California wildfires of 2008: coarse and fine particulate matter toxicity

Gestational exposure to wildfire PM2.5 and its specific components and the risk of gestational hypertension and eclampsia in the southwestern United States

In the southwestern United States, the frequency of summer wildfires has elevated ambient PM2.5 concentrations and rates of adverse birth outcomes. Notably, hypertensive disorders in pregnancy (HDP) constitute a significant determinant associated with maternal mortality and adverse birth outcomes. Despite the accumulating body of evidence, scant research has delved into the correlation between chemical components of wildfire PM2.5 and the risk of HDP. Derived from data provided by the National Center for Health Statistics, singleton births from >2.68 million pregnant women were selected across 8 states (Arizona, AZ; California, CA, Idaho, ID, Montana, MT; Nevada, NV; Oregon, OR; Utah, UT, and Wyoming, WY) in the southwestern US from 2001 to 2004. A spatiotemporal model and a Goddard Earth Observing System chemical transport model were employed to forecast daily concentrations of total and wildfire PM2.5-derived exposure. Various modeling techniques including unadjusted analyses, covariate-adjusted models, propensity-score matching, and double robust typical logit models were applied to assess the relationship between wildfire PM2.5 exposure and gestational hypertension and eclampsia. Exposure to fire PM2.5, fire-sourced black carbon (BC) and organic carbon (OC) were associated with an augmented risk of gestational hypertension (ORPM2.5 = 1.125, 95 % CI: 1.109,1.141; ORBC = 1.247, 95 % CI: 1.214,1.281; OROC = 1.153, 95 % CI: 1.132, 1.174) and eclampsia (ORPM2.5 = 1.217, 95 % CI: 1.145,1.293; ORBC = 1.458, 95 % CI: 1.291,1.646; OROC = 1.309, 95 % CI: 1.208,1.418) during the pregnancy exposure window with the strongest effect. The associations were stronger that the observed effects of ambient PM2.5 in which the sources primarily came from urban emissions. Social vulnerability index (SVI), education years, pre-pregnancy diabetes, and hypertension acted as effect modifiers. Gestational exposure to wildfire PM2.5 and specific chemical components (BC and OC) increased gestational hypertension and eclampsia risk in the southwestern United States.

Climate change and public health in California: A structured review of exposures, vulnerable populations, and adaptation measures

California faces several serious direct and indirect climate exposures that can adversely affect public health, some of which are already occurring. The public health burden now and in the future will depend on atmospheric greenhouse gas concentrations, underlying population vulnerabilities, and adaptation efforts. Here, we present a structured review of recent literature to examine the leading climate risks to public health in California, including extreme heat, extreme precipitation, wildfires, air pollution, and infectious diseases. Comparisons among different climate-health pathways are difficult due to inconsistencies in study design regarding spatial and temporal scales and health outcomes examined. We find, however, that the current public health burden likely affects thousands of Californians each year, depending on the exposure pathway and health outcome. Further, while more evidence exists for direct and indirect proximal health effects that are the focus of this review, distal pathways (e.g., impacts of drought on nutrition) are more uncertain but could add to this burden. We find that climate adaptation measures can provide significant health benefits, particularly in disadvantaged communities. We conclude with priority recommendations for future analyses and solution-driven policy actions.

Mortality attributable to PM2.5 from wildland fires in California from 2008 to 2018

In California, wildfire risk and severity have grown substantially in the last several decades. Research has characterized extensive adverse health impacts from exposure to wildfire-attributable fine particulate matter (PM2.5), but few studies have quantified long-term outcomes, and none have used a wildfire-specific chronic dose-response mortality coefficient. Here, we quantified the mortality burden for PM2.5 exposure from California fires from 2008 to 2018 using Community Multiscale Air Quality modeling system wildland fire PM2.5 estimates. We used a concentration-response function for PM2.5, applying ZIP code-level mortality data and an estimated wildfire-specific dose-response coefficient accounting for the likely toxicity of wildfire smoke. We estimate a total of 52,480 to 55,710 premature deaths are attributable to wildland fire PM2.5 over the 11-year period with respect to two exposure scenarios, equating to an economic impact of $432 to $456 billion. These findings extend evidence on climate-related health impacts, suggesting that wildfires account for a greater mortality and economic burden than indicated by earlier studies.

Repeated exposure to eucalyptus wood smoke alters pulmonary gene and metabolic profiles in male Long-Evans rats

Exposure to wildfire smoke is associated with both acute and chronic cardiopulmonary illnesses, which are of special concern for wildland firefighters who experience repeated exposure to wood smoke. It is necessary to better understand the underlying pathophysiology by which wood smoke exposure increases pulmonary disease burdens in this population. We hypothesize that wood smoke exposure produces pulmonary dysfunction, lung inflammation, and gene expression profiles associated with future pulmonary complications. Male Long-Evans rats were intermittently exposed to smoldering eucalyptus wood smoke at 2 concentrations, low (11.0 ± 1.89 mg/m3) and high (23.7 ± 0.077 mg/m3), over a 2-week period. Whole-body plethysmography was measured intermittently throughout. Lung tissue and lavage fluid were collected 24 h after the final exposure for transcriptomics and metabolomics. Increasing smoke exposure upregulated neutrophils and select cytokines in the bronchoalveolar lavage fluid. In total, 3446 genes were differentially expressed in the lungs of rats in the high smoke exposure and only 1 gene in the low smoke exposure (Cd151). Genes altered in the high smoke group reflected changes to the Eukaryotic Initiation Factor 2 stress and oxidative stress responses, which mirrored metabolomics analyses. xMWAS-integrated analysis revealed that smoke exposure significantly altered pathways associated with oxidative stress, lung morphogenesis, and tumor proliferation pathways. These results indicate that intermittent, 2-week exposure to eucalyptus wood smoke leads to transcriptomic and metabolic changes in the lung that may predict future lung disease development. Collectively, these findings provide insight into cellular signaling pathways that may contribute to the chronic pulmonary conditions observed in wildland firefighters.

Wildfire particulate exposure and risks of preterm birth and low birth weight in the Southwestern United States

OBJECTIVES

Wildfire air pollution is a growing concern on human health. The study aims to assess the associations between wildfire air pollution and pregnancy outcomes in the Southwestern United States.

STUDY DESIGN

This was a retrospective cohort study.

METHODS

Birth records of 627,404 singleton deliveries in 2018 were obtained in eight states of the Southwestern United States and were linked to wildfire-sourced fine particulate matter (PM2.5) and their constituents (black carbon [BC] and organic carbon [OC]) during the entire gestational period. A double-robust logistic regression model was used to assess the associations of wildfire-sourced PM2.5 exposures and preterm birth and term low birth weight, adjusting for non-fire-sourced PM2.5 exposure and individual- and area-level confounder variables.

RESULTS

Wildfire-sourced PM2.5 contributed on average 15% of the ambient total PM2.5 concentrations. For preterm birth, the strongest association was observed in the second trimester (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.05-1.07 for PM2.5; 1.06, 95% CI: 1.05-1.07 for BC; 1.04, 95% CI: 1.03-1.05 for OC, per interquartile range increment of exposure), with higher risks identified among non-smokers or those with low socio-economic status. For term low birth weight, the associations with wildfire-sourced PM2.5 exposures were consistently elevated for all trimesters except for the exposure averaged over the entire gestational period. Overall, the associations between wildfire-sourced PM2.5 and pregnancy outcomes were stronger than those with total PM2.5.

CONCLUSIONS

Wildfire-sourced PM2.5 and its constituents are linked to higher risks of preterm birth and term low birth weight among a significant US population than the effects of ambient total PM2.5.

The firestorm within: A narrative review of extreme heat and wildfire smoke effects on brain health

Climate change is generating increased heatwaves and wildfires across much of the world. With these escalating environmental changes comes greater impacts on human health leading to increased numbers of people suffering from heat- and wildfire smoke-associated respiratory and cardiovascular impairment. One area of health impact of climate change that has received far less attention is the effects of extreme heat and wildfire smoke exposure on human brain health. As elevated temperatures, and wildfire-associated smoke, are increasingly experienced simultaneously over summer periods, understanding this combined impact is critical to management of human health especially in the elderly, and people with dementia, and other neurological disorders. Both extreme heat and wildfire smoke air pollution (especially particulate matter, PM) induce neuroinflammatory and cerebrovascular effects, oxidative stress, and cognitive impairment, however the combined effect of these impacts are not well understood. In this narrative review, a comprehensive examination of extreme heat and wildfire smoke impact on human brain health is presented, with a focus on how these factors contribute to cognitive impairment, and dementia, one of the leading health issues today. Also discussed is the potential impact of combined heat and wildfire smoke on brain health, and where future efforts should be applied to help advance knowledge in this rapidly growing and critical field of health research.

