Associations Between Wildfire-Related PM2.5 and Intensive Care Unit Admissions in the United States, 2006-2015.

Wildfire smoke is a growing public health concern in the United States. Numerous studies have documented associations between ambient smoke exposure and severe patient outcomes for single-fire seasons or limited geographic regions. However, there are few national-scale health studies of wildfire smoke in the United States, few studies investigating Intensive Care Unit (ICU) admissions as an outcome, and few specifically framed around hospital operations. This study retrospectively examined the associations between ambient wildfire-related PM2.5 at a hospital ZIP code with total hospital ICU admissions using a national-scale hospitalization data set. Wildfire smoke was characterized using a combination of kriged PM2.5 monitor observations and satellite-derived plume polygons from National Oceanic and Atmospheric Administration's Hazard Mapping System. ICU admissions data were acquired from Premier, Inc. and encompass 15%-20% of all U.S. ICU admissions during the study period. Associations were estimated using a distributed-lag conditional Poisson model under a time-stratified case-crossover design. We found that a 10 µg/m3 increase in daily wildfire PM2.5 was associated with a 2.7% (95% CI: 1.3, 4.1; p = 0.00018) increase in ICU admissions 5 days later. Under stratification, positive associations were found among patients aged 0-20 and 60+, patients living in the Midwest Census Region, patients admitted in the years 2013-2015, and non-Black patients, though other results were mixed. Following a simulated severe 7-day 120 µg/m3 smoke event, our results predict ICU bed utilization peaking at 131% (95% CI: 43, 239; p < 10-5) over baseline. Our work suggests that hospitals may need to preposition vital critical care resources when severe smoke events are forecast.

Past Variance and Future Projections of the Environmental Conditions Driving Western U.S. Summertime Wildfire Burn Area.

Increases in vapor pressure deficit (VPD) have been hypothesized as the primary driver of future fire changes. The Coupled Model Intercomparison Project Phase 5 (CMIP5) models agree that western U.S. surface temperatures and associated dryness of air as defined by the VPD will increase in the 21st century for Representative Concentration Pathways (RCPs) 4.5 and 8.5. However, we find that averaged over seasonal and regional scales, other environmental variables demonstrated to be relevant to flammability, moisture abundances, and aridity-such as precipitation, evaporation, relative humidity, root zone soil moisture, and wind speed-can be used to explain observed variance in wildfire burn area as well or better than VPD. However, the magnitude and sign of the change of these variables in the 21st century are less certain than the predicted changes in VPD. Our work demonstrates that when objectively selecting environmental variables to maximize predictive skill of linear regressions (minimize square error on unseen data) VPD is not always selected and when it is not, the magnitude of future increases in burn area becomes less certain. Hence, this work shows that future burn area predictions are sensitive to what environmental predictors are chosen to drive burn area.

The Associations Between Clinical Respiratory Outcomes and Ambient Wildfire Smoke Exposure Among Pediatric Asthma Patients at National Jewish Health, 2012-2015.

Wildfires are a growing threat in the United States. At a population level, exposure to ambient wildfire smoke is known to be associated with severe asthma outcomes such as hospitalizations. However, little work has been done on subacute clinical asthma outcomes, especially in sensitive populations. This study retrospectively investigated associations between ambient wildfire smoke exposure and measures of lung function and asthma control, Forced Expiratory Volume in 1 Second (FEV1) and the Asthma Control Test (ACT) and Children's Asthma Control Test (CACT) test scores, during nonurgent clinic visits. The study population consisted of pediatric asthma patients (ages 4-21; n = 1,404 for FEV1 and n = 395 for ACT/CACT) at National Jewish Health, a respiratory referral hospital in Denver, Colorado, and therefore represents a more severe asthma phenotype than the general pediatric asthma population. Wildfire smoke-related PM2.5 at patients' residential ZIP codes was characterized using satellite-derived smoke polygons from NOAA's Hazard Mapping System combined with kriging of ground-based U.S. EPA monitors. Mixed effect models were used to estimate associations between clinical outcomes and smoke PM2.5 exposure, controlling for known risk factors and confounders. Among older children aged 12-21 we found that wildfire PM2.5 was associated with lower FEV1 the next day but higher FEV1 the day after. We found no associations between wildfire PM2.5 and FEV1 in younger children or between wildfire PM2.5 and asthma control measured by the ACT/CACT in all ages. We speculate that rescue medication usage by older children may decrease respiratory symptoms caused by wildfire smoke.

Environmental Conditions, Ignition Type, and Air Quality Impacts of Wildfires in the Southeastern and Western United States.

This research contrasts the environmental conditions, meteorological drivers, and air quality impacts of human- and lightning-ignited wildfires in the southeastern and western United States, the two continental U.S. regions with the most wildfire burn area. We use the Fire Program Analysis Wildfire Occurrence Data (FPA FOD) to determine wildfire abundance and ignition sources between 1992 and 2015. We investigate specific ecoregions within these two U.S. regions and find that in the majority of ecoregions, annual lightning- and human-ignited wildfire burn area have similar relationships with key meteorological parameters. We investigate the fuel moisture values where wildfires occur segregated by ignition type and show that within a given ecoregion, the differences in median fuel moisture between ignition types are generally smaller than the differences between ecoregions. Our results suggest that annual wildfire burn area for human- and lightning-ignited wildfires within a given ecoregion are modulated by environmental conditions, and climate change may similarly impact wildfires of both ignition types. Finally, we estimate fine particulate matter emissions for Fire Program Analysis Wildfire Occurrence Data wildfires using the Fire INventory from NCAR model framework. We show that emissions of fine particulate matter from human-ignited wildfires is significant and of a similar total magnitude between the west and southeastern United States. Additionally, the west and southeast have a similar number of wildfires associated with National Weather Service air quality smoke forecasts.

Smoke in the City: How Often and Where Does Smoke Impact Summertime Ozone in the United States?

We investigate the influence of smoke on ozone (O3) abundances over the contiguous United States. Using colocated observations of particulate matter and the National Weather Service Hazard Mapping System smoke data, we identify summertime days between 2005 and 2014 that Environmental Protection Agency Air Quality System O3 monitors are influenced by smoke. We compare O3 mixing ratio distributions for smoke-free and smoke-impacted days for each monitor, while controlling for temperature. This analysis shows that (i) the mean O3 abundance measured on smoke-impacted days is higher than on smoke-free days, and (ii) the magnitude of the effect varies by location with a range of 3 to 36 ppbv. For each site, we present the percentage of days when the 8-h average O3 mixing ratio (MDA8) exceeds 75 ppbv and smoke is present. Smoke-impacted O3 mixing ratios are most elevated in locations with the highest emissions of nitrogen oxides. The Northeast corridor, Dallas, Houston, Atlanta, Birmingham, and Kansas City stand out as having smoke present 10-20% of the days when 8-h average O3 mixing ratios exceed 75 ppbv. Most U.S. cities maintain a similar proportion of smoke-impacted exceedance days when they are held against the new MDA8 limit of 70 ppbv.