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Zhang Y, Xu R, Huang W, Morawska L, Johnston FH, Abramson M, Knibbs L, Matus P, Ye T, Yu W, Hales S, Morgan G, Yang Z, Liu Y, Ju K, Yu P, Lavigne E, Wu Y, Wen B, Zhang Y, Heyworth J, Marks G, Saldiva PHN, Coelho MSZS, Guo YL, Song J, Guo Y, Li S. Short-term Exposure to Wildfire-Specific PM2.5 and Diabetes Hospitalization: A Study in Multiple Countries and Territories. Diabetes Care 2024; 47:1664-1672. [PMID: 39012781 DOI: 10.2337/dc24-0703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/19/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE To evaluate associations of wildfire fine particulate matter ≤2.5 mm in diameter (PM2.5) with diabetes across multiple countries and territories. RESEARCH DESIGN AND METHODS We collected data on 3,612,135 diabetes hospitalizations from 1,008 locations in Australia, Brazil, Canada, Chile, New Zealand, Thailand, and Taiwan during 2000-2019. Daily wildfire-specific PM2.5 levels were estimated through chemical transport models and machine-learning calibration. Quasi-Poisson regression with distributed lag nonlinear models and random-effects meta-analysis were applied to estimate associations between wildfire-specific PM2.5 and diabetes hospitalization. Subgroup analyses were by age, sex, location income level, and country or territory. Diabetes hospitalizations attributable to wildfire-specific PM2.5 and nonwildfire PM2.5 were compared. RESULTS Each 10 µg/m3 increase in wildfire-specific PM2.5 levels over the current day and previous 3 days was associated with relative risks (95% CI) of 1.017 (1.011-1.022), 1.023 (1.011-1.035), 1.023 (1.015-1.032), 0.962 (0.823-1.032), 1.033 (1.001-1.066), and 1.013 (1.004-1.022) for all-cause, type 1, type 2, malnutrition-related, other specified, and unspecified diabetes hospitalization, respectively. Stronger associations were observed for all-cause, type 1, and type 2 diabetes in Thailand, Australia, and Brazil; unspecified diabetes in New Zealand; and type 2 diabetes in high-income locations. An estimate of 0.67% (0.16-1.18%) and 1.02% (0.20-1.81%) for all-cause and type 2 diabetes hospitalizations were attributable to wildfire-specific PM2.5. Compared with nonwildfire PM2.5, wildfire-specific PM2.5 posed greater risks of all-cause, type 1, and type 2 diabetes and were responsible for 38.7% of PM2.5-related diabetes hospitalizations. CONCLUSIONS We show the relatively underappreciated links between diabetes and wildfire air pollution, which can lead to a nonnegligible proportion of PM2.5-related diabetes hospitalizations. Precision prevention and mitigation should be developed for those in advantaged communities and in Thailand, Australia, and Brazil.
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Affiliation(s)
- Yiwen Zhang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rongbin Xu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wenzhong Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lidia Morawska
- School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fay H Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Michael Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Luke Knibbs
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Patricia Matus
- School of Medicine, University of the Andes (Chile), Las Condes, Región Metropolitana, Chile
| | - Tingting Ye
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wenhua Yu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simon Hales
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Geoffrey Morgan
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Zhengyu Yang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yanming Liu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ke Ju
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pei Yu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eric Lavigne
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Environmental Health Science and Research Bureau, Health Canada, Ottawa