Spatial Heterogeneity of the Respiratory Health Impacts of Wildfire Smoke PM2.5 in California

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.

Monitoring redox stress in human airway epithelial cells exposed to woodsmoke at an air-liquid interface

Wildland fires contribute significantly to the ambient air pollution burden worldwide, causing a range of adverse health effects in exposed populations. The toxicity of woodsmoke, a complex mixture of gases, volatile organic compounds, and particulate matter, is commonly studied in vitro using isolated exposures of conventionally cultured lung cells to either resuspended particulate matter or organic solvent extracts of smoke, leading to incomplete toxicity evaluations. This study aimed to improve our understanding of the effects of woodsmoke inhalation by building an advanced in vitro exposure system that emulates human exposure of the airway epithelium. We report the development and characterization of an innovative system that permits live-cell monitoring of the intracellular redox status of differentiated primary human bronchial epithelial cells cultured at an air-liquid interface (pHBEC-ALI) as they are exposed to unfractionated woodsmoke generated in a tube furnace in real time. pHBEC-ALI exposed to freshly generated woodsmoke showed oxidative changes that were dose-dependent and reversible, and not attributable to carbon monoxide exposure. These findings show the utility of this novel system for studying the molecular initiating events underlying woodsmoke-induced toxicity in a physiologically relevant in vitro model, and its potential to provide biological plausibility for risk assessment and public health measures.

"Air That Once Was Breath" Part 1: Wildfire-Smoke-Induced Mechanisms of Airway Inflammation - "Climate Change, Allergy and Immunology" Special IAAI Article Collection: Collegium Internationale Allergologicum Update 2023

BACKGROUND

Wildfires are a global concern due to their wide-ranging environmental, economic, and public health impacts. Climate change contributes to an increase in the frequency and intensity of wildfires making smoke exposure a more significant and recurring health concern for individuals with airway diseases. Some of the most prominent effects of wildfire smoke exposure are asthma exacerbations and allergic airway sensitization. Likely due to the delayed recognition of its health impacts in comparison with cigarette smoke and industrial or traffic-related air pollution, research on the composition, the mechanisms of toxicity, and the cellular/molecular pathways involved is poor or non-existent.

SUMMARY

This review discusses potential underlying pathological mechanisms of wildfire-smoke-related allergic airway disease and asthma. We focused on major gaps in understanding the role of wildfire smoke composition in the development of airway disease and the known and potential mechanisms involving cellular and molecular players of oxidative injury at the epithelial barrier in airway inflammation. We examine how PM2.5, VOCs, O3, endotoxin, microbes, and toxic gases may affect oxidative stress and inflammation in the respiratory mucosal barrier. We discuss the role of AhR in mediating smoke's effects in alarmin release and IL-17A production and how glucocorticoid responsiveness may be impaired by IL-17A-induced signaling and epigenetic changes leading to steroid-resistant severe airway inflammation.

KEY MESSAGE

Effective mitigation of wildfire-smoke-related respiratory health effects would require comprehensive research efforts aimed at a better understanding of the immune regulatory effects of wildfire smoke in respiratory health and disease.

Fine particle pollution during megafires contains potentially toxic elements

Wildfires that raged across Australia during the 2019-2020 'Black Summer' produced an enormous quantity of particulate matter (PM) pollution, with plumes that cloaked many urban centres and ecosystems along the eastern seaboard. This has motivated a need to understand the magnitude and nature of PM exposure, so that its impact on both built and natural environments can be more accurately assessed. Here we present the potentially toxic fingerprint of PM captured by building heating, ventilation, and air conditioning filters in Sydney, Australia during the peak of the Wildfires, and from ambient urban emissions one year later (Reference period). Atmospheric PM and meteorological monitoring data were also assessed to determine the magnitude and source of high PM exposure. The wildfires were a major source of PM pollution in Sydney, exceeding the national standards on 19 % of days between November-February. Wildfire particles were finer and more spherical compared to Reference PM, with count median diameters of 892.1 ± 23.1 versus 1484.8 ± 96.7 nm (mean ± standard error). On an equal-mass basis, differences in potentially toxic elements were predominantly due to higher SO42--S (median 20.4 vs 4.7 mg g-1) and NO3--N (2.4 vs 1.2 mg g-1) in Wildfire PM, and higher PO43--P (10.4 vs 1.4 mg g-1) in Reference PM. Concentrations of remaining elements were similar or lower than Reference PM, except for enrichments to F-, Cl-, dissolved Mn, and particulate Mn, Co and Sb. Fractional solubilities of trace elements were similar or lower than Reference PM, except for enhanced Hg (12.1 vs 1.0 %) and greater variability in Cd, Hg and Mn solubility, which displayed upper quartiles exceeding that of Reference PM. These findings contribute to our understanding of human and ecosystem exposures to the toxic components of mixed smoke plumes, especially in regions downwind of the source.

Adverse Health Impacts of Outdoor Air Pollution, Including from Wildland Fires, in the United States: "Health of the Air," 2018-2020

Rationale: Adverse health impacts from outdoor air pollution occur across the United States, but the magnitude of these impacts varies widely by geographic region. Ambient pollutant concentrations, emission sources, baseline health conditions, and population sizes and distributions are all important factors that need to be taken into account to quantify local health burdens. Objectives: To determine health impacts from ambient air pollution concentrations in the United States that exceed the levels recommended by the American Thoracic Society. Methods: Using a methodology that has been well established in previous "Health of the Air" reports, this study provides policy-relevant estimates for every monitored county and city in the United States for the adverse health impacts of outdoor pollution concentrations using U.S. Environmental Protection Agency design values for years 2018-2020. Additionally, for the first time, the report includes adverse birth outcomes as well as estimates of health impacts specifically attributable to wildland fires using an exposure dataset generated through Community Multiscale Air Quality simulations. Results: The adverse health burdens attributable to air pollution occur across the entire age spectrum, including adverse birth outcomes (10,660 preterm and/or low-weight births; 95% confidence interval [CI], 3,180-18,330), in addition to mortality impacts (21,300 avoidable deaths; 95% CI, 16,180-26,200), lung cancer incidence (3,000 new cases; 95% CI, 1,550-4,390), multiple types of cardiovascular and respiratory morbidity (748,660 events; 95% CI, 326,050-1,057,080), and adversely impacted days (52.4 million days; 95% CI, 7.9-92.4 million days). Two different estimates of mortality impacts from wildland fires were created based on assumptions regarding the underlying toxicity of particles from wildland fires (low estimate of 4,080 deaths, 95% CI, 240-7,890; middle estimate of 28,000 deaths, 95% CI, 27,300-28,700). Conclusions: This year's report identified sizable health benefits that would be expected to occur across the United States with compliance with more health-protective air quality standards such as those recommended by the American Thoracic Society. This study also indicates that a large number of excess deaths are attributable to emissions from wildland fires; air quality management strategies outside what is required by the Clean Air Act will be needed to best address this important source of air pollution and its associated health risks.

The Impact of Ambient and Wildfire Air Pollution on Rhinosinusitis and Olfactory Dysfunction

PURPOSE OF REVIEW

With increasing industrialization, exposure to ambient and wildfire air pollution is projected to increase, necessitating further research to elucidate the complex relationship between exposure and sinonasal disease. This review aims to summarize the role of ambient and wildfire air pollution in chronic rhinosinusitis (CRS) and olfactory dysfunction and provide a perspective on gaps in the literature.

RECENT FINDINGS

Based on an emerging body of evidence, exposure to ambient air pollutants is correlated with the development of chronic rhinosinusitis in healthy individuals and increased symptom severity in CRS patients. Studies have also found a robust relationship between long-term exposure to ambient air pollutants and olfactory dysfunction. Ambient air pollution exposure is increasingly recognized to impact the development and sequelae of sinonasal pathophysiology. Given the rising number of wildfire events and worsening impacts of climate change, further study of the impact of wildfire-related air pollution is a crucial emerging field.

Emergency department visits associated with wildfire smoke events in California, 2016-2019

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.

Extreme weather-Wildfires & pregnancy

As described in the previous chapter, Chapter 4: Air pollution and pregnancy, there is robust literature on the adverse health impacts of ambient air pollution on perinatal outcomes. With climate change contributing to more extreme weather patterns, wildfire events are becoming more intense and frequent. Wildfire smoke is a major contributor to poor air quality and data are beginning to emerge with respect to the negative impact on perinatal outcomes. The aim of this chapter is to provide an overview of the current literature on wildfire smoke exposure in pregnancy and associated adverse outcomes.

