California Wildfire Impact on Pediatric Asthma Hospitalizations

Abstract

Background:

Wildfire activity in California has increased over recent years due climate change resulting in severe droughts. There are demonstrated connections between wildfire smoke exposure and increased ED visits and hospitalizations in those with asthma. Our health system experienced an increase in pediatric asthma hospital admissions during November 2018 Camp fire and November 2019 Kincade fire. We compared this admission data to Novembers 2020 and 2021 when there was a lower fire season. We aim to evaluate the pediatric asthma admissions during these times.

Methods:

Retrospective data was analyzed from a Vizient database of patients <18 years with a hospital admission for a primary diagnosis of asthma exacerbation at UC Davis Health in Sacramento California. Data were analyzed during the months of November in 2018 when 153,336 acres burned and 2019 when 77,758 acres burned. We then compared the admission data to Novembers 2020 during which 379 acres burned and 2021 where 24 acres burned. Admissions and patients with asthma action plans (AAP) were evaluated and compared. Descriptive statistical analysis was performed with Chi square, Student t-test, and 95% confidence intervals when appropriate.

Results:

There were 47 admissions for asthma during 2018-19 (70%) vs. 20 (32%) in 2020-21, P = .02. For admissions during high fire months, 53% of patients had an AAP prior to hospitalization (n = 25), 28% did not have an AAP (n = 13), and 19% (n = 9) were unknown. Of those patients with an AAP, 48% were following their AAP at time of admission (n = 12) and 52% were not (n = 13). Patients following their AAP were younger, (M = 4 y ± 2.7 vs. M = 8.3 ± 5.1, P = .02) and had a shorter LOS (1.08 ± 0.08 vs. 1.85 ± 0.27, P = .02). There was no difference in sex (P = .81), race (P = .61), and those living in areas with low income and access to care (P = .81) in those following vs. not following their AAP. 45 of the 47 patients admitted during wildfire season were discharged with an AAP.

Conclusions:

A statistically significant increase in hospital admissions were seen during November’s high wildfire months in 2018 and 2019 compared to low fire seasons in Novembers 2020 and 2021. During the high fire seasons, those implementing their AAP were younger and had lower LOS. Efforts to prevent hospitalizations, such as education on action plan utilization, should be considered for pediatric asthma patients living in regions where wildfires have become seasonal norms.