San Francisco Veterans' Affairs Medical Center, San Francisco, CA, USA.
University of California San Francisco, San Francisco, CA, USA.
Lancet Planet Health. 2023 May;7(5):e381-e386. doi: 10.1016/S2542-5196(23)00046-3.
Large-scale wildfires in California, USA, are increasing in both size and frequency, with substantial health consequences. The capacity for wildfire smoke to displace microbes and cause clinically significant fungal infections is poorly understood. We aimed to determine whether exposure to wildfire smoke was associated with an increased risk of hospital admissions for systemic fungal infections.
In this population-based, retrospective study, we used hospital administrative data from 22 hospitals in California, USA, to analyse the association between wildfire smoke exposure and monthly hospital admissions for aspergillosis and coccidioidomycosis. We included hospitals that were members of the Vizient Clinical Data Base or Resource Manager during the study and excluded those that did not have complete reporting into Vizient during the study period. Smoke exposure was estimated using satellite-imaged smoke plumes in the hospital county. Incident rate ratios were calculated for all infection types 1 month and 3 months after smoke exposure.
Between Oct 1, 2014, and May 31, 2018, there were a median of 1638 annual admissions per hospital in the study sample. Individual patient demographics were not collected. We did not observe an association between smoke exposure and rate of hospital admission for aspergillosis. However, hospital admission for coccidioidomycosis increased by 20% (95% CI 5-38) in the month following any smoke exposure. Hospital admission increased by 2% (0-4) for every day that there had been smoke exposure in the previous month, after adjustment for temperature and temporal trend. Similar results were obtained with smoke exposure data from the 3 months before admission.
In the months following wildfire smoke exposure, California hospitals saw increased coccidioidomycosis infections. Given the projected increase in California wildfires and their expansion in endemic territories of soil-dwelling fungi, the ability for wildfire smoke to carry microbes and cause human disease warrants further research.
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美国加利福尼亚州的大规模野火在规模和频率上都有所增加，造成了重大的健康后果。野火烟雾置换微生物并导致临床上显著的真菌感染的能力尚未得到充分理解。我们旨在确定暴露于野火烟雾是否与医院收治系统性真菌感染的风险增加有关。
在这项基于人群的回顾性研究中，我们使用了美国加利福尼亚州 22 家医院的医院管理数据，分析了暴露于野火烟雾与每月医院收治曲霉菌病和球孢子菌病的相关性。我们纳入了在研究期间是 Vizient 临床数据库或资源管理器成员的医院，并排除了在研究期间没有完整向 Vizient 报告的医院。使用医院所在县的卫星成像烟雾羽流来估计烟雾暴露情况。在烟雾暴露后 1 个月和 3 个月计算所有感染类型的发病率比值。
在 2014 年 10 月 1 日至 2018 年 5 月 31 日期间，研究样本中每家医院每年的平均住院人数为 1638 人。未收集患者的个体人口统计学信息。我们没有观察到烟雾暴露与曲霉菌病住院率之间存在关联。然而，在任何烟雾暴露后的一个月内，球孢子菌病的住院率增加了 20%（95%CI，5-38）。在校正温度和时间趋势后，在前一个月有烟雾暴露的每一天，住院率增加 2%（0-4）。在入院前 3 个月的烟雾暴露数据中也得到了类似的结果。
在暴露于野火烟雾后的几个月里，加利福尼亚州的医院看到了更多的球孢子菌病感染。鉴于加利福尼亚州野火的预计增加及其在土壤栖居真菌的流行地区的扩展，野火烟雾携带微生物并导致人类疾病的能力需要进一步研究。
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