Wildfire Exposure and Health Care Use Among People Who Use Durable Medical Equipment in Southern California
People using electricity-dependent durable medical equipment (DME) may be vulnerable to health effects from wildfire smoke, residence near wildfires, or residence in evacuation zones. To our knowledge, no studies have examined their healthcare utilization during wildfires. We obtained 2016-2020 coun...
Saved in:
| Published in: | Epidemiology (Cambridge, Mass.) Vol. 34; no. 5; p. 700 |
|---|---|
| Main Authors: | , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
01.09.2023
|
| Subjects: | |
| ISSN: | 1531-5487, 1531-5487 |
| Online Access: | Get more information |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Abstract | People using electricity-dependent durable medical equipment (DME) may be vulnerable to health effects from wildfire smoke, residence near wildfires, or residence in evacuation zones. To our knowledge, no studies have examined their healthcare utilization during wildfires.
We obtained 2016-2020 counts of residential Zip Code Tabulation Area (ZCTA) level outpatient, emergency department (ED), and inpatient visits made by DME-using Kaiser Permanente Southern California members 45+. We linked counts to daily ZCTA-level wildfire particulate matter (PM) 2.5 and wildfire boundary and evacuation data from the 2018 Woolsey and 2019 Getty wildfires. We estimated the association of lagged (up to 7 days) wildfire PM 2.5 and residence near a fire or in an evacuation zone and healthcare visit frequency with negative binomial and difference-in-differences models.
Among 236,732 DME users, 10 µg/m 3 increases in wildfire PM 2.5 concentration were associated with the reduced rate (RR = 0.96; 95% confidence interval [CI] = 0.94, 0.99) of all-cause outpatient visits 1 day after exposure and increased rate on 4 of 5 subsequent days (RR range 1.03-1.12). Woolsey Fire proximity (<20 km) was associated with reduced all-cause outpatient visits, whereas evacuation and proximity were associated with increased inpatient cardiorespiratory visits (proximity RR = 1.45; 95% CI = 0.99, 2.12, evacuation RR = 1.72; 95% CI = 1.00, 2.96). Neither Getty Fire proximity nor evacuation was associated with healthcare visit frequency.
Our results support the hypothesis that wildfire smoke or proximity interrupts DME users' routine outpatient care, via sheltering in place. However, wildfire exposures were also associated with increased urgent healthcare utilization in this vulnerable group. |
|---|---|
| AbstractList | People using electricity-dependent durable medical equipment (DME) may be vulnerable to health effects from wildfire smoke, residence near wildfires, or residence in evacuation zones. To our knowledge, no studies have examined their healthcare utilization during wildfires.
We obtained 2016-2020 counts of residential Zip Code Tabulation Area (ZCTA) level outpatient, emergency department (ED), and inpatient visits made by DME-using Kaiser Permanente Southern California members 45+. We linked counts to daily ZCTA-level wildfire particulate matter (PM) 2.5 and wildfire boundary and evacuation data from the 2018 Woolsey and 2019 Getty wildfires. We estimated the association of lagged (up to 7 days) wildfire PM 2.5 and residence near a fire or in an evacuation zone and healthcare visit frequency with negative binomial and difference-in-differences models.
Among 236,732 DME users, 10 µg/m 3 increases in wildfire PM 2.5 concentration were associated with the reduced rate (RR = 0.96; 95% confidence interval [CI] = 0.94, 0.99) of all-cause outpatient visits 1 day after exposure and increased rate on 4 of 5 subsequent days (RR range 1.03-1.12). Woolsey Fire proximity (<20 km) was associated with reduced all-cause outpatient visits, whereas evacuation and proximity were associated with increased inpatient cardiorespiratory visits (proximity RR = 1.45; 95% CI = 0.99, 2.12, evacuation RR = 1.72; 95% CI = 1.00, 2.96). Neither Getty Fire proximity nor evacuation was associated with healthcare visit frequency.
