCID: PMC10855577 DOI: 10.3390/healthcare12030307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Wildfires are a global natural phenomenon. In North America, wildfires have not only become more frequent, but also more severe and longer in duration, a trend ascribed to climate change combined with large fuel stores left from modern fire suppression. The intensification of wildfire activity has significant implications for planetary health and public health, as exposure to fine particulate matter (PM2.5) in wildfire smoke is linked to adverse health effects. This review focuses on respiratory morbidity from wildfire smoke exposure. Inhalation of wildfire PM2.5 causes lung injury via oxidative stress, local and systemic inflammation, airway epithelium compromise, and increased vulnerability to infection. Wildfire PM2.5 exposure results in exacerbations of pre-existing asthma and chronic obstructive pulmonary disease, with an escalation in healthcare utilization, including emergency department visits and hospitalizations. Wildfire smoke exposure may be associated with asthma onset, long-term impairment of lung function, and increased all-cause mortality. Children, older adults, occupationally-exposed groups, and possibly women are the most at risk from wildfire smoke. Future research is needed to clarify best practices for risk mitigation and wildfire management.
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Affiliation(s)
- May-Lin Wilgus
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095-1405, USA;
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Xue T, Li J, Tong M, Fan X, Li P, Wang R, Li Y, Zheng Y, Li J, Guan T, Zhu T. Stillbirths attributable to open fires and their geographic disparities in non-Western countries. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 334:122170. [PMID: 37451590 DOI: 10.1016/j.envpol.2023.122170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Due to global warming, an increased number of open fires is becoming a major contributor to PM2.5 pollution and thus a threat to public health. However, the burden of stillbirths attributable to fire-sourced PM2.5 is unknown. In low- and middle-income countries (LMICs), there is a co-occurrence of high baseline stillbirth rates and frequent firestorms, which may lead to a geographic disparity. Across 54 LMICs, we conducted a self-matched case-control study, making stillbirths comparable to the corresponding livebirths in terms of time-invariant characteristics (e.g., genetics) and duration of gestational exposure. We established a joint-exposure-response function (JERF) by simultaneously associating stillbirth with fire- and non-fire-sourced PM2.5 concentrations, which were estimated by fusing multi-source data, such as chemical transport model simulations and satellite observations. During 2000-2014, 35,590 pregnancies were selected from multiple Demographic and Health Surveys. In each mother, a case of stillbirth was compared to her livebirth(s) based on gestational exposure to fire-sourced PM2.5. We further applied the JERF to assess stillbirths attributable to fire-sourced PM2.5 in 136 non-Western countries. The disparity was evaluated using the Gini index. The risk of stillbirth increased by 17.4% (95% confidence interval [CI]: 1.6-35.7%) per 10 μg/m3 increase in fire-sourced PM2.5. In 2014, referring to a minimum-risk exposure level of 10 μg/m3, total and fire-sourced PM2.5 contributed to 922,860 (95% CI: 578,451-1,183,720) and 49,951 (95% CI: 3,634-92,629) stillbirths, of which 10% were clustered within the 6.4% and 0.6% highest-exposure pregnancies, respectively. The Gini index of stillbirths attributable to fire-sourced PM2.5 was 0.65, much higher than for total PM2.5 (0.28). Protecting pregnant women against PM2.5 exposure during wildfires is critical to avoid stillbirths, as the burden of fire-associated stillbirths leads to a geographic disparity in maternal health.
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Affiliation(s)
- Tao Xue
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, China; Advanced Institute of Information Technology, Peking University, Hangzhou, Zhejiang, China; State Environmental Protection Key Laboratory of Atmospheric Exposure and Health Risk Management and Center for Environment and Health, Peking University, Beijing, China.
| | - Jiajianghui Li
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, China.
| | - Mingkun Tong
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, China.
| | - Xinguang Fan
- Department of Sociology, Peking University, Beijing, China.
| | - Pengfei Li
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, China; Advanced Institute of Information Technology, Peking University, Hangzhou, Zhejiang, China; National Institute of Health Data Science, Peking University, Beijing, China.
| | - Ruohan Wang
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, China.
| | - Yanshun Li
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA.
| | - Yixuan Zheng
- Center of Air Quality Simulation and System Analysis, Chinese Academy of Environmental Planning, Beijing, China.
| | - Jiwei Li
- School of Computer Science, Zhejiang University, Hangzhou, China.
| | - Tianjia Guan
- Department of Health Policy, School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Tong Zhu
- College of Environmental Science and Engineering, Peking University, Beijing, 100084, China; State Environmental Protection Key Laboratory of Atmospheric Exposure and Health Risk Management and Center for Environment and Health, Peking University, Beijing, China.
