Abstract
BackgroundCharacterizing factors which determine susceptibility to air pollution is an important step in understanding the distribution of risk in a population and is critical for setting appropriate policies. We evaluate general and specific measures of community health as modifiers of risk for asthma and congestive heart failure following an episode of acute exposure to wildfire smoke.MethodsA population-based study of emergency department visits and daily concentrations of fine particulate matter during a wildfire in North Carolina was performed. Determinants of community health defined by County Health Rankings were evaluated as modifiers of the relative risk. A total of 40 mostly rural counties were included in the study. These rankings measure factors influencing health: health behaviors, access and quality of clinical care, social and economic factors, and physical environment, as well as, the outcomes of health: premature mortality and morbidity. Pollutant concentrations were obtained from a mathematically modeled smoke forecasting system. Estimates of relative risk for emergency department visits were based on Poisson mixed effects regression models applied to daily visit counts.ResultsFor asthma, the strongest association was observed at lag day 0 with excess relative risk of 66%(28,117). For congestive heart failure the excess relative risk was 42%(5,93). The largest difference in risk was observed after stratifying on the basis of Socio-Economic Factors. Difference in risk between bottom and top ranked counties by Socio-Economic Factors was 85% and 124% for asthma and congestive heart failure respectively.ConclusionsThe results indicate that Socio-Economic Factors should be considered as modifying risk factors in air pollution studies and be evaluated in the assessment of air pollution impacts.
Highlights
Characterizing factors which determine susceptibility to air pollution is an important step in understanding the distribution of risk in a population and is critical for setting appropriate policies
We found significant increases in emergency department (ED) visits for congestive heart failure (CHF), asthma, chronic obstructive pulmonary disease, pneumonia, and acute bronchitis in those counties which were most impacted by the wildfire
We focus on two clinical outcomes, CHF and asthma, that have distinct pathology but that have both been associated with susceptibility to the health effects of air pollution exposures [7,12,13]
Summary
Characterizing factors which determine susceptibility to air pollution is an important step in understanding the distribution of risk in a population and is critical for setting appropriate policies. We evaluate general and specific measures of community health as modifiers of risk for asthma and congestive heart failure following an episode of acute exposure to wildfire smoke. The most common difficulty encountered in evaluating community risk to air pollutants is that many health factors associated with poor health outcomes occur in communities where exposure to air pollutants is high. We evaluated health responses following brief but acute wildfire smoke exposure in a region with low background pollution and utilized County Health Rankings (CHR) [10], based on a well established model of population health that characterize factors which determine community health. Concentrations of fine particulate matter (PM2.5) from smoke forecasting models averaged to the county are taken as the exposure matrix
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