| | - Yao Wu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bo Wen
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuxi Zhang
- School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Jane Heyworth
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Guy Marks
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Paulo H N Saldiva
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Micheline S Z S Coelho
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Yue Leon Guo
- Environmental and Occupational Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Jiangning Song
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Horne BD, Johnson MM, Blagev DP, Haddad F, Knowlton KU, Bride D, Bair TL, Joy EA, Nadeau KC. Association of Short-Term Increases in Ambient Fine Particulate Matter With Hospitalization for Asthma or COPD During Wildfire Season and Other Time Periods. CHEST PULMONARY 2024; 2:100053. [PMID: 38993972 PMCID: PMC11238943 DOI: 10.1016/j.chpulm.2024.100053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
BACKGROUND Short-term increases in air pollution are associated with poor asthma and COPD outcomes. Short-term elevations in fine particulate matter (PM2.5) due to wildfire smoke are becoming more common. RESEARCH QUESTION Are short-term increases in PM2.5 and ozone in wildfire season and in winter inversion season associated with a composite of emergency or inpatient hospitalization for asthma and COPD? STUDY DESIGN AND METHODS Case-crossover analyses evaluated 63,976 and 18,514 patients hospitalized for primary discharge diagnoses of asthma and COPD, respectively, between January 1999 and March 2022. Patients resided on Utah's Wasatch Front where PM2.5 and ozone were measured by Environmental Protection Agency-based monitors. ORs were calculated using Poisson regression adjusted for weather variables. RESULTS Asthma risk increased on the same day that PM2.5 increased during wildfire season (OR, 1.057 per + 10 μg/m3; 95% CI, 1.019-1.097; P = .003) and winter inversions (OR, 1.023 per +10 μg/m3; 95% CI, 1.010-1.037; P = .0004). Risk decreased after 1 week, but during wildfire season risk rebounded at a 4-week lag (OR, 1.098 per +10 μg/m3; 95% CI, 1.033-1.167). Asthma risk for adults during wildfire season was highest in the first 3 days after PM2.5 increases, but for children, the highest risk was delayed by 3 to 4 weeks. PM2.5 exposure was weakly associated with COPD hospitalization. Ozone exposure was not associated with elevated risks. INTERPRETATION In a large urban population, short-term increases in PM2.5 during wildfire season were associated with asthma hospitalization, and the effect sizes were greater than for PM2.5 during inversion season.
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Affiliation(s)
- Benjamin D Horne
- Intermountain Medical Center Heart Institute (B. D. H., K. U. K., D. B., and T. L. B.), Salt Lake City, UT; the Division of Cardiovascular Medicine, Department of Medicine (B. D. H. and F. H.) and the Cardiovascular Institute (B. D. H. and F. H.), Stanford University, Stanford, CA; the Department of Environmental Health (M. M. J. and K. C. N.), Harvard T.H. Chan School of Public Health, Boston, MA; the Division of Pulmonary and Critical Care Medicine (D. B. P.), Department of Internal Medicine, Intermountain Health, Salt Lake City, UT; the Division of Cardiology (K. U. K.), Department of Internal Medicine, University of Utah, Salt Lake City, UT; the Wellness & Nutrition (E. A. J.), Intermountain Health, Salt Lake City, UT; and the Department of Family and Preventive Medicine (E. A. J.), University of Utah, Salt Lake City, UT
| | - Mary M Johnson
