Wildfire smoke exposure and early childhood respiratory health: a study of prescription claims data

Abstract

Wildfire smoke is associated with short-term respiratory outcomes including asthma exacerbation in children. As investigations into developmental wildfire smoke exposure on children’s longer-term respiratory health are sparse, we investigated associations between developmental wildfire smoke exposure and first use of respiratory medications. Prescription claims from IBM MarketScan Commercial Claims and Encounters database were linked with wildfire smoke plume data from NASA satellites based on Metropolitan Statistical Area (MSA). A retrospective cohort of live infants (2010–2016) born into MSAs in six western states (U.S.A.), having prescription insurance, and whose birthdate was estimable from claims data was constructed (N = 184,703); of these, gestational age was estimated for 113,154 infants. The residential MSA, gestational age, and birthdate were used to estimate average weekly smoke exposure days (smoke-day) for each developmental period: three trimesters, and two sequential 12-week periods post-birth. Medications treating respiratory tract inflammation were classified using active ingredient and mode of administration into three categories:: 'upper respiratory', 'lower respiratory', 'systemic anti-inflammatory'. To evaluate associations between wildfire smoke exposure and medication usage, Cox models associating smoke-days with first observed prescription of each medication category were adjusted for infant sex, birth-season, and birthyear with a random intercept for MSA. Smoke exposure during postnatal periods was associated with earlier first use of upper respiratory medications (1–12 weeks: hazard ratio (HR) = 1.094 per 1-day increase in average weekly smoke-day, 95%CI: (1.005,1.191); 13–24 weeks: HR = 1.108, 95%CI: (1.016,1.209)). Protective associations were observed during gestational windows for both lower respiratory and systemic anti-inflammatory medications; it is possible that these associations may be a consequence of live-birth bias. These findings suggest wildfire smoke exposure during early postnatal developmental periods impact subsequent early life respiratory health.

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

“…Although not conclusively proven, it is plausible that PM 2.5 exposure during critical developmental periods could impair lung growth [96]. A retrospective study demonstrated that smoke exposure in the first trimester of pregnancy and in the postnatal period was associated with earlier pediatric treatment for the first upper respiratory infection [99].…”

“Air That Once Was Breath” Part 2: Wildfire Smoke and Airway Disease – “Climate Change, Allergy and Immunology” Special IAAI Article Collection: Collegium Internationale Allergologicum Update 2023

“…However, many of the effects of wildfire smoke exposure on respiratory development and later disease phenotypes remain unclear. In a recent study, Dhingra et al [108] found that smoke exposure during postnatal periods was associated with earlier first use of upper respiratory medications and concluded that wildfire smoke exposure during early postnatal developmental periods impacts subsequent childhood respiratory health.…”

PM2.5 Is Insufficient to Explain Personal PAH Exposure

“…Example measures include PM data from stationary air monitors and wildfire smoke density data from satellites (Gan et al., 2017). Numerous studies have analyzed the relationship between wildfire smoke and health outcomes using PM stationary air monitoring data, HMS data, or a combination of both as proxies for personal chemical exposure (Abdo et al., 2019; Aguilera, Corringham, Gershunov, Leibel, & Benmarhnia, 2021; Aguilera, Corringham, Gershunov, & Benmarhnia, 2021; Cleland et al., 2022; Dhingra et al., 2023; Heft‐Neal et al., 2022; Jones et al., 2020; Lipner et al., 2019; Magzamen et al., 2021; Mirabelli et al., 2022; O’Dell et al., 2022; Sorensen et al., 2021; Stowell et al., 2019; Wettstein et al., 2018). For example, a recent wildfire epidemiology study compared mental health symptoms with HMS smoke categories and stated that the HMS estimates are “a proxy for exposure to wildfire smoke” (Mirabelli et al., 2022).…”