The Burden of Wildfire Smoke on Respiratory Health in California at the Zip Code Level: Uncovering the Disproportionate Impacts of Differential Fine Particle Composition

Wildfires constitute a growing source of extremely high levels of particulate matter that is less than 2.5 microns in diameter (PM2.5). Recently, toxicologic and epidemiologic studies have shown that PM2.5 generated from wildfires may have a greater health burden than PM2.5 generated from other pollutant sources. This study examined the impact of PM2.5 on hospitalizations for respiratory diseases in California between 2006 and 2019 using a health impact assessment approach that considers differential concentration-response functions (CRF) for PM2.5 from wildfire and non-wildfire sources of emissions. We quantified the burden of respiratory hospitalizations related to PM2.5 exposure at the zip code level through two different approaches: (a) naïve (considering the same CRF for all PM2.5 emissions) and (b) nuanced (considering different CRFs for PM2.5 from wildfires and from other sources). We conducted a Geographically Weighted Regression to analyze spatially varying relationships between the delta (i.e., the difference between the naïve and nuanced approaches) and the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI). A higher attributable number of respiratory hospitalizations was found when accounting for the larger health burden of wildfire PM2.5. We found that, between 2006 and 2019, the number of hospitalizations attributable to PM2.5 may have been underestimated by approximately 13% as a result of not accounting for the higher CRF of wildfire-related PM2.5 throughout California. This underestimation was higher in northern California and areas with higher SVI rankings. The relationship between delta and SVI varied spatially across California. These findings can be useful for updating future air pollution guideline recommendations.

Unraveling the link: exploring the effects of environmental change on the cardiovascular system

Climate change has a particularly detrimental effect on the cardiovascular system, which is highly vulnerable to harmful impacts. The accumulation of particulate matter (PM) and greenhouse gasses in the environment negatively impacts the cardiovascular system through several mechanisms. The burden of climate change-related diseases falls disproportionately on vulnerable populations, including the elderly, the poor, and those with pre-existing health conditions. A key component of addressing the complex interplay between climate change and cardiovascular diseases is acknowledging health disparities among vulnerable populations resulting from climate change, familiarizing themselves with strategies for adapting to changing conditions, educating patients about climate-related cardiovascular risks, and advocating for policies that promote cleaner environments and sustainable practices.

Short-Term total and wildfire fine particulate matter exposure and work loss in California

BACKGROUND

Few studies investigated the impact of particulate matter (PM2.5) on some symptom exacerbations that are not perceived as severe enough to search for medical assistance. We aimed to study the association of short-term daily total PM2.5 exposure with work loss due to sickness among adults living in California.

METHODS

We included 44,544 adult respondents in the workforce from 2015 to 2018 California Health Interview Survey data. Daily total PM2.5 concentrations were linked to respondents' home addresses from continuous spatial surfaces of PM2.5 generated by a geostatistical surfacing algorithm. We estimated the effect of a 2-week average of daily total PM2.5 exposure on work loss using logistic regression models.

RESULTS

About 1.69% (weighted percentage) of adult respondents reported work loss in the week before the survey interview. The odds ratio of work loss was 1.45 (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.03, 2.03) when a 2-week average of daily total PM2.5 exposure was higher than 12 µg/m3. The OR for work loss was 1.05 (95% CI: 0.98, 1.13) for each 2.56ug/m3 increase in the 2-week average of daily total PM2.5 exposure, and became stronger among those who were highly exposed to wildfire smoke (OR = 1.06, 95% CI: 1.00, 1.13), compared to those with lower wildfire smoke exposure (OR = 1.04, 95% CI: 0.79, 1.39).

CONCLUSIONS

Our findings suggest that short-term ambient PM2.5 exposure is positively associated with work loss due to sickness and the association was stronger among those with higher wildfire smoke exposure. It also indicated that the current federal and state PM2.5 standards (annual average of 12 µg/m3) could be further strengthened to protect the health of the citizens of California.

Wildfire smoke exposure and emergency department visits in Washington State

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 PM_2.5. 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.

Associations between prenatal and early-life air pollution exposure and lung function in young children: Exploring influential windows of exposure on lung development

BACKGROUND

Evidence in the literature suggests that air pollution exposures experienced prenatally and early in life can be detrimental to normal lung development, however the specific timing of critical windows during development is not fully understood.

OBJECTIVES

We evaluated air pollution exposures during the prenatal and early-life period in association with lung function at ages 6-9, in an effort to identify potentially influential windows of exposure for lung development.

METHODS

Our study population consisted of 222 children aged 6-9 from the Fresno-Clovis metro area in California with spirometry data collected between May 2015 and May 2017. We used distributed-lag non-linear models to flexibly model the exposure-lag-response for monthly average exposure to fine particulate matter (PM2.5) and ozone (O3) during the prenatal months and first three years of life in association with forced vital capacity (FVC), and forced expiratory volume in the first second (FEV1), adjusted for covariates.

RESULTS

PM2.5 exposure during the prenatal period and the first 3-years of life was associated with lower FVC and FEV1 assessed at ages 6-9. Specifically, an increase from the 5th percentile of the observed monthly average exposure (7.55 μg/m3) to the median observed exposure (12.69 μg/m3) for the duration of the window was associated with 0.42 L lower FVC (95% confidence interval (CI): -0.82, -0.03) and 0.38 L lower FEV1 (95% CI: -0.75, -0.02). The shape of the lag-response indicated that the second half of pregnancy may be a particularly influential window of exposure. Associations for ozone were not as strong and typically CIs included the null.

CONCLUSIONS

Our findings indicate that prenatal and early-life exposures to PM2.5 are associated with decreased lung function later in childhood. Exposures during the latter months of pregnancy may be especially influential.

Inequities in ambient fine particulate matter: A spatiotemporal analysis in Canadian communities

BACKGROUND

Exposure to fine particulate matter (PM_2.5) is associated with adverse health outcomes but communities are not randomly exposed to PM_2.5. Previous cross-sectional environmental injustice analyses in Canada found disproportionately higher exposure to PM_2.5 in low-income populations, visible minorities and immigrants. Beyond static surveillance, it is also important to evaluate how changes in PM_2.5 exposure over time may differentially impact disadvantaged communities. We examine whether communities with different sociodemographic characteristics benefited equitably from the overall decreases in ambient concentrations of PM_2.5 from 2001 to 2016 in Canada.

METHODS

We derived census tract level estimates of average annual PM_2.5 using validated satellite-based estimations of annual average PM_2.5 concentration surfaces. We investigated how the spatial distribution of PM_2.5 has evolved over 15 years (2001-2016) by comparing absolute values and rank percentiles of census tract level annual average PM_2.5 concentrations in 2001 and 2016. Using decennial census data and multivariable linear regression, we determined if sociodemographic characteristics are associated with changes in exposure to PM_2.5, accounting for geographic boundary changes between census periods.

RESULTS

Overall, ambient PM_2.5 concentrations decreased from 2001 (median of 9.1 μg/m³) to 2016 (median of 6.4 μg/m³), with varying provincial patterns. Across communities, ranked census tract specific PM_2.5 in 2001 and in 2016 are highly correlated (Spearman's rho = 0.75). We found that, on average and accounting for provincial differences and baseline PM_2.5, communities with greater density of aboriginal population, lower education, higher shelter-cost-to-income ratio, unemployment or lower income experienced smaller absolute decreases in PM_2.5 from 2001 to 2016.

CONCLUSIONS

Identifying sociodemographic groups that benefit least from decreasing exposure to PM_2.5 highlights the need to consider environmental injustice when designing or revising air pollution policies.

The impact of fire-specific PM2.5 calibration on health effect analyses

The quantification of PM_2.5 concentrations solely stemming from both wildfire and prescribed burns (hereafter referred to as 'fire') is viable using the Community Multiscale Air Quality (CMAQ), although CMAQ outputs are subject to biases and uncertainties. To reduce the biases in CMAQ-based outputs, we propose a two-stage calibration strategy that improves the accuracy of CMAQ-based fire PM_2.5 estimates. First, we calibrated CMAQ-based non-fire PM_2.5 to ground PM_2.5 observations retrieved during non-fire days using an ensemble-based model. We estimated fire PM_2.5 concentrations in the second stage by multiplying the calibrated non-fire PM_2.5 obtained from the first stage by location- and time-specific conversion ratios. In a case study, we estimated fire PM_2.5 during the Washington 2016 fire season using the proposed calibration approach. The calibrated PM_2.5 better agreed with ground PM_2.5 observations with a 10-fold cross-validated (CV) R² of 0.79 compared to CMAQ-based PM_2.5 estimates with R² of 0.12. In the health effect analysis, we found significant associations between calibrated fire PM_2.5 and cardio-respiratory hospitalizations across the fire season: relative risk (RR) for cardiovascular disease = 1.074, 95% confidence interval (CI) = 1.021-1.130 in October; RR = 1.191, 95% CI = 1.099-1.291 in November; RR for respiratory disease = 1.078, 95% CI = 1.005-1.157 in October; RR = 1.153, 95% CI = 1.045-1.272 in November. However, the results were inconsistent when non-calibrated PM_2.5 was used in the analysis. We found that calibration affected health effect assessments in the present study, but further research is needed to confirm our findings.