- Intermountain Medical Center Heart Institute (B. D. H., K. U. K., D. B., and T. L. B.), Salt Lake City, UT; the Division of Cardiovascular Medicine, Department of Medicine (B. D. H. and F. H.) and the Cardiovascular Institute (B. D. H. and F. H.), Stanford University, Stanford, CA; the Department of Environmental Health (M. M. J. and K. C. N.), Harvard T.H. Chan School of Public Health, Boston, MA; the Division of Pulmonary and Critical Care Medicine (D. B. P.), Department of Internal Medicine, Intermountain Health, Salt Lake City, UT; the Division of Cardiology (K. U. K.), Department of Internal Medicine, University of Utah, Salt Lake City, UT; the Wellness & Nutrition (E. A. J.), Intermountain Health, Salt Lake City, UT; and the Department of Family and Preventive Medicine (E. A. J.), University of Utah, Salt Lake City, UT
| | - Denitza P Blagev
- Intermountain Medical Center Heart Institute (B. D. H., K. U. K., D. B., and T. L. B.), Salt Lake City, UT; the Division of Cardiovascular Medicine, Department of Medicine (B. D. H. and F. H.) and the Cardiovascular Institute (B. D. H. and F. H.), Stanford University, Stanford, CA; the Department of Environmental Health (M. M. J. and K. C. N.), Harvard T.H. Chan School of Public Health, Boston, MA; the Division of Pulmonary and Critical Care Medicine (D. B. P.), Department of Internal Medicine, Intermountain Health, Salt Lake City, UT; the Division of Cardiology (K. U. K.), Department of Internal Medicine, University of Utah, Salt Lake City, UT; the Wellness & Nutrition (E. A. J.), Intermountain Health, Salt Lake City, UT; and the Department of Family and Preventive Medicine (E. A. J.), University of Utah, Salt Lake City, UT
| | - Francois Haddad
- Intermountain Medical Center Heart Institute (B. D. H., K. U. K., D. B., and T. L. B.), Salt Lake City, UT; the Division of Cardiovascular Medicine, Department of Medicine (B. D. H. and F. H.) and the Cardiovascular Institute (B. D. H. and F. H.), Stanford University, Stanford, CA; the Department of Environmental Health (M. M. J. and K. C. N.), Harvard T.H. Chan School of Public Health, Boston, MA; the Division of Pulmonary and Critical Care Medicine (D. B. P.), Department of Internal Medicine, Intermountain Health, Salt Lake City, UT; the Division of Cardiology (K. U. K.), Department of Internal Medicine, University of Utah, Salt Lake City, UT; the Wellness & Nutrition (E. A. J.), Intermountain Health, Salt Lake City, UT; and the Department of Family and Preventive Medicine (E. A. J.), University of Utah, Salt Lake City, UT
| | - Kirk U Knowlton
- Intermountain Medical Center Heart Institute (B. D. H., K. U. K., D. B., and T. L. B.), Salt Lake City, UT; the Division of Cardiovascular Medicine, Department of Medicine (B. D. H. and F. H.) and the Cardiovascular Institute (B. D. H. and F. H.), Stanford University, Stanford, CA; the Department of Environmental Health (M. M. J. and K. C. N.), Harvard T.H. Chan School of Public Health, Boston, MA; the Division of Pulmonary and Critical Care Medicine (D. B. P.), Department of Internal Medicine, Intermountain Health, Salt Lake City, UT; the Division of Cardiology (K. U. K.), Department of Internal Medicine, University of Utah, Salt Lake City, UT; the Wellness & Nutrition (E. A. J.), Intermountain Health, Salt Lake City, UT; and the Department of Family and Preventive Medicine (E. A. J.), University of Utah, Salt Lake City, UT
| | - Daniel Bride
- Intermountain Medical Center Heart Institute (B. D. H., K. U. K., D. B., and T. L. B.), Salt Lake City, UT; the Division of Cardiovascular Medicine, Department of Medicine (B. D. H. and F. H.) and the Cardiovascular Institute (B. D. H. and F. H.), Stanford University, Stanford, CA; the Department of Environmental Health (M. M. J. and K. C. N.), Harvard T.H. Chan School of Public Health, Boston, MA; the Division of Pulmonary and Critical Care Medicine (D. B. P.), Department of Internal Medicine, Intermountain Health, Salt Lake City, UT; the Division of Cardiology (K. U. K.), Department of Internal Medicine, University of Utah, Salt Lake City, UT; the Wellness & Nutrition (E. A. J.), Intermountain Health, Salt Lake City, UT; and the Department of Family and Preventive Medicine (E. A. J.), University of Utah, Salt Lake City, UT
