规定的火灾、烟雾暴露和心力衰竭患者的医院利用情况。
Prescribed fires, smoke exposure, and hospital utilization among heart failure patients.
机构信息
Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Human Studies Building, 104 Mason Farm Rd, Chapel Hill, NC, 27514, USA.
Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, NC, 27606, USA.
出版信息
Environ Health. 2023 Dec 13;22(1):86. doi: 10.1186/s12940-023-01032-4.
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.
背景
规定的火灾通常具有生态效益，但它们对环境健康的风险却很少被研究。我们调查了居住在规定的火灾附近、野火烟雾暴露与心力衰竭（HF）患者住院利用之间的关联。
方法
我们使用北卡罗来纳州一家医院的电子健康记录，从 2014 年 1 月至 2016 年 12 月，确定 HF 诊断、主要居住地和医院利用情况。使用横断面研究设计，我们将患者主要居住地周围 1、2 和 5 公里范围内规定的火灾发生情况与医院就诊次数以及 7 天和 30 天再入院次数相关联。为了比较规定的火灾与观察到的野火烟雾之间的关联，我们还将邮政编码级别的烟雾密度数据与 HF 患者的医院利用情况相关联，该数据旨在捕捉野火烟雾排放。使用准泊松回归模型对医院就诊次数进行建模，而使用零膨胀泊松回归模型对再入院次数进行建模。所有模型均根据年龄、性别、种族和社区社会经济地位进行调整，并包括随访时间的偏移量。结果为百分比变化和 95%置信区间（CI）。
结果
规定的火灾发生与医院就诊次数之间的关联通常为零，观察到的几个关联是在主要居住地周围 5 和 2 公里范围内的规定火灾呈负向，但不包括更严格的 1 公里半径。然而，邮政编码级别的中等到重度烟雾（主要来自野火）暴露与 7 天（8.5%增加；95%CI=1.5%，16.0%）和 30 天再入院（5.4%；95%CI=2.3%，8.5%）均相关，对医院就诊的影响程度较小（1.5%；95%CI：0.0%，3.0%），与之前的研究一致。
结论
由野火驱动的区域水平烟雾暴露与医院利用率呈正相关，但与规定的火灾接近程度无关。
Zotero 插件