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Do V, Chen C, Benmarhnia T, Casey JA. Spatial Heterogeneity of the Respiratory Health Impacts of Wildfire Smoke PM 2.5 in California. GEOHEALTH 2024; 8:e2023GH000997. [PMID: 38560560 PMCID: PMC10978801 DOI: 10.1029/2023gh000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/04/2024]
Abstract
Wildfire smoke fine particles (PM2.5) are a growing public health threat as wildfire events become more common and intense under climate change, especially in the Western United States. Studies assessing the association between wildfire PM2.5 exposure and health typically summarize the effects over the study area. However, health responses to wildfire PM2.5 may vary spatially. We evaluated spatially-varying respiratory acute care utilization risks associated with short-term exposure to wildfire PM2.5 and explored community characteristics possibly driving spatial heterogeneity. Using ensemble-modeled daily wildfire PM2.5, we defined a wildfire smoke day to have wildfire-specific PM2.5 concentration ≥15 μg/m3. We included daily respiratory emergency department visits and unplanned hospitalizations in 1,396 California ZIP Code Tabulation Areas (ZCTAs) and 15 census-derived community characteristics. Employing a case-crossover design and conditional logistic regression, we observed increased odds of respiratory acute care utilization on wildfire smoke days at the state level (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 1.05, 1.07). Across air basins, ORs ranged from 0.88 to 1.57, with the highest effect estimate in San Diego. A within-community matching design and spatial Bayesian hierarchical model also revealed spatial heterogeneity in ZCTA-level rate differences. For example, communities with a higher percentage of Black or Pacific Islander residents had stronger wildfire PM2.5-outcome relationships, while more air conditioning and tree canopy attenuated associations. We found an important heterogeneity in wildfire smoke-related health impacts across air basins, counties, and ZCTAs, and we identified characteristics of vulnerable communities, providing evidence to guide policy development and resource allocation.
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Affiliation(s)
- V. Do
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - C. Chen
- Scripps Institution of Oceanography, UC San DiegoLa JollaCAUSA
| | - T. Benmarhnia
- Scripps Institution of Oceanography, UC San DiegoLa JollaCAUSA
- Irset Institut de Recherche en Santé, Environnement et Travail, UMR‐S 1085, Inserm, University of Rennes, EHESPRennesFrance
| | - J. A. Casey
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
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Weheba A, Vertigan A, Abdelsayad A, Tarlo SM. Respiratory Diseases Associated With Wildfire Exposure in Outdoor Workers. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00326-X. [PMID: 38548173 DOI: 10.1016/j.jaip.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024]
Abstract
Wildfires, including forest fires, bushfires, and landscape fires, have become increasingly prevalent, fueled by climate change and environmental factors and posing significant challenges to both ecosystems and public health. This review article examines the relationship between wildfires and respiratory diseases in outdoor workers, with a main focus on airway disease. In addition to the expected effects of direct thermal respiratory injuries and possible carbon monoxide poisoning, there are associations between wildfires and upper and lower respiratory effects, including infections as well as exacerbations of asthma and chronic obstructive pulmonary disease. A few studies have also shown an increased risk of new-onset asthma among wildfire firefighters. Outdoor workers are likely to have greater exposure to wildfire smoke with associated increased risks of adverse effects. As wildfires become increasingly prevalent globally, it is crucial to understand the various dimensions of this association. Furthermore, this review addresses preventive measures and potential interventions to alleviate the airway burden on individuals during and after work with wildfires events.
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Affiliation(s)
- Ahmed Weheba
- Toronto Metropolitan University, Faculty of Science, Toronto, Ontario, Canada
| | - Anne Vertigan
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Speech Pathology Department, John Hunter Hospital, Newcastle, New South Wales, Australia; Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Abeer Abdelsayad
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Respiratory Division, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Susan M Tarlo
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Respiratory Division, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Dalla Lana Department of Public Health, University of Toronto, Ontario, Canada.
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Bowman WS, Schmidt RJ, Sanghar GK, Thompson Iii GR, Ji H, Zeki AA, Haczku A. "Air That Once Was Breath" Part 2: Wildfire Smoke and Airway Disease - "Climate Change, Allergy and Immunology" Special IAAI Article Collection: Collegium Internationale Allergologicum Update 2023. Int Arch Allergy Immunol 2024; 185:617-630. [PMID: 38527432 DOI: 10.1159/000536576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/23/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Population growth and climate change have led to more frequent and larger wildfires, increasing the exposure of individuals to wildfire smoke. Notably, asthma exacerbations and allergic airway sensitization are prominent outcomes of such exposure. SUMMARY Key research questions relate to determining the precise impact on individuals with asthma, including the severity, duration, and long-term consequences of exacerbations. Identifying specific risk factors contributing to vulnerability, such as age, genetics, comorbidities, or environmental factors, is crucial. Additionally, reliable biomarkers for predicting severe exacerbations need exploration. Understanding the long-term health effects of repeated wildfire smoke exposures in individuals with asthma and addressing healthcare disparities are important research areas. KEY MESSAGES This review discusses the need for comprehensive research efforts to better grasp wildfire smoke-induced respiratory health, particularly in vulnerable populations such as farmworkers, firefighters, pregnant women, children, the elderly, and marginalized communities. Effective mitigation would require addressing the current limitations we face by supporting research aimed at a better understanding of wildfire smoke-induced airway disease.
