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      Health Impact Assessment of the 2020 Washington State Wildfire Smoke Episode: Excess Health Burden Attributable to Increased PM 2.5 Exposures and Potential Exposure Reductions

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          Abstract

          Major wildfires starting in the summer of 2020 along the west coast of the United States made PM 2.5 concentrations in this region rank among the highest in the world. Washington was impacted both by active wildfires in the state and aged wood smoke transported from fires in Oregon and California. This study aims to estimate the magnitude and disproportionate spatial impacts of increased PM 2.5 concentrations attributable to these wildfires on population health. Daily PM 2.5 concentrations for each county before and during the 2020 Washington wildfire episode (September 7–19) were obtained from regulatory air monitors. Utilizing previously established concentration‐response function (CRF) of PM 2.5 (CRF of total PM 2.5) and odds ratio (OR) of wildfire smoke days (OR of wildfire smoke days) for mortality, we estimated excess mortality attributable to the increased PM 2.5 concentrations in Washington. On average, daily PM 2.5 concentrations increased 97.1 μg/m 3 during the wildfire smoke episode. With CRF of total PM 2.5, the 13‐day exposure to wildfire smoke was estimated to lead to 92.2 (95% CI: 0.0, 178.7) more all‐cause mortality cases; with OR of wildfire smoke days, 38.4 (95% CI: 0.0, 93.3) increased all‐cause mortality cases and 15.1 (95% CI: 0.0, 27.9) increased respiratory mortality cases were attributable to the wildfire smoke episode. The potential impact of avoiding elevated PM 2.5 exposures during wildfire events significantly reduced the mortality burden. Because wildfire smoke episodes are likely to impact the Pacific Northwest in future years, continued preparedness and mitigations to reduce exposures to wildfire smoke are necessary to avoid excess health burden.

          Key Points

          • Elevated PM 2.5 levels from a wildfire smoke episode were estimated to place a heavy mortality burden on counties in western Washington

          • Counties in central and eastern Washington were estimated to have the highest per‐capita mortality during the wildfire smoke episode

          • Reducing 40% of PM 2.5 exposure for people below the federal poverty level was associated with 4.1 (95% CI: 0.0, 8.2) reduced all‐cause deaths

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          Most cited references49

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          Increasing western US forest wildfire activity: sensitivity to changes in the timing of spring

          Prior work shows western US forest wildfire activity increased abruptly in the mid-1980s. Large forest wildfires and areas burned in them have continued to increase over recent decades, with most of the increase in lightning-ignited fires. Northern US Rockies forests dominated early increases in wildfire activity, and still contributed 50% of the increase in large fires over the last decade. However, the percentage growth in wildfire activity in Pacific northwestern and southwestern US forests has rapidly increased over the last two decades. Wildfire numbers and burned area are also increasing in non-forest vegetation types. Wildfire activity appears strongly associated with warming and earlier spring snowmelt. Analysis of the drivers of forest wildfire sensitivity to changes in the timing of spring demonstrates that forests at elevations where the historical mean snow-free season ranged between two and four months, with relatively high cumulative warm-season actual evapotranspiration, have been most affected. Increases in large wildfires associated with earlier spring snowmelt scale exponentially with changes in moisture deficit, and moisture deficit changes can explain most of the spatial variability in forest wildfire regime response to the timing of spring. This article is part of the themed issue ‘The interaction of fire and mankind’.
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            Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases.

            Evidence on the health risks associated with short-term exposure to fine particles (particulate matter 200,000) with 11.5 million Medicare enrollees (aged >65 years) living an average of 5.9 miles from a PM2.5 monitor. Daily counts of county-wide hospital admissions for primary diagnosis of cerebrovascular, peripheral, and ischemic heart diseases, heart rhythm, heart failure, chronic obstructive pulmonary disease, and respiratory infection, and injuries as a control outcome. There was a short-term increase in hospital admission rates associated with PM2.5 for all of the health outcomes except injuries. The largest association was for heart failure, which had a 1.28% (95% confidence interval, 0.78%-1.78%) increase in risk per 10-microg/m3 increase in same-day PM2.5. Cardiovascular risks tended to be higher in counties located in the Eastern region of the United States, which included the Northeast, the Southeast, the Midwest, and the South. Short-term exposure to PM2.5 increases the risk for hospital admission for cardiovascular and respiratory diseases.
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              Critical Review of Health Impacts of Wildfire Smoke Exposure

