Advancing the community health vulnerability index for wildland fire smoke exposure.

Wildland fire smoke risks are not uniformly distributed across people and places, and the most vulnerable communities are often disproportionately impacted. This study develops a county level community health vulnerability index (CHVI) for the Contiguous United States (CONUS) using three major vulnerability components: adaptive capacity, sensitivity, and exposure at the national and regional level. We first calculated sensitivity and adaptive capacity sub-indices using nine sensitivity and twenty adaptive capacity variables. These sub-indices were then combined with an exposure sub-index, which is based on the Community Multiscale Air Quality data (2008-2018), to develop CHVI. Finally, we conducted several analyses with the derived indices to: 1) explore associations between the level of fine particulate matter from wildland fires (fire-PM) and the sub-indices/CHVI; 2) measure the impact of fire-PM on the increase in the annual number of days with 12-35 μg/m (moderate) and >35 μg/m (at or above unhealthy for sensitive groups) based on the US EPA Air Quality Index categories, and 3) calculate population size in different deciles of the sub-indices/CHVI. This study has three main findings. First, we showed that the counties with higher daily fire-PM concentration tend to have lower adaptive capacity and higher sensitivity and vulnerability. Relatedly, the counties at high risk tended to experience a greater increase in the annual number of days with 12-35 μg/m and >35 μg/m than their counterparts. Second, we found that 16.1, 12.0, and 17.6 million people out of 332 million in CONUS reside in the counties in the lowest adaptive capacity decile, highest sensitivity decile, and highest vulnerability decile, respectively. Third, we identified that the US Northwest, California, and Southern regions tended to have higher vulnerability than others. Accurately identifying a community's vulnerability to wildfire smoke can help individuals, researchers, and policymakers better understand, prepare for, and respond to future wildland fire events.