Song Hyeonjin, Liang Menglu, Sieck Nicole E, Lin Huang, Raimann Jochen, Maddux Frank W, Desai Priya, Ellicott Evan Andrew, He Xin, Nguyen Quynh, Liang Xin-Zhong, Kotanko Peter, Sapkota Amir
Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA.
Climate Science Team, First Street, New York, New York, USA.
Kidney Int Rep. 2025 Apr 23;10(6):1750-1760. doi: 10.1016/j.ekir.2025.04.002. eCollection 2025 Jun.
Smoke plumes from the 2023 Canadian wildfires severely impacted air quality across the Eastern and Midwestern USA. However, a comprehensive health impact assessment is lacking in this large region. We investigated the association between wildfire-related air pollutants and the risk of mortality and hospitalization among hemodialysis patients in 22 heavily impacted states in the Eastern and Midwestern USA.
We conducted a retrospective observational study using a time-stratified case-crossover analysis with a conditional quasi-Poisson model. The study included 52,995 patients with end-stage kidney disease (ESKD) receiving hemodialysis at Fresenius Kidney Care clinics during June and July 2023. The presence of wildfire smoke and fine particulate matter (with aerodynamic diameter < 2.5 microns, PM) concentrations were assessed using satellite-derived smoke polygons and ground-based monitors. Daily number of all-cause deaths, all-cause hospitalizations, respiratory disease hospitalizations, and cardiovascular disease hospitalizations were counted for each hemodialysis clinic.
The highest daily wildfire-related PM concentration observed (251.1 μg/m) far exceeded the National Ambient Air Quality Standard (35 μg/m). The presence of wildfire smoke plume was associated with an 18% increase in risk of same day (lag0) all-cause mortality (rate ratio [RR]:1.18; 95% confidence interval [CI], 1.13-1.24) and a 3% increase in risk of all-cause hospitalization (RR:1.03; 95% CI: 1.00-1.07). A 10 μg/m increase in wildfire-related PM was associated with a 139% increase in same day all-cause mortality (RR: 2.39; 95% CI: 1.79-3.18), and a 33% increase in all-cause hospitalization (RR:1.33; 95% CI: 1.10-1.62).
Our findings suggest that air pollution from the 2023 Canadian wildfires resulted in increased risk of mortality and hospitalization among hemodialysis patients in Eastern and Midwestern USA.
2023年加拿大野火产生的烟雾羽流严重影响了美国东部和中西部的空气质量。然而，在这个广大地区缺乏全面的健康影响评估。我们调查了美国东部和中西部22个受严重影响州的野火相关空气污染物与血液透析患者死亡率和住院风险之间的关联。
我们进行了一项回顾性观察研究，采用时间分层病例交叉分析和条件准泊松模型。该研究纳入了2023年6月和7月在费森尤斯肾脏护理诊所接受血液透析的52995例终末期肾病（ESKD）患者。利用卫星衍生的烟雾多边形和地面监测器评估野火烟雾的存在和细颗粒物（空气动力学直径<2.5微米，PM）浓度。统计每个血液透析诊所的全因死亡、全因住院、呼吸道疾病住院和心血管疾病住院的每日数量。
观察到的与野火相关的最高每日PM浓度（251.1μg/m）远远超过国家环境空气质量标准（35μg/m）。野火烟雾羽流的存在与当日（滞后0）全因死亡率风险增加18%（率比[RR]：1.18；95%置信区间[CI]，1.13 - 1.24）以及全因住院风险增加3%（RR：1.03；95%CI：1.00 - 1.07）相关。与野火相关的PM每增加10μg/m，当日全因死亡率增加139%（RR：2.39；95%CI：1.79 - 3.18），全因住院增加33%（RR：1.33；95%CI：1.10 - 1.62）。
我们的研究结果表明，2023年加拿大野火造成的空气污染导致美国东部和中西部血液透析患者的死亡率和住院风险增加。
