Adverse Health Impacts of Outdoor Air Pollution, Including from Wildland Fires, in the United States: “Health of the Air,” 2018–2020

Abstract

Rationale Adverse health impacts from outdoor air pollution occur across the United States, but the magnitude of these impacts varies widely by geographic region. Ambient pollutant concentrations, emission sources, baseline health conditions, and population sizes and distributions are all important factors that need to be taken into account to quantify local health burdens. Objectives To determine health impacts from ambient air pollution concentrations in the United States that exceed the levels recommended by the American Thoracic Society. Methods Using a methodology that has been well established in previous “Health of the Air” reports, this study provides policy-relevant estimates for every monitored county and city in the United States for the adverse health impacts of outdoor pollution concentrations using U.S. Environmental Protection Agency design values for years 2018–2020. Additionally, for the first time, the report includes adverse birth outcomes as well as estimates of health impacts specifically attributable to wildland fires using an exposure dataset generated through Community Multiscale Air Quality simulations. Results The adverse health burdens attributable to air pollution occur across the entire age spectrum, including adverse birth outcomes (10,660 preterm and/or low-weight births; 95% confidence interval [CI], 3,180–18,330), in addition to mortality impacts (21,300 avoidable deaths; 95% CI, 16,180–26,200), lung cancer incidence (3,000 new cases; 95% CI, 1,550–4,390), multiple types of cardiovascular and respiratory morbidity (748,660 events; 95% CI, 326,050–1,057,080), and adversely impacted days (52.4 million days; 95% CI, 7.9–92.4 million days). Two different estimates of mortality impacts from wildland fires were created based on assumptions regarding the underlying toxicity of particles from wildland fires (low estimate of 4,080 deaths, 95% CI, 240–7,890; middle estimate of 28,000 deaths, 95% CI, 27,300–28,700). Conclusions This year’s report identified sizable health benefits that would be expected to occur across the United States with compliance with more health-protective air quality standards such as those recommended by the American Thoracic Society. This study also indicates that a large number of excess deaths are attributable to emissions from wildland fires; air quality management strategies outside what is required by the Clean Air Act will be needed to best address this important source of air pollution and its associated health risks.

Clearing the Air: Understanding the Impact of Wildfire Smoke on Asthma and COPD

“…Several studies confirm the respiratory risks associated with wildfire smoke-related PM 2.5 are distinct from the risks of non-smoke ambient PM 2.5 exposure and from co-pollutants such as ozone [26,59,60]. Asthma symptoms [71][72][73] Asthma incidence [74] COPD hospitalization [13,61,63,64] COPD emergency department visit [13,26,75] COPD symptoms [76] Long-term impact on lung function [8,77,78] Respiratory infection [44,72,[79][80][81] Lung cancer incidence [82] Respiratory mortality [58] Wildfire smoke exposure is strongly associated with asthma symptoms, healthcare utilization, emergency department visits, and hospitalizations. The majority of studies looking at wildfire smoke exposure and asthma emergency department visits have shown a positive association [13,25,26,59,61,62,[66][67][68][69], although Tinling et al showed no significant association [83].…”

“…Increased bronchitis and acute respiratory infection after wildfire smoke exposure have been described [72]. Fungal infections such as coccidioidomycosis may spike after wildfire [44,79]. In a casecrossover study, wildfire-associated PM 2.5 exposure was associated with 23% higher odds of active tuberculosis diagnosis, which the authors propose is due to increased risk of TB reactivation since exposure to inhaled pollutants such as tobacco smoking is an established risk factor for TB reactivation [80].…”

“…Children are more susceptible to smoke exposure due to greater minute ventilation per unit body weight, smaller airways, more time outdoors, and developing lungs [95,96]. Little is known about the long-term effects of wildfire exposures in utero or very early in life; however, data suggests that prenatal exposure to wildfire PM 2.5 is associated with higher rates of adverse obstetrical outcomes such as low birth weight and preterm birth [79,97,98]. Although not conclusively proven, it is plausible that PM 2.5 exposure during critical developmental periods could impair lung growth [96].…”

Air Pollution, Physical Exercise, and Physical Health: An Analysis Based on Data from the China General Social Survey

“…As air pollution levels rise, adverse effects on life expectancy and health conditions become evident. Cromar and Gladson (2024) [13] analyzed data from the U.S. Environmental Protection Agency for 2018-2020, revealing that air pollution leads to health problems nationwide, including preterm birth, low birth weight, preventable deaths, lung cancer, cardiovascular and respiratory diseases, and affected days. The study also suggests that outdoor wildfires are a crucial factor directly impacting health due to air pollution.…”

A Study on a Health Impact Assessment and Healthcare Cost Calculation of Beijing–Tianjin–Hebei Residents under PM2.5 and O3 Pollution

“…Moreover, they evaluated the economic losses and medical expenses of premature death caused by related diseases. Most existing studies take countries (such as the United States [18], Mexico [19], and East Africa [20]) and provinces [21,22] as research subjects to explore the impacts of atmospheric contamination on residents' health. Moreover, the United States and European countries started studies on the health effects of air pollution and the formulation of pollution prevention and control policies early, achieving notable results.…”