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

摘要 与美国西部其他城市类似，内华达州里诺的空气质量经常受到野火烟雾的影响。烟雾 烟羽含有复杂的空气污染物混合物，其气溶胶成分受若干因素控制。这些 因素包括老化，其中二次有机气溶胶形成时，生物质燃烧排放物经历 大气氧化，和燃料类型（即，燃烧的植物）。整个西部的居民也 暴露在规定的燃烧产生的烟雾中，土地管理者使用这些烟雾来减轻野火风险。由于其较低 强度，规定的燃烧更容易闷烧，闷烧的排放物与燃烧的不同。 火灾模拟西部烟羽混合物的气溶胶成分需要详细的排放信息 从区域相关的燃料，气溶胶老化的准确表征，并考虑低 规定的烧伤和燃烧的野火强度。 2006年，里诺的主要医疗保健提供商（Renown Health）过渡到电子病历（EMR）。 目前，该数据库包含超过140万名患者就诊的信息。这个资源，加上里诺的 经常暴露于火灾产生的烟雾中，这些烟雾来自影响美国西部许多主要城市的生态系统， 里诺是一个调查烟羽混合物与人群健康之间关系的合适场所。 我们提出的研究有两个总体目标。1)我们将改进西方的烟雾暴露模型， 公共卫生应用。我们将创建一个新的、创新的空气质量模型， 从区域生物质燃料到模型烟羽混合物的排放信息，这将根据 生态系统的起源，大气老化和火灾强度（低强度规定烧伤与燃烧野火）。2)我们 将促进对烟雾暴露对人群健康的急性影响的理解。我们将执行一个 使用Renown EMR进行流行病学调查，考虑总体相关性和潜在异质性， 烟羽混合物。我们将评估吸烟暴露与四大类健康的关系 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血 压力）和这些类别中的先验感兴趣的特定急性状况（即，哮喘、支气管炎、COPD 急性加重、肺炎、充血性心力衰竭急性加重、缺血性中风和心肌梗塞）。 预期的成果包括提高我们对生物质燃烧事件的烟羽混合物建模的能力， 每年影响数百万美国人，预计未来还会增加。我们将提供第一个健康 协会估计规定的烧伤，这将是立即使用的土地管理人员和其他利益相关者， 自然资源和公共政策领域。我们还将提供潜在异质性的初步估计， 烟羽混合物对人群健康的影响。从长远来看，我们的研究将有助于了解 更准确的、基于证据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.