| | - Tami L Bair
- Intermountain Medical Center Heart Institute (B. D. H., K. U. K., D. B., and T. L. B.), Salt Lake City, UT; the Division of Cardiovascular Medicine, Department of Medicine (B. D. H. and F. H.) and the Cardiovascular Institute (B. D. H. and F. H.), Stanford University, Stanford, CA; the Department of Environmental Health (M. M. J. and K. C. N.), Harvard T.H. Chan School of Public Health, Boston, MA; the Division of Pulmonary and Critical Care Medicine (D. B. P.), Department of Internal Medicine, Intermountain Health, Salt Lake City, UT; the Division of Cardiology (K. U. K.), Department of Internal Medicine, University of Utah, Salt Lake City, UT; the Wellness & Nutrition (E. A. J.), Intermountain Health, Salt Lake City, UT; and the Department of Family and Preventive Medicine (E. A. J.), University of Utah, Salt Lake City, UT
| | - Elizabeth A Joy
- Intermountain Medical Center Heart Institute (B. D. H., K. U. K., D. B., and T. L. B.), Salt Lake City, UT; the Division of Cardiovascular Medicine, Department of Medicine (B. D. H. and F. H.) and the Cardiovascular Institute (B. D. H. and F. H.), Stanford University, Stanford, CA; the Department of Environmental Health (M. M. J. and K. C. N.), Harvard T.H. Chan School of Public Health, Boston, MA; the Division of Pulmonary and Critical Care Medicine (D. B. P.), Department of Internal Medicine, Intermountain Health, Salt Lake City, UT; the Division of Cardiology (K. U. K.), Department of Internal Medicine, University of Utah, Salt Lake City, UT; the Wellness & Nutrition (E. A. J.), Intermountain Health, Salt Lake City, UT; and the Department of Family and Preventive Medicine (E. A. J.), University of Utah, Salt Lake City, UT
| | - Kari C Nadeau
- Intermountain Medical Center Heart Institute (B. D. H., K. U. K., D. B., and T. L. B.), Salt Lake City, UT; the Division of Cardiovascular Medicine, Department of Medicine (B. D. H. and F. H.) and the Cardiovascular Institute (B. D. H. and F. H.), Stanford University, Stanford, CA; the Department of Environmental Health (M. M. J. and K. C. N.), Harvard T.H. Chan School of Public Health, Boston, MA; the Division of Pulmonary and Critical Care Medicine (D. B. P.), Department of Internal Medicine, Intermountain Health, Salt Lake City, UT; the Division of Cardiology (K. U. K.), Department of Internal Medicine, University of Utah, Salt Lake City, UT; the Wellness & Nutrition (E. A. J.), Intermountain Health, Salt Lake City, UT; and the Department of Family and Preventive Medicine (E. A. J.), University of Utah, Salt Lake City, UT
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3
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Blaustein JR, Quisel MJ, Hamburg NM, Wittkopp S. Environmental Impacts on Cardiovascular Health and Biology: An Overview. Circ Res 2024; 134:1048-1060. [PMID: 38662864 PMCID: PMC11058466 DOI: 10.1161/circresaha.123.323613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Environmental stressors associated with human activities (eg, air and noise pollution, light disturbance at night) and climate change (eg, heat, wildfires, extreme weather events) are increasingly recognized as contributing to cardiovascular morbidity and mortality. These harmful exposures have been shown to elicit changes in stress responses, circadian rhythms, immune cell activation, and oxidative stress, as well as traditional cardiovascular risk factors (eg, hypertension, diabetes, obesity) that promote cardiovascular diseases. In this overview, we summarize evidence from human and animal studies of the impacts of environmental exposures and climate change on cardiovascular health. In addition, we discuss strategies to reduce the impact of environmental risk factors on current and future cardiovascular disease burden, including urban planning, personal monitoring, and mitigation measures.
