Prescribed fires, smoke exposure, and hospital utilization among heart failure patients

• Published in: Environmental health Vol. 22; no. 1; p. 86
• Main Authors: Raab, Henry, Moyer, Joshua, Afrin, Sadia, Garcia-Menendez, Fernando, Ward-Caviness, Cavin K
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.12.2023; BioMed Central; Springer Science + Business Media; BMC
• Subjects: Air pollution; Care and treatment; Congestive heart failure; Controlled burning; Electronic health records; Electronic medical records; Environmental aspects; Environmental health; Exposure; Health aspects; Health risks; Heart failure; Hospitalizations; Hospitals; Medical care; Mortality; Poisson density functions; Prescribed burning; Prescribed fire; Prescribed fires; Regression analysis; Regression models; Smoke; Smoke exposure; Socioeconomics; Statistical analysis; Utilization; Wildfires; United States; North Carolina; United States > US; Heart failure; Smoke exposure; Hospitalizations; Prescribed fires
• ISSN: 1476-069X; 1476-069X
• DOI: 10.1186/s12940-023-01032-4

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. 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). 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. Area-level smoke exposure driven by wildfires is positively associated with hospital utilization but not proximity to prescribed fires.