Fire association with respiratory disease and COVID-19 complications in the State of Pará, Brazil

BACKGROUND: Brazil has faced two simultaneous problems related to respiratory health: forest fires and the high mortality rate due to COVID-19 pandemics. The Amazon rain forest is one of the Brazilian biomes that suffers the most with fires caused by droughts and illegal deforestation. These fires can bring respiratory diseases associated with air pollution, and the State of Pará in Brazil is the most affected. COVID-19 pandemics associated with air pollution can potentially increase hospitalizations and deaths related to respiratory diseases. Here, we aimed to evaluate the association of fire occurrences with the COVID-19 mortality rates and general respiratory diseases hospitalizations in the State of Pará, Brazil. METHODS: We employed machine learning technique for clustering k-means accompanied with the elbow method used to identify the ideal quantity of clusters for the k-means algorithm, clustering 10 groups of cities in the State of Pará where we selected the clusters with the highest and lowest fires occurrence from the 2015 to 2019. Next, an Auto-regressive Integrated Moving Average Exogenous (ARIMAX) model was proposed to study the serial correlation of respiratory diseases hospitalizations and their associations with fire occurrences. Regarding the COVID-19 analysis, we computed the mortality risk and its confidence level considering the quarterly incidence rate ratio in clusters with high and low exposure to fires. FINDINGS: Using the k-means algorithm we identified two clusters with similar DHI (Development Human Index) and GDP (Gross Domestic Product) from a group of ten clusters that divided the State of Pará but with diverse behavior considering the hospitalizations and forest fires in the Amazon biome. From the auto-regressive and moving average model (ARIMAX), it was possible to show that besides the serial correlation, the fires occurrences contribute to the respiratory diseases increase, with an observed lag of six months after the fires for the case with high exposure to fires. A highlight that deserves attention concerns the relationship between fire occurrences and deaths. Historically, the risk of mortality by respiratory diseases is higher (about the double) in regions and periods with high exposure to fires than the ones with low exposure to fires. The same pattern remains in the period of the COVID-19 pandemic, where the risk of mortality for COVID-19 was 80% higher in the region and period with high exposure to fires. Regarding the SARS-COV-2 analysis, the risk of mortality related to COVID-19 is higher in the period with high exposure to fires than in the period with low exposure to fires. Another highlight concerns the relationship between fire occurrences and COVID-19 deaths. The results show that regions with high fire occurrences are associated with more cases of COVID deaths. INTERPRETATION: The decision-make process is a critical problem mainly when it involves environmental and health control policies. Environmental policies are often more cost-effective as health measures than the use of public health services. This highlight the importance of data analyses to support the decision making and to identify population in need of better infrastructure due to historical environmental factors and the knowledge of associated health risk. The results suggest that The fires occurrences contribute to the increase of the respiratory diseases hospitalization. The mortality rate related to COVID-19 was higher for the period with high exposure to fires than the period with low exposure to fires. The regions with high fire occurrences is associated with more COVID-19 deaths, mainly in the months with high number of fires. FUNDING: No additional funding source was required for this study.