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Xue T, Wang R, Tong M, Kelly FJ, Liu H, Li J, Li P, Qiu X, Gong J, Shang J, Zhu T. Estimating the exposure-response function between long-term ozone exposure and under-5 mortality in 55 low-income and middle-income countries: a retrospective, multicentre, epidemiological study. Lancet Planet Health 2023; 7:e736-e746. [PMID: 37673544 DOI: 10.1016/s2542-5196(23)00165-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND In 2021, WHO suggested new target concentration limits for long-term exposure to ambient ozone. However, the harmful effects of ozone on vulnerable children have not been sufficiently studied. We aimed to evaluate the association between long-term ozone exposure and mortality in children younger than 5 years (hereafter denoted under-5 mortality) in low-income and middle-income countries (LMICs) and to estimate this mortality burden for 97 LMICs. METHODS By combining information from 128 Demographic and Health Surveys, we evaluated the association between the survival status of more than 1·2 million children younger than 5 years from 2457 sampling strata in 55 LMICs and the average peak-season ozone concentration during the life course, using a fixed-effects Cox model. A non-linear exposure-response function was developed by integrating the marginal effects of within-strata variation in exposure. We extrapolated the function obtained from the 55 LMICs to estimate the under-5 mortality burden attributable to ozone exposure in 97 LMICs, in which more than 95% of global deaths in this age group occur. FINDINGS The fixed-effects model showed a robust association between ozone and under-5 mortality. According to the fully adjusted linear model, an increment of 10 ppb in the life-course average peak-season ozone concentration was associated with a 6·4% (95% CI 2·4-10·7) increase in the risk of under-5 mortality. The non-linear exposure-response function showed a sublinear curvature with a threshold, suggesting that the effect of ozone exposure was non-significant at concentrations lower than the first-stage interim target (100 μg/m3) recommended by WHO. Using this function, we estimate that, in 2010, long-term ozone exposure contributed to 153 361 (95% CI 17 077-276 768; 2·3% [0·3-4·1]) deaths of children younger than 5 years in 97 LMICs, which is equivalent to 56·8% of all ozone-related deaths in adults (269 785) in these countries. From 2003 to 2017, the ozone-related under-5 mortality burden decreased in most of the 97 LMICs. INTERPRETATION Long-term exposure to ozone concentrations higher than the WHO first-stage interim target is a risk factor for under-5 mortality, and ozone exposure contributes substantially to mortality in this age group in LMICs. Increased efforts should be made to control ambient ozone pollution as this will lead to positive health benefits. FUNDING Ministry of Science and Technology of the People's Republic of China and China National Natural Science Foundation.
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Affiliation(s)
- Tao Xue
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University Health Science Centre, Beijing, China; Department of Epidemiology and Biostatistics/Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, China; Advanced Institute of Information Technology, Peking University, Hangzhou, China.
| | - Ruohan Wang
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University Health Science Centre, Beijing, China; Department of Epidemiology and Biostatistics/Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Mingkun Tong
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University Health Science Centre, Beijing, China; Department of Epidemiology and Biostatistics/Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Frank J Kelly
- Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Hengyi Liu
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University Health Science Centre, Beijing, China; Department of Epidemiology and Biostatistics/Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Jiajianghui Li
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University Health Science Centre, Beijing, China; Department of Epidemiology and Biostatistics/Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Pengfei Li
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University Health Science Centre, Beijing, China; Department of Epidemiology and Biostatistics/Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, China; Advanced Institute of Information Technology, Peking University, Hangzhou, China
| | - Xinghua Qiu
- State Environmental Protection Key Laboratory of Atmospheric Exposure and Health Risk Management, Center for Environment and Health, Peking University, Beijing, China; College of Environmental Sciences and Engineering, Peking University, Beijing, China
| | - Jicheng Gong
- State Environmental Protection Key Laboratory of Atmospheric Exposure and Health Risk Management, Center for Environment and Health, Peking University, Beijing, China; College of Environmental Sciences and Engineering, Peking University, Beijing, China
| | - Jing Shang
- State Environmental Protection Key Laboratory of Atmospheric Exposure and Health Risk Management, Center for Environment and Health, Peking University, Beijing, China; College of Environmental Sciences and Engineering, Peking University, Beijing, China
| | - Tong Zhu
- State Environmental Protection Key Laboratory of Atmospheric Exposure and Health Risk Management, Center for Environment and Health, Peking University, Beijing, China; College of Environmental Sciences and Engineering, Peking University, Beijing, China.
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