Gestational age-dependent decrease in fetal Hofbauer cells in placentas from pregnancies exposed to wildfire smoke in California

OBJECTIVE

Wildfires are more common over the last decade and the frequency of wildfire events has been accelerated by climate change. The existing body of literature suggests that exposure to wildfire smoke during pregnancy contributes to adverse perinatal outcomes such as preterm birth and fetal growth restriction. We hypothesize that exposures to wildfire smoke and its constituents triggers a fetal inflammatory response which contributes to pathological changes that underlie these adverse pregnancy outcomes. In this study, we quantified the presence of fetal macrophages (i.e., Hofbauer cells) in human placentas obtained between 2018 and 2020 to assess the relationship between fetal immune status and wildfire exposure.

STUDY DESIGN

We collected placentas from pregnancies from two hospitals in San Francisco over a two-year period that included two severe major wildfires. The average particulate matter < 2.5 μm (PM2.5) or wildfire specific PM2.5 levels were estimated over the gestational duration of each sample. Immunostaining against CK7 and CD68 was performed to identify intravillous fetal Hofbauer cells. We assessed the gestational-age dependent relationship between placental CD68+ cell density and mean daily PM2.5 or wildfire-specific PM2.5 via linear regression and Welch's t-test. Additionally, we compared placental CD68+ cell density with estimated peak wildfire exposures during the gestation to determine if timing of exposure during pregnancy may influence the occurrence of Hofbauer cells in the placenta.

RESULTS

The gestational ages ranged from 7-41 weeks (n = 67). The majority of samples were collected during one of two major wildfire events in Northern California (70%; n = 47). In general, we observed a significant inverse relationship between placental CD68 density and PM2.5 or wildfire specific PM2.5, however, these associations were only observed in first or second trimester samples, and not in term samples. For example, among first trimester samples (n=22), we observed lower mean CD68 density among samples likely to be exposed to wildfire events (mean = 1.42, SD = 0.8) as compared to those not exposed (mean = 3.73, SD = 1.983) (p = 0.0015). Based on our linear regression model results, we predicted that a one μg/m3 increase in daily mean wildfire PM2.5 was associated with a 0.457 decrease in CD68 density (ß =-0.457; 95% CI: -0.722, -0.193). This association was also significant for daily mean overall PM2.5, though smaller in magnitude (ß = -0.139; 95% CI: -0.218, -0.059).

CONCLUSIONS

Our results suggest that wildfire smoke exposures are associated with decreased presence of fetal Hofbauer cells in first and second trimester placentas, suggesting exposure may lead to impaired placental function via altered presence of fetal Hofbauer cells and changes in immune status.

Effects of wildfire smoke PM2.5 on indicators of inflammation, health, and metabolism of preweaned Holstein heifers

Wildfires are a growing concern as large, catastrophic fires are becoming more commonplace. Wildfire smoke consists of fine particulate matter (PM2.5), which can cause immune responses and disease in humans. However, the present knowledge of the effects of wildfire PM2.5 on dairy cattle is sparse. The present study aimed to elucidate the effects of wildfire-PM2.5 exposure on dairy calf health and performance. Preweaned Holstein heifers (N = 15) were assessed from birth through weaning, coinciding with the 2021 wildfire season. Respiratory rate, heart rate, rectal temperatures, and health scores were recorded and blood samples were collected weekly or twice a week for analysis of hematology, blood metabolites, and acute phase proteins. Hourly PM2.5 concentrations and meteorological data were obtained, and temperature-humidity index (THI) was calculated. Contribution of wildfires to PM2.5 fluxes were determined utilizing AirNowTech Navigator and HYSPLIT modeling. Mixed models were used for data analysis, with separate models for lags of up to 7 d, and fixed effects of daily average PM2.5, THI, and PM2.5 × THI, and calf as a random effect. THI ranged from 48 to 73, while PM2.5 reached concentrations up to 118.8 µg/m3 during active wildfires. PM2.5 and THI positively interacted to elevate respiratory rate, heart rate, rectal temperature, and eosinophils on lag day 0 (day of exposure; all P < 0.05). There was a negative interactive effect of PM2.5 and THI on lymphocytes after a 2-d lag (P = 0.03), and total white blood cells, neutrophils, hemoglobin, and hematocrit after a 3-d lag (all P < 0.02), whereas there was a positive interactive effect on cough scores and eye scores on lag day 3 (all P < 0.02). Glucose and NEFA were increased as a result of combined elevated PM2.5 and THI on lag day 1, whereas BHB was decreased (all P < 0.05). Contrarily, on lag day 3 and 6, there was a negative interactive effect of PM2.5 and THI on glucose and NEFA, but a positive interactive effect on BHB (all P < 0.03). Serum amyloid A was decreased whereas haptoglobin was increased with elevated PM2.5 and THI together on lag days 0 to 4 (all P < 0.05). These findings indicate that exposure to wildfire-derived PM2.5, along with increased THI during the summer months, elicits negative effects on preweaned calf health and performance both during and following exposure.

Landscape fire smoke enhances the association between fine particulate matter exposure and acute respiratory infection among children under 5 years of age: Findings of a case-crossover study for 48 low- and middle-income countries

BACKGROUND

Fine particulate matter (PM2.5) produced by landscape fires is thought to be more toxic than that from non-fire sources. However, the effects of "fire-sourced" PM2.5 on acute respiratory infection (ARI) are unknown.

METHODS

We combined Demographic and Health Survey (DHS) data from 48 countries with gridded global estimates of PM2.5 concentrations from 2003 to 2014. The proportions of fire-sourced PM2.5 were assessed by a chemical transport model using a variety of PM2.5 source data. We tested for associations between ARI and short-term exposure to fire- and "non-fire-sourced" PM2.5 using a bidirectional case-crossover analysis. The robustness and homogeneity of the associations were examined by sensitivity analyses. We also established a nonlinear exposure-response relationship between fire- and non-fire-sourced PM2.5 and ARI using a two-dimensional spline function.

RESULTS

The study included 36,432 children under 5 years who reported ARI symptoms. Each 1 µg/m3 increment of fire-sourced PM2.5 was associated with a 3.2 % (95 % confidence interval [CI] 0.2, 6.2) increment in the risk of ARI. This effect was comparable to that of each ∼5 µg/m3 increment in PM2.5 from non-fire sources (3.1 %; 95 % CI 2.4, 3.7). The association between ARI and total PM2.5 concentration was significantly mediated by the proportion of fire-sourced particles. Nonlinear analysis showed that the risk of ARI was increased by both fire- and non-fire-sourced PM2.5, but especially by the former.

CONCLUSIONS

PM2.5 produced by landscape fire was more strongly associated to ARI among children under 5 years than that from non-fire sources.

A novel ensemble-based statistical approach to estimate daily wildfire-specific PM2.5 in California (2006-2020)

Though fine particulate matter (PM2.5) has decreased in the United States (U.S.) in the past two decades, the increasing frequency, duration, and severity of wildfires significantly (though episodically) impairs air quality in wildfire-prone regions and beyond. Increasing PM2.5 concentrations derived from wildfire smoke and associated impacts on public health require dedicated epidemiological studies. Main sources of PM2.5 data are provided by government-operated monitors sparsely located across U.S., leaving several regions and potentially vulnerable populations unmonitored. Current approaches to estimate PM2.5 concentrations in unmonitored areas often rely on big data, such as satellite-derived aerosol properties and meteorological variables, apply computationally-intensive deterministic modeling, and do not distinguish wildfire-specific PM2.5 from other sources of emissions such as traffic and industrial sources. Furthermore, modelling wildfire-specific PM2.5 presents a challenge since measurements of the smoke contribution to PM2.5 pollution are not available. Here, we aim to use statistical methods to isolate wildfire-specific PM2.5 from other sources of emissions. Our study presents an ensemble model that optimally combines multiple machine learning algorithms (including gradient boosting machine, random forest and deep learning), and a large set of explanatory variables to, first, estimate daily PM2.5 concentrations at the ZIP code level, a relevant spatiotemporal resolution for epidemiological studies. Subsequently, we propose a novel implementation of an imputation approach to estimate the wildfire-specific PM2.5 concentrations that could be applied geographical regions in the US or worldwide. Our ensemble model achieved comparable results to previous machine learning studies for PM2.5 prediction while avoiding processing larger, computationally intensive datasets. Our study is the first to apply a suite of statistical models using readily available datasets to provide daily wildfire-specific PM2.5 at a fine spatial scale for a 15-year period, thus providing a relevant spatiotemporal resolution and timely contribution for epidemiological studies.

