Health Outcomes

Health Outcome List:

• Respiratory outcomes (asthma, acute bronchitis, lower respiratory symptoms, asthma exacerbations, asthma attacks, upper respiratory symptoms in asthmatics)
• cardiovascular outcomes (congestive heart failure, nonfatal heart attacks)
• mortality (premature death)

Environmental Agents

List of Environmental Agents:

• Air pollutants (particulate matter (PM2.5/fine))

Source of Environmental Agents:

• Wildfire smoke

Economic Evaluation / Methods and Source

Type:

• Cost-benefit analysis (CBA), Cost-effectiveness analysis (CEA)

Cost Measures:

• Costs of emergency department visits and hospital admissions related to asthma and congestive heart failure attributable to smoke-based PM2.5 exposure
• costs of illness (premature deaths, nonfatal heart attacks, chronic cardiovascular conditions, acute bronchitis, lower respiratory symptoms, upper respiratory symptoms, aggravated asthma)
• costs of lost productivity (days of work lost, minor restricted activity days)

Potential Cost Measures:

• Cost of protective measures to mitigate individual smoke exposure (e.g., HEPA filters and personal masks)
• impacts on quality of life

Benefits Measures:

• Avoided healthcare costs from emergency department visits and hospital admissions related to asthma and congestive heart failure attributable to smoke-based PM2.5 exposure
• avoided loss of productivity
• avoided cases of premature mortality attributable to smoke exposure

Potential Benefits Measures:

• Not available

Location:

• 31 counties in eastern North Carolina

Models Used:

• Benefits Mapping and Analysis Program - Community Edition (BenMAP-CE) tool (v0.63)

Models References:

• Not available

Methods Used:

• The authors simulated forecast-based interventions using a wildfire smoke episode/case study in rural North Carolina to demonstrate the potential for using modeled smoke forecasts to reduce the human health burden and estimated the resulting economic benefits of reduced smoke exposures. The authors — 1) established a baseline risk model without any intervention to build county level forecast-based interventions; 2) simulated forecast-based intervention scenarios that vary based on the levels of smoke-based PM2.5 used to trigger advisories; 3) simulated three adherence levels for each of the three smoke-based PM2.5 interventions; 4) estimated relative risk of adverse health outcomes for each of the interventions; 5) evaluated the association between asthma and congestive heart failure related to emergency department visits and smoke-based PM2.5 for each intervention; and 6) quantified the economic value of non-avoidance of smoke in these outcomes as well as in a number of general health outcomes.

Sources Used:

• Peat bog wildfire smoke exposure in rural North Carolina is associated with cardiopulmonary emergency department visits assessed through syndromic surveillance (Rappold et al., 2011); NOAA Smoke Forecasting System for the 2008 Evans Road wildfire in North Carolina; North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) (North Carolina Divisions of Public Health, 2010); 2008 Nationwide Emergency Department Sample from the Healthcare Cost and Utilization Project (Agency for Healthcare Research and Quality, 2008); Regulatory impact analysis for the final revisions to the national ambient air quality standards for particulate matter (U.S. EPA); additional sources cited in publication

Economic Citation / Fundings

Citation:

• Rappold AG, Fann NL, Crooks J, Huang J, Cascio WE, Devlin RB, and Diaz-Sanchez D. Forecast-based interventions can reduce the health and economic burden of wildfires. Environ Sci Technol. 2014. 48; 18.
• Pubmed
• DOI

NIEHS Funding:

• Not available

Other Funding:

• Internal funding by US Environmental Protection Agency