Associations between prescribed fire and smoke exposure on hospital visits and readmissions of heart failure patients
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Background and Aim: Prescribed burns are used for land management, but their environmental health risks have been infrequently studied. We contrasted the health effects of prescribed burns and smoke exposure on heart failure (HF) patients in North Carolina.
Methods: We used electronic health records from a North Carolina hospital-based cohort diagnosed with HF between 2014-2016. Prescribed fire data was obtained using the Satellite Mapping Automatic Reanalysis Tool for Fire Incident Reconciliation and the National Emissions Inventory. Smoke density data came from NOAA’s Hazard Mapping System and was linked to patients based on the zip code of residence. Exposures were the number prescribed burns within 1 km of the primary residence and the number of days of smoke exposure. Outcomes were the number of hospital visits and 30-day readmissions after HF diagnosis. We used a cross-sectional study design and quasi-Poisson models to model the number of hospital visits and zero-inflated Poisson models to model 30-day readmissions. Models were adjusted for age, sex, race, smoking status, urbanicity, poverty, education level, unemployment, median household value, and public assistance, and included an offset for follow-up time. Results presented are the percent change and associated 95% confidence interval (CI).
Results: The number of prescribed burns within 1 km of a patient’s residence showed weak evidence for an association with total hospital visits (-4.5%; 95% CI: -13.7%, 5.2%) and was not associated with 30-day readmissions. However, exposure to an additional medium or heavy smoke day was associated with an increase in both hospital visits (1.3%; 95% CI: -0.2%, 2.7%) and 30-day readmissions (5.3%; 95% CI: 2.3%, 8.5%).
Conclusions: Smoke exposure is associated with increased hospital utilization among HF patients, but no positive association with prescribed burns was seen. This work does not necessarily represent the views or policies of the US Environmental Protection Agency.