Associations of smoke from wildfires and prescribed burns with cardiorespiratory health outcomes in Reno, NV

摘要 与美国其他西部城市一样，内华达州里诺市的空气质量经常受到野地大火烟雾的影响。冒烟 羽流含有复杂的空气污染物混合物，它们的气溶胶成分受几个因素的影响。这些 因素包括老化，即当生物质燃烧排放时形成二次有机气溶胶。 大气氧化和燃料类型(即燃烧的植被类型)。整个西部的居民也在 暴露在规定燃烧产生的烟雾中，这是土地管理者用来减轻野火风险的。由于他们的价格较低 强度，规定的燃烧更有可能阴燃，而且阴燃火灾的排放与燃烧的不同 着火了。要对西方烟羽混合物的气溶胶成分进行建模，需要详细的排放信息 从区域相关的燃料，气溶胶老化的准确特征，并考虑低 强度规定的烧伤和熊熊燃烧的野火。 2006年，Reno(Renown Health)的主要医疗保健提供者过渡到电子病历(EMR)。 目前，这个数据库包含了超过140万人次的就诊信息。这一资源与雷诺的 频繁暴露在火灾产生的烟雾中，这些火灾源于影响美国西部许多主要城市的生态系统，使得 雷诺是研究烟羽混合物与人口健康之间关系的一个合适的环境。 我们提议的研究有两个首要目标。1)我们将改进西方的烟雾暴露模型，以用于 公共卫生应用。我们将创造一个新的、创新的空气质量模式，它将是第一个使用定制的 区域生物质燃料的排放信息，以模拟烟羽混合物，这将根据 起源的生态系统、大气老化和火灾强度(低强度规定的燃烧与燃烧的野火)。2)我们 将促进对吸烟暴露对人群健康的急性影响的了解。我们将表演一场 使用著名的EMR进行流行病学调查，考虑总体相关性和潜在的异质性 烟羽混合物。我们将评估吸烟暴露与四大类健康之间的关系 结果(急性上呼吸道疾病、急性下呼吸道疾病、急性心血管疾病和母体血液 压力)，并具有这些类别中预先感兴趣的特定急性情况(即哮喘、支气管炎、慢性阻塞性肺病 急性加重、肺炎、充血性心力衰竭恶化、缺血性中风和心肌梗死)。 预期的结果包括提高我们为生物质燃烧事件模拟烟雾羽流混合物的能力 每年影响数以百万计的美国人，预计未来还会增加。我们将提供第一个健康 协会对规定烧伤的估计，这将立即用于土地管理人员和其他利益攸关方 自然资源和公共政策领域。我们还将提供对潜在异质性的第一次估计 烟羽混合物造成的人口健康后果。从长远来看，我们的研究将有助于了解 更准确、更循证的公共卫生预警系统。

ABSTRACT Similar to other Western U.S. cities, air quality in Reno, NV is routinely impacted by smoke from wildland fires. Smoke plumes contain complex air pollutant mixtures, and their aerosol composition is governed by several factors. These factors include aging, in which secondary organic aerosols are formed when biomass burning emissions undergo atmospheric oxidation, and fuel type (i.e., the type of vegetation burned). Residents throughout the West are also exposed to smoke from prescribed burns, which are used by land managers to mitigate wildfire risks. Due to their lower intensity, prescribed burns are more likely to smolder, and emissions from smoldering fires differ from those of flaming fires. To model the aerosol composition of smoke plume mixtures in the West requires detailed emissions information from regionally relevant fuels, accurate characterization of aerosol aging, and consideration of differences between low intensity prescribed burns and flaming wildfires. In 2006, the major health care provider in Reno (Renown Health) transitioned to electronic medical records (EMRs). At present, this database contains information on over 1.4 million patient visits. This resource, combined with Reno’s frequent exposure to smoke from fires that originate from ecosystems impacting many major Western U.S. cities, make Reno an opportune setting to investigate associations between smoke plume mixtures and population health. Our proposed study has two overarching goals. 1) We will improve smoke exposure modeling in the West for use in public health applications. We will create a new, innovative air quality model that will be the first to use tailored emissions information from regional biomass fuels to model smoke plume mixtures, which will vary according to the ecosystem of origin, atmospheric aging, and fire intensity (low intensity prescribed burns vs. flaming wildfires). 2) We will advance understanding of the acute population-level health effects of smoke exposures. We will perform an epidemiologic investigation using the Renown EMRs, considering overall associations and potential heterogeneity by smoke plume mixtures. We will estimate associations of smoke exposures with four broad categories of health outcomes (acute upper airway disease, acute lower airway disease, acute cardiovascular disease, and maternal blood pressure) and with specific acute conditions of a priori interest within these categories (i.e., asthma, bronchitis, COPD exacerbation, pneumonia, congestive heart failure exacerbation, ischemic stroke, and myocardial infarction). Anticipated outcomes include improving our ability to model smoke plume mixtures for biomass burning events that impact millions of Americans annually and are projected to increase in the future. We will provide the first health association estimates for prescribed burns, which will be of immediate use to land managers and other stakeholders in the natural resources and public policy arenas. We will also provide the first estimates of potential heterogeneity in population health outcomes by smoke plume mixtures. Longer-term, our study will help to inform the development of more accurate, evidence-based public health warning systems.