Wildfire smoke exposure and emergency department visits for headache: A case-crossover analysis in California, 2006-2020

OBJECTIVE

To evaluate the association of short-term exposure to overall fine particulate matter of <2.5 μm (PM_2.5 ) and wildfire-specific PM_2.5 with emergency department (ED) visits for headache.

BACKGROUND

Studies have reported associations between PM_2.5 exposure and headache risk. As climate change drives longer and more intense wildfire seasons, wildfire PM_2.5 may contribute to more frequent headaches.

METHODS

Our study included adult Californian members (aged ≥18 years) of a large de-identified commercial and Medicare Advantage claims database from 2006 to 2020. We identified ED visits for primary headache disorders (subtypes: tension-type headache, migraine headache, cluster headache, and "other" primary headache). Claims included member age, sex, and residential zip code. We linked daily overall and wildfire-specific PM_2.5 to residential zip code and conducted a time-stratified case-crossover analysis considering 7-day average PM_2.5 concentrations, first for primary headache disorders combined, and then by headache subtype.

RESULTS

Among 9898 unique individuals we identified 13,623 ED encounters for primary headache disorders. Migraine was the most frequently diagnosed headache (N = 5534/13,623 [47.6%]) followed by "other" primary headache (N = 6489/13,623 [40.6%]). For all primary headache ED diagnoses, we observed an association of 7-day average wildfire PM_2.5 (odds ratio [OR] 1.17, 95% confidence interval [CI] 0.95-1.44 per 10 μg/m³ increase) and by subtype we observed increased odds of ED visits associated with 7-day average wildfire PM_2.5 for tension-type headache (OR 1.42, 95% CI 0.91-2.22), "other" primary headache (OR 1.40, 95% CI 0.96-2.05), and cluster headache (OR 1.29, 95% CI 0.71-2.35), although these findings were not statistically significant under traditional null hypothesis testing. Overall PM_2.5 was associated with tension-type headache (OR 1.29, 95% CI 1.03-1.62), but not migraine, cluster, or "other" primary headaches.

CONCLUSIONS

Although imprecise, these results suggest short-term wildfire PM_2.5 exposure may be associated with ED visits for headache. Patients, healthcare providers, and systems may need to respond to increased headache-related healthcare needs in the wake of wildfires and on poor air quality days.

The mental health and well-being effects of wildfire smoke: a scoping review

BACKGROUND

Smoke from wildfires is a growing public health risk due to the enormous amount of smoke-related pollution that is produced and can travel thousands of kilometers from its source. While many studies have documented the physical health harms of wildfire smoke, less is known about the effects on mental health and well-being. Understanding the effects of wildfire smoke on mental health and well-being is crucial as the world enters a time in which wildfire smoke events become more frequent and severe. We conducted a scoping review of the existing information on wildfire smoke's impact on mental health and well-being and developed a model for understanding the pathways in which wildfire smoke may contribute to mental health distress.

METHODS

We conducted searches using PubMed, Medline, Embase, Google, Scopus, and ProQuest for 1990-2022. These searches yielded 200 articles. Sixteen publications met inclusion criteria following screening and eligibility assessment. Three more publications from the bibliographies of these articles were included for a total of 19 publications.

RESULTS

Our review suggests that exposure to wildfire smoke may have mental health impacts, particularly in episodes of chronic and persistent smoke events, but the evidence is inconsistent and limited. Qualitative studies disclose a wider range of impacts across multiple mental health and well-being domains. The potential pathways connecting wildfire smoke with mental health and well-being operate at multiple interacting levels including individual, social and community networks, living and working conditions, and ecological levels.

CONCLUSIONS

Priorities for future research include: 1) applying more rigorous methods; 2) differentiating between mental illness and emotional well-being; 3) studying chronic, persistent or repeated smoke events; 4) identifying the contextual factors that set the stage for mental health and well-being effects, and 5) identifying the causal processes that link wildfire smoke to mental health and well-being effects. The pathways model can serve as a basis for further research and knowledge synthesis on this topic. Also, it helps public health, community mental health, and emergency management practitioners mitigate the mental health and well-being harms of wildfire smoke.

Wildfire Smoke Exposure during Pregnancy: A Review of Potential Mechanisms of Placental Toxicity, Impact on Obstetric Outcomes, and Strategies to Reduce Exposure

Climate change is accelerating the intensity and frequency of wildfires globally. Understanding how wildfire smoke (WS) may lead to adverse pregnancy outcomes and alterations in placental function via biological mechanisms is critical to mitigate the harms of exposure. We aim to review the literature surrounding WS, placental biology, biological mechanisms underlying adverse pregnancy outcomes as well as interventions and strategies to avoid WS exposure in pregnancy. This review includes epidemiologic and experimental laboratory-based studies of WS, air pollution, particulate matter (PM), and other chemicals related to combustion in relation to obstetric outcomes and placental biology. We summarized the available clinical, animal, and placental studies with WS and other combustion products such as tobacco, diesel, and wood smoke. Additionally, we reviewed current recommendations for prevention of WS exposure. We found that there is limited data specific to WS; however, studies on air pollution and other combustion sources suggest a link to inflammation, oxidative stress, endocrine disruption, DNA damage, telomere shortening, epigenetic changes, as well as metabolic, vascular, and endothelial dysregulation in the maternal-fetal unit. These alterations in placental biology contribute to adverse obstetric outcomes that disproportionally affect the most vulnerable. Limiting time outdoors, wearing N95 respirator face masks and using high quality indoor air filters during wildfire events reduces exposure to related environmental exposures and may mitigate morbidities attributable to WS.

The Unintended Benefits of the Conservation Reserve Program for Air Quality

The link between agriculture and air pollution is well-established, as are the benefits of the US Department of Agriculture's Conservation Reserve Program (CRP). However, little research has linked CRP to air quality directly. This study aims to address this gap by modeling the relationship between CRP and fine particulate matter (PM2.5) concentrations at the county level from 2001 to 2016. Several econometric models are estimated with panel data while controlling for drought, population, and wildfire. Results show that CRP has a statistically significant negative effect on PM2.5 concentrations. Using estimates from this model, we project an avoided 1,353 deaths, 1,687 deaths, and 3,022 deaths nationally in 2008 relative to three different counterfactual scenarios: all CRP acreage placed under cultivation, increased drought, and a combination of the first two. The value of the avoided mortality is estimated to be $9.5 billion, $11.8 billion, and $21.2 billion, respectively. These findings provide evidence that CRP may generate economic gains in terms of avoided mortality, well above the cost of the program.

Health Outcomes in Children Associated with Prenatal and Early-Life Exposures to Air Pollution: A Narrative Review

(1) Background: The developmental origins of health and disease (DOHaD) hypothesis links adverse fetal exposures with developmental mal-adaptations and morbidity later in life. Short- and long-term exposures to air pollutants are known contributors to health outcomes; however, the potential for developmental health effects of air pollution exposures during gestation or early-childhood have yet to be reviewed and synthesized from a DOHaD lens. The objective of this study is to summarize the literature on cardiovascular and metabolic, respiratory, allergic, and neuropsychological health outcomes, from prenatal development through early childhood, associated with early-life exposures to outdoor air pollutants, including traffic-related and wildfire-generated air pollutants. (2) Methods: We conducted a search using PubMed and the references of articles previously known to the authors. We selected papers that investigated health outcomes during fetal or childhood development in association with early-life ambient or source-specific air pollution exposure. (3) Results: The current literature reports that prenatal and early-childhood exposures to ambient and traffic-related air pollutants are associated with a range of adverse outcomes in early life, including cardiovascular and metabolic, respiratory and allergic, and neurodevelopmental outcomes. Very few studies have investigated associations between wildfire-related air pollution exposure and health outcomes during prenatal, postnatal, or childhood development. (4) Conclusion: Evidence from January 2000 to January 2022 supports a role for prenatal and early-childhood air pollution exposures adversely affecting health outcomes during development. Future studies are needed to identify both detrimental air pollutants from the exposure mixture and critical exposure time periods, investigate emerging exposure sources such as wildfire, and develop feasible interventional tools.