Our results support the hypothesis that wildfire smoke or proximity interrupts DME users' routine outpatient care, via sheltering in place. However, wildfire exposures were also associated with increased urgent healthcare utilization in this vulnerable group. People using electricity-dependent durable medical equipment (DME) may be vulnerable to health effects from wildfire smoke, residence near wildfires, or residence in evacuation zones. To our knowledge, no studies have examined their healthcare utilization during wildfires.BACKGROUNDPeople using electricity-dependent durable medical equipment (DME) may be vulnerable to health effects from wildfire smoke, residence near wildfires, or residence in evacuation zones. To our knowledge, no studies have examined their healthcare utilization during wildfires.We obtained 2016-2020 counts of residential Zip Code Tabulation Area (ZCTA) level outpatient, emergency department (ED), and inpatient visits made by DME-using Kaiser Permanente Southern California members 45+. We linked counts to daily ZCTA-level wildfire particulate matter (PM) 2.5 and wildfire boundary and evacuation data from the 2018 Woolsey and 2019 Getty wildfires. We estimated the association of lagged (up to 7 days) wildfire PM 2.5 and residence near a fire or in an evacuation zone and healthcare visit frequency with negative binomial and difference-in-differences models.METHODSWe obtained 2016-2020 counts of residential Zip Code Tabulation Area (ZCTA) level outpatient, emergency department (ED), and inpatient visits made by DME-using Kaiser Permanente Southern California members 45+. We linked counts to daily ZCTA-level wildfire particulate matter (PM) 2.5 and wildfire boundary and evacuation data from the 2018 Woolsey and 2019 Getty wildfires. We estimated the association of lagged (up to 7 days) wildfire PM 2.5 and residence near a fire or in an evacuation zone and healthcare visit frequency with negative binomial and difference-in-differences models.Among 236,732 DME users, 10 µg/m 3 increases in wildfire PM 2.5 concentration were associated with the reduced rate (RR = 0.96; 95% confidence interval [CI] = 0.94, 0.99) of all-cause outpatient visits 1 day after exposure and increased rate on 4 of 5 subsequent days (RR range 1.03-1.12). Woolsey Fire proximity (<20 km) was associated with reduced all-cause outpatient visits, whereas evacuation and proximity were associated with increased inpatient cardiorespiratory visits (proximity RR = 1.45; 95% CI = 0.99, 2.12, evacuation RR = 1.72; 95% CI = 1.00, 2.96). Neither Getty Fire proximity nor evacuation was associated with healthcare visit frequency.RESULTSAmong 236,732 DME users, 10 µg/m 3 increases in wildfire PM 2.5 concentration were associated with the reduced rate (RR = 0.96; 95% confidence interval [CI] = 0.94, 0.99) of all-cause outpatient visits 1 day after exposure and increased rate on 4 of 5 subsequent days (RR range 1.03-1.12). Woolsey Fire proximity (<20 km) was associated with reduced all-cause outpatient visits, whereas evacuation and proximity were associated with increased inpatient cardiorespiratory visits (proximity RR = 1.45; 95% CI = 0.99, 2.12, evacuation RR = 1.72; 95% CI = 1.00, 2.96). Neither Getty Fire proximity nor evacuation was associated with healthcare visit frequency.Our results support the hypothesis that wildfire smoke or proximity interrupts DME users' routine outpatient care, via sheltering in place. However, wildfire exposures were also associated with increased urgent healthcare utilization in this vulnerable group.CONCLUSIONSOur results support the hypothesis that wildfire smoke or proximity interrupts DME users' routine outpatient care, via sheltering in place. However, wildfire exposures were also associated with increased urgent healthcare utilization in this vulnerable group. |
