The relationship of respiratory and cardiovascular hospital admissions to the southern California wildfires of 2003

Objective: There is limited information on the public health impact of wildfires. The relationship of cardiorespiratory hospital admissions (n = 40 856) to wildfire-related particulate matter (PM2.5) during catastrophic wildfires in southern California in October 2003 was evaluated. Methods: Zip cod...

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Bibliographic Details
Published in:Occupational and environmental medicine (London, England) England), 2009-03, Vol.66 (3), p.189-197
Main Authors: Delfino, R J, Brummel, S, Wu, J, Stern, H, Ostro, B, Lipsett, M, Winer, A, Street, D H, Zhang, L, Tjoa, T, Gillen, D L
Format: Article
Language:English
Subjects:
Acute Disease
Adolescent
Adult
Age
Age groups
Aged
Aged, 80 and over
Air Pollutants - toxicity
Air pollution
Asthma
Biological and medical sciences
Bronchitis
Bronchitis - etiology
Bronchitis - therapy
California
Cardiovascular Diseases - etiology
Cardiovascular Diseases - therapy
Censuses
Child
Child, Preschool
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease, asthma
Disasters
Environmental Exposure
Fires
Hospital admissions
Hospitalization
Hospitals
Humans
Infant
Infant, Newborn
International Statistical Classification of Diseases
Medical sciences
Middle Aged
Outdoor air quality
Particulate Matter
Patient admissions
Pneumology
Pneumonia - etiology
Pneumonia - therapy
Population
Postal codes
Public health
Pulmonary Disease, Chronic Obstructive - etiology
Pulmonary Disease, Chronic Obstructive - therapy
Regression Analysis
Smoke
Spores, Fungal
Wildfires
Young Adult
ZIP codes
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Summary:Objective: There is limited information on the public health impact of wildfires. The relationship of cardiorespiratory hospital admissions (n = 40 856) to wildfire-related particulate matter (PM2.5) during catastrophic wildfires in southern California in October 2003 was evaluated. Methods: Zip code level PM2.5 concentrations were estimated using spatial interpolations from measured PM2.5, light extinction, meteorological conditions, and smoke information from MODIS satellite images at 250 m resolution. Generalised estimating equations for Poisson data were used to assess the relationship between daily admissions and PM2.5, adjusted for weather, fungal spores (associated with asthma), weekend, zip code-level population and sociodemographics. Results: Associations of 2-day average PM2.5 with respiratory admissions were stronger during than before or after the fires. Average increases of 70 μg/m3 PM2.5 during heavy smoke conditions compared with PM2.5 in the pre-wildfire period were associated with 34% increases in asthma admissions. The strongest wildfire-related PM2.5 associations were for people ages 65–99 years (10.1% increase per 10 μg/m3 PM2.5, 95% CI 3.0% to 17.8%) and ages 0–4 years (8.3%, 95% CI 2.2% to 14.9%) followed by ages 20–64 years (4.1%, 95% CI −0.5% to 9.0%). There were no PM2.5–asthma associations in children ages 5–18 years, although their admission rates significantly increased after the fires. Per 10 μg/m3 wildfire-related PM2.5, acute bronchitis admissions across all ages increased by 9.6% (95% CI 1.8% to 17.9%), chronic obstructive pulmonary disease admissions for ages 20–64 years by 6.9% (95% CI 0.9% to 13.1%), and pneumonia admissions for ages 5–18 years by 6.4% (95% CI −1.0% to 14.2%). Acute bronchitis and pneumonia admissions also increased after the fires. There was limited evidence of a small impact of wildfire-related PM2.5 on cardiovascular admissions. Conclusions: Wildfire-related PM2.5 led to increased respiratory hospital admissions, especially asthma, suggesting that better preventive measures are required to reduce morbidity among vulnerable populations.
ISSN:1351-0711
1470-7926
DOI:10.1136/oem.2008.041376