Wildfire Exposure and Health Care Use Among People Who Use Durable Medical Equipment in Southern California.
Wildfire Exposure and Health Care Use Among People Who Use Durable Medical Equipment in Southern California.
复制标题
南加州使用耐用医疗设备的人们的野火暴露和医疗保健使用情况。
DOI：
10.1097/ede.0000000000001634
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Casey,JoanA
中科院分区：
文献类型：
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作者：
McBrien,Heather;Rowland,SebastianT;Benmarhnia,Tarik;Tartof,SaraY;Steiger,Benjamin;Casey,JoanA
背景：使用依赖电力的耐用医疗设备 (DME) 的人们可能容易受到野火烟雾、居住在野火附近或居住在疏散区的健康影响。据我们所知，还没有研究调查过他们在野火期间的医疗保健利用率。 方法：我们获得了 2016 年至 2020 年居住邮政编码列表区域 (ZCTA) 级别门诊、急诊科 (ED) 和住院患者就诊的计数，这些计数由使用 DME 的南加州凯撒医疗机构 45 岁以上会员进行。我们将计数与每日 ZCTA 级野火颗粒物 (PM) 2.5 以及 2018 年伍尔西和 2019 年盖蒂野火的野火边界和疏散数据联系起来。我们利用负二项式和双重差分模型估计了滞后（最多 7 天）野火 PM 2.5 与火灾附近或疏散区的居住以及医疗保健就诊频率之间的关联。结果：在 236,732 名 DME 用户中，野火 PM 2.5 浓度增加 10 µg/m 3 与降低率相关（RR= 0.96；95% 置信区间 [CI]=暴露后 1 天全因门诊就诊的比例为 0.94, 0.99)，随后 5 天中有 4 天的比例增加（RR 范围 1.03-1.12）。伍尔西火灾附近（< 20 公里）与全因门诊就诊次数减少相关，而疏散和接近则与住院心肺就诊次数增加相关（接近 RR= 1.45；95% CI= 0.99, 2.12，疏散 RR= 1.72；95% CI= 1.00, 2.96）。盖蒂火灾的接近程度和疏散都与医疗保健就诊频率无关。结论：我们的结果支持这样的假设：野火烟雾或接近程度通过就地避难中断了 DME 用户的常规门诊护理。然而，野火暴露也与这一弱势群体的紧急医疗利用增加有关。
Background: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.Methods: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.Results: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.Conclusions: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.