Impacts of Sugarcane Fires on Air Quality and Public Health in South Florida

BACKGROUND

Preharvest burning of sugarcane is a common agricultural practice in Florida, which produces fine particulate matter [particulate matter (PM) with aerodynamic diameter ≤2.5μm (PM2.5)] that is associated with higher mortality.

OBJECTIVES

We estimated premature mortality associated with exposure to PM2.5 from sugarcane burning in people age 25 y and above for 20 counties in South Florida.

METHODS

We combined information from an atmospheric dispersion model, satellites, and surface measurements to quantify PM2.5 concentrations in South Florida and the fraction of PM2.5 from sugarcane fires. From these concentrations, estimated mortalities attributable to PM2.5 from sugarcane fires were calculated by census tract using health impact functions derived from literature for six causes of death linked to PM2.5. Confidence intervals (CI) are provided based on Monte Carlo simulations that propagate uncertainty in the emissions, dispersion model, health impact functions, and demographic data.

RESULTS

Sugarcane fires emitted an amount of primary PM2.5 similar to that of motor vehicles in Florida. PM2.5 from sugarcane fires is estimated to contribute to mortality rates within the Florida Sugarcane Growing Region (SGR) by 0.4 death per 100,000 people per year (95% CI: 0.3, 1.6 per 100,000). These estimates imply 2.5 deaths per year across South Florida were associated with PM2.5 from sugarcane fires (95% CI: 1.2, 6.1), with 0.16 in the SGR (95% CI: 0.09, 0.6) and 0.72 in Palm Beach County (95% CI: 0.17, 2.2).

DISCUSSION

PM2.5 from sugarcane fires was estimated to contribute to mortality risk across South Florida, particularly in the SGR. This is consistent with prior studies that documented impacts of sugarcane fire on air quality but did not quantify mortality. Additional health impacts of sugarcane fires, which were not quantified here, include exacerbating nonfatal health conditions such as asthma and cardiovascular problems. Harvesting sugarcane without field burning would likely reduce PM2.5 and health burdens in this region. https://doi.org/10.1289/EHP9957.

Systematic review of climate change effects on reproductive health

Climate change is a major risk factor for overall health, including reproductive health, and well-being. Increasing temperatures, due mostly to increased greenhouse gases trapping excess heat in the atmosphere, result in erratic weather patterns, wildfires, displacement of large communities, and stagnant water resulting in vector-borne diseases that, together, have set the stage for new and devastating health threats across the globe. These conditions disproportionately affect disadvantaged and vulnerable populations, including women, pregnant persons, young children, the elderly, and the disabled. This review reports on the evidence for the adverse impacts of air pollution, wildfires, heat stress, floods, toxic chemicals, and vector-borne diseases on male and female fertility, the developing fetus, and obstetric outcomes. Reproductive health care providers are uniquely positioned and have an unprecedented opportunity to educate patients and policy makers about mitigating the impact of climate change to assure reproductive health in this and future generations.

Gestational exposure to landscape fire increases under-5 child death via reducing birthweight: A risk assessment based on mediation analysis in low- and middle-income countries

BACKGROUND

Exposure to landscape fire smoke (LFS) is linked to child mortality and birthweight. It is unknown whether gestational exposure to LFS affects child survival rate. We aimed to link under-five death (U5D) to gestational LFS exposure by performing a causal mediation analysis based on birthweight.

METHOD

We conducted a sibling-matched case-control study of children under 5 years of age who were affiliated with the same mothers from Demographic and Health Surveys in 54 low- and middle-income countries, during the period from 2000 to 2014. LFS exposure was quantified as the surface concentration of fine particulate matter (PM_2.5) attributable to landscape fires, estimated using a global atmospheric model. Three pairwise associations between fire-sourced PM_2.5, birthweight, and U5D were assessed using fixed-effects regressions. We used a bootstrap-based mediation test of regression coefficients to examine whether the LFS-birthweight-U5D pathway was statistically significant. We also conducted three pairwise exposure-response functions using nonlinear models and used them to estimate the pathway-specific disease burden from 2000 to 2014.

RESULTS

After adjustments for multiple confounders, each 1-µg/m³ increase in gestational exposure to fire-sourced PM_2.5 was associated with a reduction of 2.179 (95% confidence interval [CI]: -3.777, -0.580) g in birthweight. Each 1-g birthweight reduction was associated with a 0.072% (95% CI: 0.065%, 0.078%) increase in U5D. Furthermore, each increase in exposure to fire-sourced PM_2.5 was associated with a 2.853% (95% CI: 0.835%, 4.911%) increase in U5D; 7.294% (95% CI: 0.710%, 24.254%) of the linkage was explained by LFS-attributable birthweight reduction. Based on the estimated exposure-response functions, from 2000 to 2014, global exposure to fire-sourced PM_2.5 contributed a mean birthweight reduction of 10.30 (95% CI: 2.93, 19.47) g, contributing to 60,350 (18,111, 106,619) premature U5Ds annually.

CONCLUSION

In low- and middle-income countries, gestational exposure to LFS can increase mortality during infancy; appropriate interventions are needed to promote health in childhood.

Prenatal exposure to wildfire-related air pollution and birth defects in Brazil

BACKGROUND

Birth defects are a major cause of poor health outcomes during both childhood and adulthood. A growing body of evidence demonstrated associations between air pollution exposure during pregnancy and birth defects. To date, there is no study looking at birth defects and exposure to wildfire-related air pollution, which is suggested as a type of air pollution source with high toxicity for reproductive health.

OBJECTIVE

Our study addresses this gap by examining the association between birth defects and wildfire smoke exposure in Brazil between 2001 and 2018. Based on known differences of impacts of wildfires across different regions of Brazil, we hypothesized differences in risks of birth defects for different regions.

METHODS

We used a logistic regression model to estimate the odds ratios (ORs) for individual birth defects (12 categories) associated with wildfire exposure during each trimester of pregnancy.

RESULTS

Among the 16,825,497 birth records in our study population, there were a total of 7595 infants born in Brazil between 2001 and 2018 with birth defects in any of the selected categories. After adjusting for several confounders in the primary analysis, we found statistically significant OR for three birth defects, including cleft lip/cleft palate [OR: 1.007 (95% CI: 1.001; 1.013)] during the second trimester of exposure, congenital anomalies of the respiratory system [OR: 1.013 (95% CI: 1.002; 1.023)] in the second trimester of exposure, and congenital anomalies of the nervous system [OR: 1.002 (95% CI: 1.001; 1.003)] during the first trimester of exposure for the regions South, North, and Midwest, respectively.

SIGNIFICANCE

Our results suggest that maternal exposure to wildfire smoke during pregnancy may increase the risk of an infant being born with some congenital anomaly. Considering that birth defects are associated with long-term disability, impacting families and the healthcare system (e.g., healthcare costs), our findings should be of great concern to the public health community.

IMPACT STATEMENT

Our study focused on the association between maternal exposure to wildfire smoke in Brazil during pregnancy and the risk of an infant being born with congenital anomalies, which presents serious public health and environmental challenges.

Birth weight following pregnancy wildfire smoke exposure in more than 1.5 million newborns in Brazil: A nationwide case-control study

Background

Air pollution exposure has been associated with critical neonatal morbidities, including low birth weight (LBW). However, little is known on short-term exposure to wildfire smoke and LBW. In this study, we estimated the association between birth weight following pregnancy and wildfire smoke exposure in more than 1.5 million newborns in Brazil (considered as a very fire-prone region worldwide).

Methods

We applied a logistic regression model to estimate the percent variation in newborns with low birth weight when exposed to wildfire in different trimesters of the pregnancy.

Findings

After adjusting the model with relevant covariates, we found that an increase of 100 wildfire records in Brazil was associated with an increase in low birth weight in the Midwest region [0.98% (95%CI:0.34; 1.63)] and in the South region [18.55% (95%CI:13.66; 23.65)] when the exposure occurred in the first trimester of pregnancy.

Interpretation

Wildfires were associated with LBW and this should be of public health concern for policymakers.

Funding

Brazilian Agencies National Council for Scientific and Technological Development (CNPq); Ministry of Science, Technology and Innovation in Brazil (MCTI); and Novo Nordisk Foundation Challenge Programme.