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Affiliation(s)
- Jacob R. Blaustein
- New York University Grossman School of Medicine, Department of Medicine, Leon H. Charney Division of Cardiology, New York, USA
| | - Matthew J. Quisel
- Department of Medicine, Boston University Chobanian and Avedision School of Medicine
| | - Naomi M. Hamburg
- Section of Vascular Biology, Whitaker Cardiovascular Institute, Chobanian and Avedisian School of Medicine, Boston University, Boston, USA
| | - Sharine Wittkopp
- New York University Grossman School of Medicine, Department of Medicine, Leon H. Charney Division of Cardiology, New York, USA
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4
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Mahakalkar AU, Gianquintieri L, Amici L, Brovelli MA, Caiani EG. Geospatial analysis of short-term exposure to air pollution and risk of cardiovascular diseases and mortality-A systematic review. CHEMOSPHERE 2024; 353:141495. [PMID: 38373448 DOI: 10.1016/j.chemosphere.2024.141495] [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: 12/28/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
The cardiovascular risk associated with short-term ambient air pollution exposure is well-documented. However, recent advancements in geospatial techniques have provided new insights into this risk. This systematic review focuses on short-term exposure studies that applied advanced geospatial pollution modelling to estimate cardiovascular disease (CVD) risk and accounted for additional unconventional neighbourhood-level confounders to analyse their modifier effect on the risk. Four databases were investigated to select publications between 2018 and 2023 that met the inclusion criteria of studying the effect of particulate matter (PM2.5 and PM10), SO2, NOx, CO, and O3 on CVD mortality or morbidity, utilizing pollution modelling techniques, and considering spatial and temporal confounders. Out of 3277 publications, 285 were identified for full-text review, of which 34 satisfied the inclusion criteria for qualitative analysis, and 12 of them were chosen for additional quantitative analysis. Quality assessment revealed that 28 out of 34 included articles scored 4 or above, indicating high quality. In 30 studies, advanced pollution modelling techniques were used, while in 4 only simpler methods were applied. The most pertinent confounders identified were socio-demographic variables (e.g., socio-economic status, population percentage by race or ethnicity) and neighbourhood-level built environment variables (e.g., urban/rural area, percentage of green space, proximity to healthcare), which exhibited varying modifier effects depending on the context. In the quantitative analysis, only PM 2.5 showed a significant positive association to all-cause CVD-related hospitalisation. Other pollutants did not show any significant effect, likely due to the high inter-study heterogeneity and a limited number of cases. The application of advanced geospatial measurement and modelling of air pollution exposure, as well as its risk, is increasing. This review underscores the importance of accounting for unconventional neighbourhood-level confounders to enhance the understanding of the CVD risk associated with short-term pollution exposure.
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Affiliation(s)
- Amruta Umakant Mahakalkar
- Politecnico di Milano, Electronics, Information and Bioengineering Dpt., Milan, Italy; University School for Advanced Studies IUSS, Pavia, Italy
| | - Lorenzo Gianquintieri
- Politecnico di Milano, Electronics, Information and Bioengineering Dpt., Milan, Italy.
| | - Lorenzo Amici
- Politecnico di Milano, Civil and Environmental Engineering Dpt., Milan, Italy
| | | | - Enrico Gianluca Caiani
- Politecnico di Milano, Electronics, Information and Bioengineering Dpt., Milan, Italy; IRCCS Istituto Auxologico Italiano, Milan, Italy
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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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Chen AI, Ebisu K, Benmarhnia T, Basu R. Emergency department visits associated with wildfire smoke events in California, 2016-2019. ENVIRONMENTAL RESEARCH 2023; 238:117154. [PMID: 37716386 DOI: 10.1016/j.envres.2023.117154] [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: 04/14/2023] [Revised: 08/09/2023] [Accepted: 09/13/2023] [Indexed: 09/18/2023]
Abstract
Wildfire smoke has been associated with adverse respiratory outcomes, but the impacts of wildfire on other health outcomes and sensitive subpopulations are not fully understood. We examined associations between smoke events and emergency department visits (EDVs) for respiratory, cardiovascular, diabetes, and mental health outcomes in California during the wildfire season June-December 2016-2019. Daily, zip code tabulation area-level wildfire-specific fine particulate matter (PM2.5) concentrations were aggregated to air basins. A "smoke event" was defined as an air basin-day with a wildfire-specific PM2.5 concentration at or above the 98th percentile across all air basin-days (threshold = 13.5 μg/m3). We conducted a two-stage time-series analysis using quasi-Poisson regression considering lag effects and random effects meta-analysis. We also conducted analyses stratified by race/ethnicity, age, and sex to assess potential effect modification. Smoke events were associated with an increased risk of EDVs for all respiratory diseases at lag 1 [14.4%, 95% confidence interval (CI): (6.8, 22.5)], asthma at lag 0 [57.1% (44.5, 70.8)], and chronic lower respiratory disease at lag 0 [12.7% (6.2, 19.6)]. We also found positive associations with EDVs for all cardiovascular diseases at lag 10. Mixed results were observed for mental health outcomes. Stratified results revealed potential disparities by race/ethnicity. Short-term exposure to smoke events was associated with increased respiratory and schizophrenia EDVs. Cardiovascular impacts may be delayed compared to respiratory outcomes.