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Wen J, Heft-Neal S, Baylis P, Boomhower J, Burke M. Quantifying fire-specific smoke exposure and health impacts. Proc Natl Acad Sci U S A 2023; 120:e2309325120. [PMID: 38085772 PMCID: PMC10743475 DOI: 10.1073/pnas.2309325120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/21/2023] [Indexed: 12/18/2023] Open
Abstract
Rapidly changing wildfire regimes across the Western United States have driven more frequent and severe wildfires, resulting in wide-ranging societal threats from wildfires and wildfire-generated smoke. However, common measures of fire severity focus on what is burned, disregarding the societal impacts of smoke generated from each fire. We combine satellite-derived fire scars, air parcel trajectories from individual fires, and predicted smoke PM2.5 to link source fires to resulting smoke PM2.5 and health impacts experienced by populations in the contiguous United States from April 2006 to 2020. We quantify fire-specific accumulated smoke exposure based on the cumulative population exposed to smoke PM2.5 over the duration of a fire and estimate excess asthma-related emergency department (ED) visits as a result of this exposure. We find that excess asthma visits attributable to each fire are only moderately correlated with common measures of wildfire severity, including burned area, structures destroyed, and suppression cost. Additionally, while recent California fires contributed nearly half of the country's smoke-related excess asthma ED visits during our study period, the most severe individual fire was the 2007 Bugaboo fire in the Southeast. We estimate that a majority of smoke PM2.5 comes from sources outside the local jurisdictions where the smoke is experienced, with 87% coming from fires in other counties and 60% from fires in other states. Our approach could enable broad-scale assessment of whether specific fire characteristics affect smoke toxicity or impact, inform cost-effectiveness assessments for allocation of suppression resources, and help clarify the growing transboundary nature of local air quality.
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Affiliation(s)
- Jeff Wen
- Department of Earth System Science, Stanford University, Stanford, CA94305
| | - Sam Heft-Neal
- Center on Food Security and the Environment, Stanford University, Stanford, CA94305
| | - Patrick Baylis
- Department of Economics, University of British Columbia, Vancouver, BCV6T 1Z4, Canada
| | - Judson Boomhower
- Department of Economics, University of California, San Diego, CA92093
- National Bureau of Economic Research, Cambridge, MA02138
| | - Marshall Burke
- Center on Food Security and the Environment, Stanford University, Stanford, CA94305
- National Bureau of Economic Research, Cambridge, MA02138
- Doerr School of Sustainability, Stanford University, Stanford, CA94305
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Heft-Neal S, Gould CF, Childs ML, Kiang MV, Nadeau KC, Duggan M, Bendavid E, Burke M. Emergency department visits respond nonlinearly to wildfire smoke. Proc Natl Acad Sci U S A 2023; 120:e2302409120. [PMID: 37722035 PMCID: PMC10523589 DOI: 10.1073/pnas.2302409120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/28/2023] [Indexed: 09/20/2023] Open
Abstract
Air pollution negatively affects a range of health outcomes. Wildfire smoke is an increasingly important contributor to air pollution, yet wildfire smoke events are highly salient and could induce behavioral responses that alter health impacts. We combine geolocated data covering all emergency department (ED) visits to nonfederal hospitals in California from 2006 to 2017 with spatially resolved estimates of daily wildfire smoke PM[Formula: see text] concentrations and quantify how smoke events affect ED visits. Total ED visits respond nonlinearly to smoke concentrations. Relative to a day with no smoke, total visits increase by 1 to 1.5% in the week following low or moderate smoke days but decline by 6 to 9% following extreme smoke days. Reductions persist for at least a month. Declines at extreme levels are driven by diagnoses not thought to be acutely impacted by pollution, including accidental injuries and several nonurgent symptoms, and declines come disproportionately from less-insured populations. In contrast, health outcomes with the strongest physiological link to short-term air pollution increase dramatically in the week following an extreme smoke day: We estimate that ED visits for asthma, COPD, and cough all increase by 30 to 110%. Data from internet searches, vehicle traffic sensors, and park visits indicate behavioral changes on high smoke days consistent with declines in healthcare utilization. Because low and moderate smoke days vastly outweigh high smoke days, we estimate that smoke was responsible for an average of 3,010 (95% CI: 1,760-4,380) additional ED visits per year 2006 to 2017. Given the increasing intensity of wildfire smoke events, behavioral mediation is likely to play a growing role in determining total smoke impacts.
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Affiliation(s)
- Sam Heft-Neal
- Center on Food Security and the Environment, Stanford University, Stanford, CA94305
| | - Carlos F. Gould
- Doerr School of Sustainability, Stanford University, Stanford, CA94305
| | | | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA94305
| | - Kari C. Nadeau
- Department of Environmental Health, Harvard University, Cambridge, MA02138
| | - Mark Duggan
- Department of Economics, Stanford University, Stanford, CA94305
- Stanford Institute of Economic Policy Research, Stanford University, Stanford, CA94305
- National Bureau of Economic Research, Cambridge, MA02138
| | - Eran Bendavid
- Department of Health Policy, Stanford University, Stanford, CA94305
- Department of Medicine, Stanford University, Stanford, CA94305
| | - Marshall Burke
- Center on Food Security and the Environment, Stanford University, Stanford, CA94305
- Doerr School of Sustainability, Stanford University, Stanford, CA94305
- National Bureau of Economic Research, Cambridge, MA02138
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