| Author | Steiger, Benjamin McBrien, Heather Casey, Joan A Rowland, Sebastian T Benmarhnia, Tarik Tartof, Sara Y |
| Author_xml | – sequence: 1 givenname: Heather orcidid: 0000-0003-1587-6614 surname: McBrien fullname: McBrien, Heather organization: From the Environmental Health Sciences, Columbia Mailman School of Public Health – sequence: 2 givenname: Sebastian T surname: Rowland fullname: Rowland, Sebastian T organization: From the Environmental Health Sciences, Columbia Mailman School of Public Health – sequence: 3 givenname: Tarik surname: Benmarhnia fullname: Benmarhnia, Tarik organization: Scripps Institution of Oceanography, University of California San Diego – sequence: 4 givenname: Sara Y surname: Tartof fullname: Tartof, Sara Y organization: Research & Evaluation, Kaiser Permanente Southern California – sequence: 5 givenname: Benjamin surname: Steiger fullname: Steiger, Benjamin organization: From the Environmental Health Sciences, Columbia Mailman School of Public Health – sequence: 6 givenname: Joan A surname: Casey fullname: Casey, Joan A organization: Environmental and Occupational Health Sciences, University of Washington School of Public Health, WA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37255240$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNUNtKw0AUXKRiL_oHIvvoS2r21k0fSxutUFHQ0sewyZ7Y1c1umgvo37tohZ6Hc2YOw8DMGA2cd4DQNYmnJJ7Lu3SVTuOTITPGz9CICEYiwRM5OMFDNG7bj6CRjIgLNGSSCkF5PEKfO2N1aRrA6Vft2z4A5TReg7LdHi9V4NsW8KLy7h2_gK8t4N3e_z5XfaPywJ9Am0JZnB56U1fgOmwcfvV9t4fGBQ9rSt84oy7RealsC1fHO0Hb-_RtuY42zw-Py8UmKrjgLBI6oZRoBkSFSIIXhM14meeJVjwmhS7KOQctteTlDOZhlbkGLqRMhCiTOdAJuv3zrRt_6KHtssq0BVirHPi-zWhCCeOUhwom6OYo7fMKdFY3plLNd_ZfEP0BiWFqHA |
| CitedBy_id | crossref_primary_10_1016_j_heliyon_2024_e38024 crossref_primary_10_1017_dmp_2025_10063 crossref_primary_10_1073_pnas_2310081121 crossref_primary_10_1016_j_ekir_2025_04_002 crossref_primary_10_1021_acs_est_4c06653 |
| ContentType | Journal Article |
| Copyright | Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. |
| Copyright_xml | – notice: Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1097/EDE.0000000000001634 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Public Health |
| EISSN | 1531-5487 |
| ExternalDocumentID | 37255240 |
| Genre | Journal Article Research Support, N.I.H., Extramural |
| GeographicLocations | California |
| GeographicLocations_xml | – name: California |
| GrantInformation_xml | – fundername: NIA NIH HHS grantid: RF1 AG071024 – fundername: NIEHS NIH HHS grantid: P30 ES007033 – fundername: NIA NIH HHS grantid: R01 AG071024 |
| GroupedDBID | --- .-D .Z2 01R 0R~ 1J1 40H 4Q1 4Q2 4Q3 5GY 5VS 71W 77Y 7O~ 8L- AAAAV AAAXR AACGO AAFWJ AAGIX AAHPQ AAIKC AAIQE AAMNW AAMOA AAMTA AANCE AAQKA AARTV AASCR AASOK AAXQO AAYEP ABASU ABBUW ABDIG ABJNI ABPLY ABPXF ABTLG ABVCZ ABXVJ ABZAD ABZZY ACDDN ACEWG ACGFO ACGFS ACHQT ACILI ACLDA ACWDW ACWRI ACXJB ACXNZ ACZKN ADGGA ADHPY AE6 AENEX AFBFQ AFDTB AFUWQ AGINI AHOMT AHQNM AHVBC AIJEX AINUH AJCLO AJIOK AJNWD AJZMW AKCTQ AKULP ALKUP ALMA_UNASSIGNED_HOLDINGS ALMTX AMJPA AMKUR AMNEI AOHHW AOQMC BOYCO BQLVK C45 CGR CS3 CUY CVF DIWNM DU5 E.X EBS ECM EEVPB EIF ERAAH EX3 F2M F2N F5P FCALG FL- GNXGY GQDEL H0~ HLJTE HZ~ IKREB IKYAY IN~ IPNFZ JK3 JK8 JLS JSG K8S KD2 L-C N9A NPM N~7 N~B O9- OAG OAH OLG OLH OLU OLY OPUJH OVD OVDNE OVIDH OVLEI OWV OWW OWY OWZ OXXIT P2P RIG RLZ S4R S4S TEORI TSPGW V2I VVN W3M WOQ WOW X3V X3W XYM YOC ZFV 7X8 ADKSD ADSXY AE3 |
