Association of Wildfire Air Pollution and Health Care Use for Atopic Dermatitis and Itch
Association of Wildfire Air Pollution and Health Care Use for Atopic Dermatitis and Itch
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DOI：
10.1001/jamadermatol.2021.0179
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发表时间：
2021-04-21
期刊：
影响因子：
10.9
通讯作者：
Wei, Maria L.
中科院分区：
文献类型：
--
作者：
Fadadu, Raj P.;Grimes, Barbara;Wei, Maria L.
重要性 空气污染是一个全球性的公共卫生问题，最近的野火加剧了这一问题，但与野火相关的空气污染与炎症性皮肤病之间的关系尚不清楚。 目的 评估与野火相关的空气污染与特应性皮炎 (AD) 或瘙痒就诊以及 AD 管理处方药物之间的关联。 设计、设置和参与者 这项横断面时间序列研究评估了加州营火造成的空气污染之间的关联2018 年 11 月，距离野火源 175 英里的旧金山一家学术三级护理医院系统进行了 8049 次皮肤科门诊就诊（4147 名患者）。参与者包括在火灾发生之前、期间和之后（2018 年 10 月至 2019 年 2 月）患有 AD 或瘙痒的儿童和成人患者，与 2015 年和 2016 年同一时间段访问的患者进行比较，当时旧金山附近没有发生大型野火。数据分析于 2019 年 11 月 1 日至 2020 年 5 月 30 日期间进行。 暴露 使用 3 个指标来表征与野火相关的空气污染：火灾状态、直径小于 2.5 μm 的颗粒物 (PM2.5) 浓度以及基于卫星的烟羽密度评分。 主要结果和措施 主要结果是每周因 AD 或瘙痒就诊的人数。次要结果是每周为成人 AD 开出的局部和全身药物的数量。 结果 分析了总共 4147 名患者（平均 [SD] 年龄，44.6 [21.1] 岁；2322 名 [56%] 女性）的就诊次数。营火期间儿科患者的 AD 就诊率为 1.49（95% CI，1.07-2.07），成人患者为滞后 0 时非火灾周的 1.15（95% CI，1.02-1.30）倍，并根据儿科患者诊所的温度、相对湿度、患者年龄和患者总人数进行调整。野火周期间儿童患者瘙痒门诊就诊的调整后比率为 1.82（95% CI，1.20-2.78），成人患者为 1.29（95% CI，0.96-1.75）。每周平均 PM2.5 浓度增加 10 mu g/m(3) 与每周儿科瘙痒门诊就诊次数增加 7.7%（95% CI，1.9%-13.7%）相关。篝火期间滞后 0 时成人处方全身药物的调整后比率为 1.45（95% CI，1.03-2.05）。 结论和相关性 这项横断面研究发现，短期暴露于野火造成的空气污染与 AD 和瘙痒患者的医疗保健使用增加相关。这些结果可以让人们更好地了解不良空气质量与皮肤健康之间的关系，并指导医疗保健专业人员对皮肤病患者的咨询和公共卫生实践。
IMPORTANCE Air pollution is a worldwide public health issue that has been exacerbated by recent wildfires, but the relationship between wildfire-associated air pollution and inflammatory skin diseases is unknown.OBJECTIVE To assess the associations between wildfire-associated air pollution and clinic visits for atopic dermatitis (AD) or itch and prescribed medications for AD management.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional time-series study assessed the associations of air pollution resulting from the California Camp Fire in November 2018 and 8049 dermatology clinic visits (4147 patients) at an academic tertiary care hospital system in San Francisco, 175 miles from the wildfire source. Participants included pediatric and adult patients with AD or itch from before, during, and after the time of the fire (October 2018 through February 2019), compared with those with visits in the same time frame of 2015 and 2016, when no large wildfires were near San Francisco. Data analysis was conducted from November 1, 2019, to May 30, 2020.EXPOSURES Wildfire-associated air pollution was characterized using 3 metrics: fire status, concentration of particulate matter less than 2.5 mu m in diameter (PM2.5), and satellite-based smoke plume density scores.MAIN OUTCOMES AND MEASURES Weekly clinic visit counts for AD or itch were the primary outcomes. Secondary outcomes were weekly numbers of topical and systemic medications prescribed for AD in adults.RESULTS Visits corresponding to a total of 4147 patients (mean [SD] age, 44.6 [21.1] years; 2322 [56%] female) were analyzed. The rates of visits for AD during the Camp Fire for pediatric patients were 1.49 (95% CI, 1.07-2.07) and for adult patients were 1.15 (95% CI, 1.02-1.30) times the rate for nonfire weeks at lag 0, adjusted for temperature, relative humidity, patient age, and total patient volume at the clinics for pediatric patients. The adjusted rate ratios for itch clinic visits during the wildfire weeks were 1.82 (95% CI, 1.20-2.78) for the pediatric patients and 1.29 (95% CI, 0.96-1.75) for adult patients. A 10-mu g/m(3) increase in weekly mean PM2.5 concentration was associated with a 7.7% (95% CI, 1.9%-13.7%) increase in weekly pediatric itch clinic visits. The adjusted rate ratio for prescribed systemic medications in adults during the Camp Fire at lag 0 was 1.45 (95% CI, 1.03-2.05).CONCLUSIONS AND RELEVANCE This cross-sectional study found that short-term exposure to air pollution due to the wildfire was associated with increased health care use for patients with AD and itch. These results may provide a better understanding of the association between poor air quality and skin health and guide health care professionals' counseling of patients with skin disease and public health practice.