Air pollution events from forest fires and emergency department attendances in Sydney, Australia 1996–2007: a case-crossover analysisReportar como inadecuado

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Environmental Health

, 13:105

First Online: 10 December 2014Received: 12 June 2014Accepted: 28 November 2014DOI: 10.1186-1476-069X-13-105

Cite this article as: Johnston, F.H., Purdie, S., Jalaludin, B. et al. Environ Health 2014 13: 105. doi:10.1186-1476-069X-13-105


BackgroundSevere air pollution generated by forest fires is becoming an increasingly frequent public health management problem. We measured the association between forest fire smoke events and hospital emergency department ED attendances in Sydney from 1996–2007.

MethodsA smoke event occurred when forest fires caused the daily citywide average concentration of particulate matter PM10 or PM2.5 to exceed the 99th percentile of the entire study period. We used a time-stratified case-crossover design and conditional logistic regression models adjusted for meteorology, influenza epidemics, and holidays to estimate odds ratios OR and 95% confidence intervals CI for ED attendances on event days compared with non-event days for all non-trauma ED attendances and selected cardiorespiratory conditions.

ResultsThe 46 validated fire smoke event days during the study period were associated with same day increases in ED attendances for all non-trauma conditions 1.03, 95% CI 1.02, 1.04, respiratory conditions OR 1.07, 95% CI 1.04, 1.10, asthma OR 1.23, 95% CI 1.15, 1.30, and chronic obstructive pulmonary disease OR 1.12, 95% CI 1.02, 1.24. Positive associations persisted for one to three days after the event. Ischaemic heart disease ED attendances were increased at a lag of two days OR 1.07, 95% CI 1.01, 1.15 while arrhythmias had an inverse association at a lag of two days OR 0.91, 95% CI 0.83, 0.99. In age-specific analyses, no associations present in children less than 15 years of age for any outcome, although a non-significant trend towards a positive association was seen with childhood asthma. A further association between smoke event and heart failure attendances was present for the 15–65 year age group, but not older adults at a lag of two days OR 1.37 95% CI 1.05, 1.78.

ConclusionSmoke events were associated with an immediate increase in presentations for respiratory conditions and a lagged increase in attendances for ischaemic heart disease and heart failure. Respiratory impacts were either absent or considerably attenuated in those <15 years. Similar to previous studies we found inconsistent associations between fire smoke and cardiovascular diseases. Better characterisation of the spectrum of population health risks is needed to guide public heath responses to severe smoke events as this exposure becomes increasingly common with global climate change

KeywordsForest fires Air pollution Emergency departments attendances Case crossover Respiratory Cardiovascular Abbreviations95% CI95% confidence intervals

COPDChronic obstructive pulmonary disease

EDEmergency Department

EDDCEmergency Department Data Collection

ICDInternational Classification of Diseases

NSWNew South Wales

OROdds ratio

PMParticulate matter

SLAStatistical local area.

Electronic supplementary materialThe online version of this article doi:10.1186-1476-069X-13-105 contains supplementary material, which is available to authorized users.

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Autor: Fay H Johnston - Stuart Purdie - Bin Jalaludin - Kara L Martin - Sarah B Henderson - Geoffrey G Morgan


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