Environment/Climate Change
Wildfire smoke exposure and emergency department visits related to alcohol, overdose, and assault: A time-stratified case-crossover analysis Holly Elser* Holly Elser Yueqi Yan Mathew V. Kiang Joan A. Casey Sidra Goldman-Mellor
Background: Wildfires have become increasingly frequent and destructive in the United States due to anthropogenic climate change. While prior literature suggests climate change and the environment influence both physical and behavioral health, research that focuses on wildfire smoke exposure and externalizing behavioral health outcomes remains scarce.
Methods: We conducted a time-stratified case-crossover analysis to examine the association of wildfire smoke exposure with emergency department (ED) visits related to alcohol use disorder, overdose, and assault. Visits were identified using diagnostic codes in statewide ED visit data from the California Department of Health Care Access and Information from 2016–2020. Daily measures of fine particles <2.5mg/m3 in diameter (PM2.5) were available for all California zip codes. We implemented distributed lag nonlinear models to assess the association of lagged daily wildfire PM2.5 exposure over a weeklong period. Conditional Poisson models were used to estimate the percent change in rates of ED visits for each outcome.
Results: We identified 1,182,760 ED visits related to alcohol use disorder, 215,126 related to overdose, and 513,835 related to assault. An increase in the same-day concentration of wildfire PM2.5 from the median to the 95th percentile was not clearly associated with a change in the rates of ED visits related to alcohol use disorder (-0.3%, 95%CI: -0.7,0.2), although we observed increased rates 3 days later (0.5%, 95%CI: 0.3,0.8). Same-day wildfire PM2.5 exposure was associated with increased rates of ED visits related to drug overdose (0.7%, 95%CI: 0.0,1.3) and assault (0.4%, 95%CI: -0.1,0.9) (Figure).
Conclusion: We found increased rates of acute ED visits for alcohol use disorder, overdose and assault associated with wildfire PM2.5 exposure. Additional research focused on identifying mechanisms that underlie these associations may yield insights into potential avenues for prevention.