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Affiliation(s)
- Annie I Chen
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
| | - Keita Ebisu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA.
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Noah TL, Worden CP, Rebuli ME, Jaspers I. The Effects of Wildfire Smoke on Asthma and Allergy. Curr Allergy Asthma Rep 2023; 23:375-387. [PMID: 37171670 PMCID: PMC10176314 DOI: 10.1007/s11882-023-01090-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE OF REVIEW To review the recent literature on the effects of wildfire smoke (WFS) exposure on asthma and allergic disease, and on potential mechanisms of disease. RECENT FINDINGS Spatiotemporal modeling and increased ground-level monitoring data are allowing a more detailed picture of the health effects of WFS exposure to emerge, especially with regard to asthma. There is also epidemiologic and some experimental evidence to suggest that WFS exposure increases allergic predisposition and upper airway or sinonasal disease, though much of the literature in this area is focused more generally on PM2.5 and is not specific for WFS. Experimental evidence for mechanisms includes disruption of epithelial integrity with downstream effects on inflammatory or immune pathways, but experimental models to date have not consistently reflected human disease in this area. Exposure to WFS has an acute detrimental effect on asthma. Potential mechanisms are suggested by in vitro and animal studies.
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Affiliation(s)
- Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, 260 Macnider Building, 333 S. Columbia St., Chapel Hill, NC, 27599, USA.
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Cameron P Worden
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Meghan E Rebuli
- Department of Pediatrics, University of North Carolina at Chapel Hill, 260 Macnider Building, 333 S. Columbia St., Chapel Hill, NC, 27599, USA
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Ilona Jaspers
- Department of Pediatrics, University of North Carolina at Chapel Hill, 260 Macnider Building, 333 S. Columbia St., Chapel Hill, NC, 27599, USA
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Doubleday A, Sheppard L, Austin E, Busch Isaksen T. Wildfire smoke exposure and emergency department visits in Washington State. ENVIRONMENTAL RESEARCH, HEALTH : ERH 2023; 1:025006. [PMID: 37252333 PMCID: PMC10213826 DOI: 10.1088/2752-5309/acd3a1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023]
Abstract
Wildfires are increasing in prevalence in western North America due to changing climate conditions. A growing number of studies examine the impact of wildfire smoke on morbidity; however, few evaluate these impacts using syndromic surveillance data that cover many emergency departments (EDs). We used syndromic surveillance data to explore the effect of wildfire smoke exposure on all-cause respiratory and cardiovascular ED visits in Washington state. Using a time-stratified case crossover design, we observed an increased odds of asthma visits immediately after and in all five days following initial exposure (lag 0 OR: 1.13; 95% CI: 1.10, 1.17; lag 1-5 ORs all 1.05 or greater with a lower CI of 1.02 or higher), and an increased odds of respiratory visits in all five days following initial exposure (lag 1 OR: 1.02; 95% CI: 1.00, 1.03; lag 2-5 ORs and lower CIs were all at least as large) comparing wildfire smoke to non-wildfire smoke days. We observed mixed results for cardiovascular visits, with evidence of increased odds emerging only several days following initial exposure. We also found increased odds across all visit categories for a 10 μg m-3 increase in smoke-impacted PM2.5. In stratified analyses, we observed elevated odds for respiratory visits among ages 19-64, for asthma visits among ages 5-64, and mixed risk estimates for cardiovascular visits by age group. This study provides evidence of an increased risk of respiratory ED visits immediately following initial wildfire smoke exposure, and increased risk of cardiovascular ED visits several days following initial exposure. These increased risks are seen particularly among children and younger to middle-aged adults.