Associations between wildfire smoke exposure during pregnancy and risk of preterm birth in California

There is limited population-scale evidence on the burden of exposure to wildfire smoke during pregnancy and its impacts on birth outcomes. In order to investigate this relationship, data on every singleton birth in California 2006-2012 were combined with satellite-based estimates of wildfire smoke plume boundaries and high-resolution gridded estimates of surface PM_2.5 concentrations and a regression model was used to estimate associations with preterm birth risk. Results suggest that each additional day of exposure to any wildfire smoke during pregnancy was associated with an 0.49 % (95 % CI: 0.41-0.59 %) increase in risk of preterm birth (<37 weeks). At sample median smoke exposure (7 days) this translated to a 3.4 % increase in risk, relative to an unexposed mother. Estimates by trimester suggest stronger associations with exposure later in pregnancy and estimates by smoke intensity indicate that observed associations were driven by higher intensity smoke-days. Exposure to low intensity smoke-days had no association with preterm birth while an additional medium (smoke PM_2.5 5-10 μg/m³) or high (smoke PM_2.5 > 10 μg/m³) intensity smoke-day was associated with an 0.95 % (95 % CI: 0.47-1.42 %) and 0.82 % (95 % CI: 0.41-1.24 %) increase in preterm risk, respectively. In contrast to previous findings for other pollution types, neither exposure to smoke nor the relative impact of smoke on preterm birth differed by race/ethnicity or income in our sample. However, impacts differed greatly by baseline smoke exposure, with mothers in regions with infrequent smoke exposure experiencing substantially larger impacts from an additional smoke-day than mothers in regions where smoke is more common. We estimate 6,974 (95 % CI: 5,513-8,437) excess preterm births attributable to wildfire smoke exposure 2007-2012, accounting for 3.7 % of observed preterm births during this period. Our findings have important implications for understanding the costs of growing wildfire smoke exposure, and for understanding the benefits of smoke mitigation measures.

Excess Morbidity and Mortality Associated with Air Pollution above American Thoracic Society Recommended Standards, 2017-2019

Rationale: Over the past year, the American Thoracic Society (ATS), led by its Environmental Health Policy Committee, has reviewed the most current air quality scientific evidence and has revised their recommendations to 8 µg/m³ and 25 µg/m³ for long- and short-term fine particulate matter (PM_2.5) and reaffirmed the recommendation of 60 ppb for ozone to protect the American public from the known adverse health effects of air pollution. The current EPA standards, in contrast, expose the American public to pollution levels that are known to result in significant morbidity and mortality. Objectives: To provide county-level estimates of annual air pollution-related health outcomes across the United States using the most recent federal air quality data, and to support the ATS's recent update to the long-term PM_2.5 recommended standard. This study is presented as part of the annual ATS/Marron Institute "Health of the Air" report. Methods: Daily air pollution values were obtained from the U.S. Environmental Protection Agency's (EPA) Air Quality System for monitored counties in the United States from 2017-2019. Concentration-response functions used in the EPA's regulatory review process were applied to pollution increments corresponding to differences between the rolling 3-year design values and ATS-recommended levels for long-term PM_2.5 (8 µg/m³), short-term PM_2.5 (25 µg/m³), and ground-level ozone (O₃; 60 ppb). Health impacts were estimated at the county level in locations with valid monitoring data. Results: Meeting ATS recommendations throughout the country prevents an estimated 14,650 (95% CI: 8,660 - 22,610) deaths; 2,950 (95% CI: 1,530 - 4,330) lung cancer incidence events; 33,100 (95% CI: 7,300 - 71,000) morbidities, and 39.8 million (95% CI: 14.6 - 63.3 million) impacted days annually (see Table 1). This prevents 11,850 more deaths; 2,580 more lung cancer incidence events; 25,400 more morbidities; and 27.2 million more impacted days than meeting EPA standards alone. Conclusions: Significant health benefits to be gained by U.S. communities that work to meet ATS-recommended air quality standards have now been identified under scenarios meeting the new ATS recommendation for long-term PM_2.5 (8 µg/m³). The "Health of the Air" report presents an opportunity for air quality managers to quantify local health burdens and EPA officials to update their standards to reflect the latest science.

Health impacts of wildfire-related air pollution in Brazil: a nationwide study of more than 2 million hospital admissions between 2008 and 2018

We quantified the impacts of wildfire-related PM2.5 on 2 million hospital admissions records due to cardiorespiratory diseases in Brazil between 2008 and 2018. The national analysis shows that wildfire waves are associated with an increase of 23% (95%CI: 12%-33%) in respiratory hospital admissions and an increase of 21% (95%CI: 8%-35%) in circulatory hospital admissions. In the North (where most of the Amazon region is located), we estimate an increase of 38% (95%CI: 30%-47%) in respiratory hospital admissions and 27% (95%CI: 15%-39%) in circulatory hospital admissions. Here we report epidemiological evidence that air pollution emitted by wildfires is significantly associated with a higher risk of cardiorespiratory hospital admissions.

Examining fine particulate matter and cause-specific morbidity during the 2017 North San Francisco Bay wildfires

BACKGROUND

Recent increases in wildfire frequency and severity necessitate better understanding of health effects of wildfire smoke to protect affected populations.

OBJECTIVES

We examined relationships between fine particulate matter (PM_2.5) and morbidity during wildfires in California, and whether those relationships differed during the fire compared to a similar non-fire period.

METHODS

For nine San Francisco Bay Area counties, daily county-level diagnosis-specific counts of emergency department visits (EDVs) and hospitalizations were linked with county-level estimates of daily mean PM_2.5 during the October 2017 Northern California wildfires and similar October days in 2015, 2016, and 2017. Associations were estimated using Poisson regression.

RESULTS

The median difference between county PM_2.5 during the fire versus the non-fire period was 23.4 μg/m³, with days exceeding 80 μg/m³ in some counties. Over the entire study period, PM_2.5 was most consistently linked to EDVs for respiratory disease (RR_EDV(lag0) per 23.4 μg/m³ increase: 1.25, 95% CI: 1.21, 1.30), asthma, chronic lower respiratory disease (CLRD; RR_EDV(lag0): 1.18, 95% CI: 1.10, 1.27), and acute myocardial infarction (RR_EDV(lag0): 1.14, 95% CI: 1.03, 1.25). Increases in acute upper respiratory infections and decreases in mental/behavioral EDVs were observed but were sensitive to model specification, specifically the inclusion of time-related covariates. Comparing fire and non-fire period EDV associations, we observed indications that PM_2.5 during the fire was more strongly associated with asthma (RR_lag0: 1.46, 95% CI: 1.38, 1.55) compared to non-fire period PM_2.5 (RR_lag0: 0.77, 95% CI: 0.55, 1.08)_, and the opposite observed for dysrhythmia, with the asthma difference being particularly robust to model choice. For hospitalizations, the most robust PM_2.5 relationships were positive associations with respiratory, CLRD, and diabetes, and inverse associations with pneumonia. Respiratory and CLRD effect estimates were generally similar or smaller than for EDVs.

CONCLUSIONS

Elevated short-term PM_2.5 levels from wildfire smoke appears to impact respiratory and other health domains.

A novel approach to the development of 1-hour threshold concentrations for exposure to particulate matter during episodic air pollution events

Episodic air pollution events that occur because of wildfires, dust storms and industrial incidents can expose populations to particulate matter (PM) concentrations in the thousands of µg m^-3. Such events have increased in frequency and duration over recent years, with this trend predicted to continue in the short to medium term because of climate warming. The human health cost of episodic PM events can be significant, and inflammatory responses are measurable even after only a few hours of exposure. Consequently, advice for the protection of public health should be available as quickly as possible, yet the shortest averaging period for which PM exposure guideline values (GVs) are available is 24-h. To address this problem, we have developed a novel approach, based on Receiver Operating Characteristic (ROC) statistical analysis, that derives 1-h threshold concentrations that have a probabilistic relationship with 24-h GVs. The ROC analysis was carried out on PM₁₀ and PM_2.5 monitoring data from across the US for the period 2014-2019. Validation of the model against US Air Quality Index (AQI) 24-h breakpoint concentrations for PM showed that the maximum-observed 1-h PM concentration in any rolling 24-h averaging period is an excellent predictor of exceedances of 24-h GVs.

Wildfire smoke impacts on indoor air quality assessed using crowdsourced data in California

Wildfires have become an important source of particulate matter (PM_2.5 < 2.5-µm diameter), leading to unhealthy air quality index occurrences in the western United States. Since people mainly shelter indoors during wildfire smoke events, the infiltration of wildfire PM_2.5 into indoor environments is a key determinant of human exposure and is potentially controllable with appropriate awareness, infrastructure investment, and public education. Using time-resolved observations outside and inside more than 1,400 buildings from the crowdsourced PurpleAir sensor network in California, we found that the geometric mean infiltration ratios (indoor PM_2.5 of outdoor origin/outdoor PM_2.5) were reduced from 0.4 during non-fire days to 0.2 during wildfire days. Even with reduced infiltration, the mean indoor concentration of PM_2.5 nearly tripled during wildfire events, with a lower infiltration in newer buildings and those utilizing air conditioning or filtration.