              Background: Wildfire activity is predicted to increase in many parts of the world due to changes in temperature and precipitation patterns from global climate change. Wildfire smoke contains numerous hazardous air pollutants and many studies have documented population health effects from this exposure. Objectives: We aimed to assess the evidence of health effects from exposure to wildfire smoke and to identify susceptible populations. Methods: We reviewed the scientific literature for studies of wildfire smoke exposure on mortality and on respiratory, cardiovascular, mental, and perinatal health. Within those reviewed papers deemed to have minimal risk of bias, we assessed the coherence and consistency of findings. Discussion: Consistent evidence documents associations between wildfire smoke exposure and general respiratory health effects, specifically exacerbations of asthma and chronic obstructive pulmonary disease. Growing evidence suggests associations with increased risk of respiratory infections and all-cause mortality. Evidence for cardiovascular effects is mixed, but a few recent studies have reported associations for specific cardiovascular end points. Insufficient research exists to identify specific population subgroups that are more susceptible to wildfire smoke exposure. Conclusions: Consistent evidence from a large number of studies indicates that wildfire smoke exposure is associated with respiratory morbidity with growing evidence supporting an association with all-cause mortality. More research is needed to clarify which causes of mortality may be associated with wildfire smoke, whether cardiovascular outcomes are associated with wildfire smoke, and if certain populations are more susceptible. Citation: Reid CE, Brauer M, Johnston FH, Jerrett M, Balmes JR, Elliott CT. 2016. Critical review of health impacts of wildfire smoke exposure. Environ Health Perspect 124:1334–1343; http://dx.doi.org/10.1289/ehp.1409277
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                Author and article information

                Contributors
                yisiliu@uw.edu
                Journal
                Geohealth
                Geohealth
                10.1002/(ISSN)2471-1403
                GH2
                GeoHealth
                John Wiley and Sons Inc. (Hoboken )
                2471-1403
                May 2021
                01 May 2021
                : 5
                : 5 ( doiID: 10.1002/gh2.v5.5 )
                : e2020GH000359
                Affiliations
                [ 1 ] Department of Environmental and Occupational Health Sciences University of Washington Seattle WA USA
                [ 2 ] Department of Civil and Environmental Engineering University of Washington Seattle WA USA
                Author notes
                [*] [* ] Correspondence to:

                Y. Liu,

                yisiliu@ 123456uw.edu

                Author information
                https://orcid.org/0000-0001-6974-1462
                Article
                GH2228 2020GH000359
                10.1029/2020GH000359
                8101535
                33977180
                3305820d-ceb2-42a6-876b-56062d39bcf6
                © 2021 The Authors. GeoHealth published by Wiley Periodicals LLC on behalf of American Geophysical Union.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 07 April 2021
                : 24 November 2020
                : 09 April 2021
                Page count
                Figures: 2, Tables: 2, Pages: 11, Words: 8099
                Funding
                Funded by: HHS, NIH, National Institute of Environmental Health Sciences (NIEHS) , open-funder-registry 10.13039/100000066;
                Award ID: 5P30 ES007033‐23
                Funded by: China Scholarship Council
                Award ID: 201706270200
                Categories
                Fire in the Earth System
                Geohealth
                Impacts of Climate Change: Human Health,
                Public Health
                Atmospheric Composition and Structure
                Pollution: Urban and Regional
                Atmospheric Composition and Structure
                Aerosols and Particles
                Biogeosciences
                Pollution: Urban, Regional and Global
                Urban Systems
                Hydrology
                Extreme Events
                Time Series Analysis
                Informatics
                Temporal Analysis and Representation
                Mathematical Geophysics
                Persistence, Memory, Correlations, Clustering
                Stochastic Processes
                Time Series Analysis
                Oceanography: General
                Marine Pollution
                Time Series Experiments
                Natural Hazards
                Extreme Events
                Health Impact
                Natural Hazards
                Megacities and Urban Environment
                Nonlinear Geophysics
                Probability Distributions, Heavy and Fat‐tailed
                Scaling: Spatial and Temporal
                Oceanography: Biological and Chemical
                Aerosols
                Paleoceanography
                Aerosols
                Space Plasma Physics
                Stochastic Phenomena
                Research Article
                Research Article
                Custom metadata
                2.0
                May 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:06.05.2021

                fine particulate matter,health impact assessment,mortality,preparedness,wildfires,wildland fires

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