| ID | FETCH-LOGICAL-c4543-5d8221d3e1a63454c1364fbb8da401cdcf94ed7d74f6e94f6fbde4577855f89e2 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 7 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=00001648-990000000-00143&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1531-5487 |
| IngestDate | Thu Oct 02 10:23:11 EDT 2025 Sat Aug 02 01:41:18 EDT 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 5 |
| Language | English |
| License | Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c4543-5d8221d3e1a63454c1364fbb8da401cdcf94ed7d74f6e94f6fbde4577855f89e2 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ORCID | 0000-0003-1587-6614 |
| OpenAccessLink | https://pmc.ncbi.nlm.nih.gov/articles/PMC10524711/pdf/nihms-1903765.pdf |
| PMID | 37255240 |
| PQID | 2821342455 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_2821342455 pubmed_primary_37255240 |
| PublicationCentury | 2000 |
| PublicationDate | 2023-09-01 |
| PublicationDateYYYYMMDD | 2023-09-01 |
| PublicationDate_xml | – month: 09 year: 2023 text: 2023-09-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | Epidemiology (Cambridge, Mass.) |
| PublicationTitleAlternate | Epidemiology |
| PublicationYear | 2023 |
| SSID | ssj0017315 |
| Score | 2.4712732 |
| Snippet | People using electricity-dependent durable medical equipment (DME) may be vulnerable to health effects from wildfire smoke, residence near wildfires, or... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 700 |
| SubjectTerms | Air Pollutants - analysis California - epidemiology Durable Medical Equipment Environmental Exposure - adverse effects Hospitalization Humans Particulate Matter - analysis Smoke - adverse effects Wildfires |
| Title | Wildfire Exposure and Health Care Use Among People Who Use Durable Medical Equipment in Southern California |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/37255240 https://www.proquest.com/docview/2821342455 |
| Volume | 34 |
| WOSCitedRecordID | wos00001648-990000000-00143&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1JS8NAFB7UehDEfakbI3gNJc5MJnOSYlM8aOnBYm9lMgsWIWkbK_583yylJ0EwhzkkBMKbNy_fWz-E7nhOS8uVc1NL5ijMwA5KoZNMaitAw2hm_RDXZz4Y5OOxGMaAWxPLKlc20RtqXSsXI--Aa5ASl6ZjD7N54lijXHY1UmhsohYBKOO0mo_XWQQeGAzgUKeJQ-ar1jnBO0WvCKML4wWwhP4OMv3Ppr__3888QHsRZuJu0ItDtGGqI7QbYnQ4tB4dow8wCdqCzcPF96x2oUIsKx0fY9eZhEeNwV3HR4SHvtQcv73X_mZvuXBNVzgmenAxX0596RGeVtjz8plFhdedXydo1C9eH5-SSL6QKMooSZgG6JBqYlIJomFUpSSjtixzLcElU1pZQY3mmlObGQGLLbWhjPOcMZsLc3-Ktqq6MucI2-zeylRQWipFCTFSWJJbYqwxKWgIa6PblSwnoNwuYyErUy-byVqabXQWNmQyC1M4JoSDNwR45OIPb1-iHUcTH2LBV6hl4Wiba7Stvj6nzeLGaw2sg-HLDylJyzA |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Wildfire+Exposure+and+Health+Care+Use+Among+People+Who+Use+Durable+Medical+Equipment+in+Southern+California&rft.jtitle=Epidemiology+%28Cambridge%2C+Mass.%29&rft.au=McBrien%2C+Heather&rft.au=Rowland%2C+Sebastian+T&rft.au=Benmarhnia%2C+Tarik&rft.au=Tartof%2C+Sara+Y&rft.date=2023-09-01&rft.issn=1531-5487&rft.eissn=1531-5487&rft.volume=34&rft.issue=5&rft.spage=700&rft_id=info:doi/10.1097%2FEDE.0000000000001634&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1531-5487&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1531-5487&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1531-5487&client=summon |