Air Pollution From Forest and Vegetation Fires in Southeast Asia Disproportionately Impacts the Poor

Forest and vegetation fires, used as tools for agriculture and deforestation, are a major source of air pollutants and can cause serious air quality issues in many parts of Asia. Actions to reduce fire may offer considerable, yet largely unrecognized, options for rapid improvements in air quality. In this study, we used a combination of regional and global air quality models and observations to examine the impact of forest and vegetation fires on air quality degradation and public health in Southeast Asia (including Mainland Southeast Asia and south-eastern China). We found that eliminating fire could substantially improve regional air quality across Southeast Asia by reducing the population exposure to fine particulate matter (PM2.5) concentrations by 7% and surface ozone concentrations by 5%. These reductions in PM2.5 exposures would yield a considerable public health benefit across the region; averting 59,000 (95% uncertainty interval (95UI): 55,200-62,900) premature deaths annually. Analysis of subnational infant mortality rate data and PM2.5 exposure suggested that PM2.5 from fires disproportionately impacts poorer populations across Southeast Asia. We identified two key regions in northern Laos and western Myanmar where particularly high levels of poverty coincide with exposure to relatively high levels of PM2.5 from fires. Our results show that reducing forest and vegetation fires should be a public health priority for the Southeast Asia region.

Estimated Mortality and Morbidity Attributable to Smoke Plumes in the United States: Not Just a Western US Problem

As anthropogenic emissions continue to decline and emissions from landscape (wild, prescribed, and agricultural) fires increase across the coming century, the relative importance of landscape-fire smoke on air quality and health in the United States (US) will increase. Landscape fires are a large source of fine particulate matter (PM2.5), which has known negative impacts on human health. The seasonal and spatial distribution, particle composition, and co-emitted species in landscape-fire emissions are different from anthropogenic sources of PM2.5. The implications of landscape-fire emissions on the sub-national temporal and spatial distribution of health events and the relative health importance of specific pollutants within smoke are not well understood. We use a health impact assessment with observation-based smoke PM2.5 to determine the sub-national distribution of mortality and the sub-national and sub-annual distribution of asthma morbidity attributable to US smoke PM2.5 from 2006 to 2018. We estimate disability-adjusted life years (DALYs) for PM2.5 and 18 gas-phase hazardous air pollutants (HAPs) in smoke. Although the majority of large landscape fires occur in the western US, we find the majority of mortality (74%) and asthma morbidity (on average 75% across 2006-2018) attributable to smoke PM2.5 occurs outside the West, due to higher population density in the East. Across the US, smoke-attributable asthma morbidity predominantly occurs in spring and summer. The number of DALYs associated with smoke PM2.5 is approximately three orders of magnitude higher than DALYs associated with gas-phase smoke HAPs. Our results indicate awareness and mitigation of landscape-fire smoke exposure is important across the US.

Open fire exposure increases the risk of pregnancy loss in South Asia

Interactions between climate change and anthropogenic activities result in increasing numbers of open fires, which have been shown to harm maternal health. However, few studies have examined the association between open fire and pregnancy loss. We conduct a self-comparison case-control study including 24,876 mothers from South Asia, the region with the heaviest pregnancy-loss burden in the world. Exposure is assessed using a chemical transport model as the concentrations of fire-sourced PM_2.5 (i.e., fire PM_2.5). The adjusted odds ratio (OR) of pregnancy loss for a 1-μg/m³ increment in averaged concentration of fire PM_2.5 during pregnancy is estimated as 1.051 (95% confidence intervals [CI]: 1.035, 1.067). Because fire PM_2.5 is more strongly linked with pregnancy loss than non-fire PM_2.5 (OR: 1.014; 95% CI: 1.011, 1.016), it contributes to a non-neglectable fraction (13%) of PM_2.5-associated pregnancy loss. Here, we show maternal health is threaten by gestational exposure to fire smoke in South Asia.

Fine Particles in Wildfire Smoke and Pediatric Respiratory Health in California

BACKGROUND AND OBJECTIVES

Exposure to airborne fine particles with diameters ≤2.5 μm (PM_2.5) pollution is a well-established cause of respiratory diseases in children; whether wildfire-specific PM_2.5 causes more damage, however, remains uncertain. We examine the associations between wildfire-specific PM_2.5 and pediatric respiratory health during the period 2011-2017 in San Diego County, California, and compare these results with other sources of PM_2.5.

METHODS

Visits to emergency and urgent care facilities of Rady's Children Hospital network in San Diego County, California, by individuals (aged ≤19 years) with ≥1 of the following respiratory conditions: difficulty breathing, respiratory distress, wheezing, asthma, or cough were regressed on daily, community-level exposure to wildfire-specific PM_2.5 and PM_2.5 from ambient sources (eg, traffic emissions).

RESULTS

A 10-unit increase in PM_2.5 (from nonsmoke sources) was estimated to increase the number of admissions by 3.7% (95% confidence interval: 1.2% to 6.1%). In contrast, the effect of PM_2.5 attributable to wildfire was estimated to be a 30.0% (95% confidence interval: 26.6% to 33.4%) increase in visits.

CONCLUSIONS

Wildfire-specific PM_2.5 was found to be ∼10 times more harmful on children's respiratory health than PM_2.5 from other sources, particularly for children aged 0 to 5 years. Even relatively modest wildfires and associated PM_2.5 resolved on our record produced major health impacts, particularly for younger children, in comparison with ambient PM_2.5.

The Impact of Bushfire Smoke on Cattle-A Review

Simple Summary

In 2019–2020, Australia had a particularly bad bushfire season which resulted in large numbers of people and animals being exposed to smoke haze for several weeks. We conducted a literature review to examine the evidence for effects of prolonged exposure to bushfire smoke on cattle. There was general agreement that small airborne particulate matter in smoke is the substance most likely to cause problems. There was indirect evidence about effects on cattle caused by other types of pollution containing particulate matter. We found little evidence to support severe effects on cattle. This may be because cattle do not tend to suffer from the co-morbidities that, in the human population, seem to be made worse by smoke and pollution. However, small changes to death rates or disease that is not severe may go unreported, so further study is warranted.

Abstract

In 2019–2020, a particularly bad bushfire season in Australia resulted in cattle being exposed to prolonged periods of smoke haze and reduced air quality. Bushfire smoke contains many harmful pollutants, and impacts on regions far from the fire front, with smoke haze persisting for weeks. Particulate matter (PM) is one of the major components of bushfire smoke known to have a negative impact on human health. However, little has been reported about the potential effects that bushfire smoke has on cattle exposed to smoke haze for extended periods. We explored the current literature to investigate evidence for likely effects on cattle from prolonged exposure to smoke generated from bushfires in Australia. We conducted a search for papers related to the impacts of smoke on cattle. Initial searching returned no relevant articles through either CAB Direct or PubMed databases, whilst Google Scholar provided a small number of results. The search was then expanded to look at two sub-questions: the type of pollution that is found in bushfire smoke, and the reported effects of both humans and cattle being exposed to these types of pollutants. The primary mechanism for damage due to bushfire smoke is due to small airborne particulate matter (PM). Although evidence demonstrates that PM from bushfire smoke has a measurable impact on both human mortality and cardiorespiratory morbidities, there is little evidence regarding the impact of chronic bushfire smoke exposure in cattle. We hypothesize that cattle are not severely affected by chronic exposure to smoke haze, as evidenced by the lack of reports. This may be because cattle do not tend to suffer from the co-morbidities that, in the human population, seem to be made worse by smoke and pollution. Further, small changes to background mortality rates or transient morbidity may also go unreported.

Wildfire smoke impacts respiratory health more than fine particles from other sources: observational evidence from Southern California

Wildfires are becoming more frequent and destructive in a changing climate. Fine particulate matter, PM_2.5, in wildfire smoke adversely impacts human health. Recent toxicological studies suggest that wildfire particulate matter may be more toxic than equal doses of ambient PM_2.5. Air quality regulations however assume that the toxicity of PM_2.5 does not vary across different sources of emission. Assessing whether PM_2.5 from wildfires is more or less harmful than PM_2.5 from other sources is a pressing public health concern. Here, we isolate the wildfire-specific PM_2.5 using a series of statistical approaches and exposure definitions. We found increases in respiratory hospitalizations ranging from 1.3 to up to 10% with a 10 μg m^-3 increase in wildfire-specific PM_2.5, compared to 0.67 to 1.3% associated with non-wildfire PM_2.5. Our conclusions point to the need for air quality policies to consider the variability in PM_2.5 impacts on human health according to the sources of emission.