Wildfire particulate matter in Shasta County, California and respiratory and circulatory disease-related emergency department visits and mortality, 2013–2018

Wildfire smoke harms health. We add to this literature by evaluating the health effects of California’s 2018 Carr Fire and preceding wildfire seasons in Shasta County. METHODS: With data from the Shasta County Health and Human Services Agency, we examined the link between weekly wildfire fine particulate matter (PM(2.5)) exposure estimated using a spatiotemporal multiple imputation approach and emergency department (ED) visits and mortality using time-series models that controlled for temporal trends and temperature. RESULTS: Between 2013 and 2018, Shasta County experienced 19 weeks with average wildfire PM(2.5) ≥5.5 μg/m(3) (hereafter, “high wildfire PM(2.5) concentration”). Among all Shasta County Zip Code Tabulation Areas (ZCTAs; n = 36), we detected no association between high wildfire PM(2.5) concentrations and respiratory or circulatory disease-related ED visits or mortality. Subsequent analyses were confined to valley ZCTAs (n = 11, lower elevation, majority of population, worse air quality in general). In valley ZCTAs, high wildfire PM(2.5) was associated with a 14.6% (95% confidence interval [CI] = 4.2, 24.9) increase in same-week respiratory disease-related ED visits but no increase in the subsequent 2 weeks nor on circulatory disease-related mortality or ED visits or all-cause mortality. Two weeks after high wildfire PM(2.5) weeks, respiratory disease-related deaths decreased (–31.5%, 95% CI = –64.4, 1.5). The 2018 Carr Fire appeared to increase respiratory disease-related ED visits by 27.0% (95% CI = 4.0, 50.0) over expectation and possibly reduce circulatory disease-related deaths (–18.2%, 95% CI = –39.4, 2.9). CONCLUSIONS: As climate change fuels wildfire seasons, studies must continue to evaluate their health effects, particularly in highly exposed populations.