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. 2025 Feb 18;14(4):e036264.
doi: 10.1161/JAHA.124.036264. Epub 2025 Feb 5.

Wildfire Air Pollution and Rates of Cardiovascular Events and Mortality in Northern California in 2018

Stacey E Alexeeff  1 , Stephen K Van Den Eeden  1 , Kamala Deosaransingh  1 , Stephen Sidney  1 , Noelle S Liao  1 , Jamal S Rana  1   2
Affiliations

Wildfire Air Pollution and Rates of Cardiovascular Events and Mortality in Northern California in 2018

Stacey E Alexeeff et al. J Am Heart Assoc. .

Abstract

Background: We examined the association between acute cardiovascular disease (CVD) events and wildfire air pollution in California in 2018.

Methods: The study included adult (≥18 years) members of Kaiser Permanente Northern California, an integrated health care system. Outcomes included CVD events (hospitalizations for acute myocardial infarction, heart failure, or stroke, and CVD death) and death from any cause. Fine particulate air pollution (particulate matter <2.5 microns in diameter; PM2.5) exposure was assessed in categories (Good <12 μg/m3, Moderate 12-34 μg/m3, High ≥35 μg/m3) and continuously. Poisson time series regression was used to model daily event rates during July 1 to December 31, 2018, using a spline to adjust for long-term time trends. We calculated rate ratios (RR) to estimate the association between wildfire air pollution and daily rate of CVD events and deaths.

Results: Our study included 3.2 million adults with a total follow-up of 587.9 million person-days. High PM2.5 concentrations during the Mendocino Complex wildfire in July to August was associated with an increased rate of CVD events (RR, 1.231 [95% CI, 1.039-1.458]) and death (RR, 1.358 [95% CI, 1.128-1.635]) compared with Good PM2.5 concentrations. In contrast, there was no evidence of increased risk during the Camp wildfire in November (RR for CVD events, 0.966 [95% CI, 0.894-1.044]; RR for all-cause mortality, 0.985 [95% CI, 0.904-1.074] High versus Good PM2.5 concentrations).

Conclusions: There was some evidence of increased rates of CVD events and death during wildfires, but results were inconsistent. With ongoing climate change, large wildfires are a pressing public health concern and future work is needed to understand differences in health outcomes by wildfire.

Keywords: myocardial infarction; particulate matter; wildfire; wildfire smoke; wildland fire.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1. PM2.5 air pollution concentrations and smoke plumes during 2018 wildfires: Mendocino Complex and other fires (A), Camp fire (B).
PM2.5 indicates particulate matter <2.5 microns in diameter.
Figure 2
Figure 2. Daily concentrations of PM2.5 at air pollution monitors in Northern and Central California during July–December 2018.
EPA indicates Environmental Protection Agency; and PM2.5, particulate matter <2.5 microns in diameter.
Figure 3
Figure 3. Associations of PM2.5 with CVD events and all‐cause mortality during 2018 in Northern and Central California, for PM2.5 concentrations below the EPA limit of 35 μg/m3, overall and by wildfire and nonwildfire PM2.5.
A, overall PM2.5 and CVD events, (B) overall PM2.5 and all‐cause mortality, (C) wildfire PM2.5, nonwildfire PM2.5 and CVD events, (D) wildfire PM2.5, nonwildfire PM2.5 and all‐cause mortality. CVD indicates cardiovascular disease; EPA, Environmental Protection Agency; and PM2.5, particulate matter <2.5 microns in diameter.
Figure 4
Figure 4. Google Trends scores for wildfire related search terms in California during July to December 2018.
See this image and copyright information in PMC

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