The Burden of Wildfire Smoke on Respiratory Health in California at the Zip Code Level: Uncovering the Disproportionate Impacts of Differential Fine Particle Composition.

Wildfires constitute a growing source of extremely high levels of particulate matter that is less than 2.5 microns in diameter (PM2.5). Recently, toxicologic and epidemiologic studies have shown that PM2.5 generated from wildfires may have a greater health burden than PM2.5 generated from other pollutant sources. This study examined the impact of PM2.5 on hospitalizations for respiratory diseases in California between 2006 and 2019 using a health impact assessment approach that considers differential concentration-response functions (CRF) for PM2.5 from wildfire and non-wildfire sources of emissions. We quantified the burden of respiratory hospitalizations related to PM2.5 exposure at the zip code level through two different approaches: (a) naïve (considering the same CRF for all PM2.5 emissions) and (b) nuanced (considering different CRFs for PM2.5 from wildfires and from other sources). We conducted a Geographically Weighted Regression to analyze spatially varying relationships between the delta (i.e., the difference between the naïve and nuanced approaches) and the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI). A higher attributable number of respiratory hospitalizations was found when accounting for the larger health burden of wildfire PM2.5. We found that, between 2006 and 2019, the number of hospitalizations attributable to PM2.5 may have been underestimated by approximately 13% as a result of not accounting for the higher CRF of wildfire-related PM2.5 throughout California. This underestimation was higher in northern California and areas with higher SVI rankings. The relationship between delta and SVI varied spatially across California. These findings can be useful for updating future air pollution guideline recommendations.