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Affiliation(s)
- Annie Doubleday
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Elena Austin
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Tania Busch Isaksen
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
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Ratter-Rieck JM, Roden M, Herder C. Diabetes and climate change: current evidence and implications for people with diabetes, clinicians and policy stakeholders. Diabetologia 2023; 66:1003-1015. [PMID: 36964771 PMCID: PMC10039694 DOI: 10.1007/s00125-023-05901-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/15/2023] [Indexed: 03/26/2023]
Abstract
Climate change will be a major challenge for the world's health systems in the coming decades. Elevated temperatures and increasing frequencies of heat waves, wildfires, heavy precipitation and other weather extremes can affect health in many ways, especially if chronic diseases are already present. Impaired responses to heat stress, including compromised vasodilation and sweating, diabetes-related comorbidities, insulin resistance and chronic low-grade inflammation make people with diabetes particularly vulnerable to environmental risk factors, such as extreme weather events and air pollution. Additionally, multiple pathogens show an increased rate of transmission under conditions of climate change and people with diabetes have an altered immune system, which increases the risk for a worse course of infectious diseases. In this review, we summarise recent studies on the impact of climate-change-associated risk for people with diabetes and discuss which individuals may be specifically prone to these risk conditions due to their clinical features. Knowledge of such high-risk groups will help to develop and implement tailored prevention and management strategies to mitigate the detrimental effect of climate change on the health of people with diabetes.
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Affiliation(s)
- Jacqueline M Ratter-Rieck
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany.
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Heaney A, Stowell JD, Liu JC, Basu R, Marlier M, Kinney P. Impacts of Fine Particulate Matter From Wildfire Smoke on Respiratory and Cardiovascular Health in California. GEOHEALTH 2022; 6:e2021GH000578. [PMID: 35795228 PMCID: PMC9166629 DOI: 10.1029/2021gh000578] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 05/26/2023]
Abstract
Increases in wildfire activity across the Western US pose a significant public health threat. While there is evidence that wildfire smoke is detrimental for respiratory health, the impacts on cardiovascular health remain unclear. This study evaluates the association between fine particulate matter (PM2.5) from wildfire smoke and unscheduled cardiorespiratory hospital visits in California during the 2004-2009 wildfire seasons. We estimate daily mean wildfire-specific PM2.5 with Goddard Earth Observing System-Chem, a global three-dimensional model of atmospheric chemistry, with wildfire emissions estimates from the Global Fire Emissions Database. We defined a "smoke event day" as cumulative 0-1-day lag wildfire-specific PM2.5 ≥ 98th percentile of cumulative 0-1 lag day wildfire PM2.5. Associations between exposure and outcomes are estimated using negative binomial regression. Results indicate that smoke event days are associated with a 3.3% (95% CI: [0.4%, 6.3%]) increase in visits for all respiratory diseases and a 10.3% (95% CI: [2.3%, 19.0%]) increase for asthma specifically. Stratifying by age, we found the largest effect for asthma among children ages 0-5 years. We observed no significant association between exposure and overall cardiovascular disease, but stratified analyses revealed increases in visits for all cardiovascular, ischemic heart disease, and heart failure among non-Hispanic white individuals and those older than 65 years. Further, we found a significant interaction between smoke event days and daily average temperature for all cardiovascular disease visits, suggesting that days with high wildfire PM2.5 concentrations and high temperatures may pose greater risk for cardiovascular disease. These results suggest substantial increases in adverse outcomes from wildfire smoke exposure and indicate the need for improved prevention strategies and adaptations to protect vulnerable populations.
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Affiliation(s)
- Alexandra Heaney
- Division of Environmental Health SciencesSchool of Public HealthUniversity of California, BerkeleyBerkeleyCAUSA
| | - Jennifer D. Stowell
- Department of Environmental HealthSchool of Public HealthBoston UniversityBostonMAUSA
| | | | - Rupa Basu
- California Office of Environmental Health Hazard AssessmentAir and Climate Epidemiology SectionOaklandCAUSA
| | - Miriam Marlier
- Department of Environmental Health SciencesUniversity of California, Los AngelesLos AngelesCAUSA
| | - Patrick Kinney
- Department of Environmental HealthSchool of Public HealthBoston UniversityBostonMAUSA
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