Prescribed fires, smoke exposure, and hospital utilization among heart failure patients
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12940_2023_Article_1032.pdf
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Author(s)
Raab, Henry
Moyer, Joshua
Afrin, Sadia
Garcia-Menendez, Fernando
Ward-Caviness, Cavin K.
Date Issued
December 13, 2023
Publisher
BioMed Central
Citation
Environmental Health. 2023 Dec 13;22(1):86
Version
Final published version
Abstract
Background
Prescribed fires often have ecological benefits, but their environmental health risks have been infrequently studied. We investigated associations between residing near a prescribed fire, wildfire smoke exposure, and heart failure (HF) patients’ hospital utilization.
Methods
We used electronic health records from January 2014 to December 2016 in a North Carolina hospital-based cohort to determine HF diagnoses, primary residence, and hospital utilization. Using a cross-sectional study design, we associated the prescribed fire occurrences within 1, 2, and 5 km of the patients’ primary residence with the number of hospital visits and 7- and 30-day readmissions. To compare prescribed fire associations with those observed for wildfire smoke, we also associated zip code-level smoke density data designed to capture wildfire smoke emissions with hospital utilization amongst HF patients. Quasi-Poisson regression models were used for the number of hospital visits, while zero-inflated Poisson regression models were used for readmissions. All models were adjusted for age, sex, race, and neighborhood socioeconomic status and included an offset for follow-up time. The results are the percent change and the 95% confidence interval (CI).
Results
Associations between prescribed fire occurrences and hospital visits were generally null, with the few associations observed being with prescribed fires within 5 and 2 km of the primary residence in the negative direction but not the more restrictive 1 km radius. However, exposure to medium or heavy smoke (primarily from wildfires) at the zip code level was associated with both 7-day (8.5% increase; 95% CI = 1.5%, 16.0%) and 30-day readmissions (5.4%; 95% CI = 2.3%, 8.5%), and to a lesser degree, hospital visits (1.5%; 95% CI: 0.0%, 3.0%) matching previous studies.
Conclusions
Area-level smoke exposure driven by wildfires is positively associated with hospital utilization but not proximity to prescribed fires.
MIT Department
Massachusetts Institute of Technology. Laboratory for Aviation and the Environment
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DOI of Published Version
https://doi.org/10.1186/s12940-023-01032-4
