Wildfire smoke exposure and emergency department visits for headache: A case-crossover analysis in California, 2006–2020
Corresponding Author
Holly Elser MD, PhD
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Center for Population Health Sciences, Stanford University, Stanford, California, USA
Correspondence
Holly Elser, Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Email: [email protected]
Search for more papers by this authorSebastian T. Rowland PhD
Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
PSE Healthy Energy, Oakland, New York, USA
Search for more papers by this authorMaksym S. Marek MD, MS
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Search for more papers by this authorMathew V. Kiang ScD
Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
Search for more papers by this authorBrittany Shea MA
Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
Search for more papers by this authorVivian Do MPH
Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
Search for more papers by this authorTarik Benmarhnia PhD
Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California, USA
Search for more papers by this authorAndrea L. C. Schneider MD, PhD
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
Search for more papers by this authorJoan A. Casey PhD
Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
Search for more papers by this authorCorresponding Author
Holly Elser MD, PhD
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Center for Population Health Sciences, Stanford University, Stanford, California, USA
Correspondence
Holly Elser, Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Email: [email protected]
Search for more papers by this authorSebastian T. Rowland PhD
Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
PSE Healthy Energy, Oakland, New York, USA
Search for more papers by this authorMaksym S. Marek MD, MS
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Search for more papers by this authorMathew V. Kiang ScD
Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
Search for more papers by this authorBrittany Shea MA
Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
Search for more papers by this authorVivian Do MPH
Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
Search for more papers by this authorTarik Benmarhnia PhD
Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California, USA
Search for more papers by this authorAndrea L. C. Schneider MD, PhD
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
Search for more papers by this authorJoan A. Casey PhD
Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
Search for more papers by this authorAbstract
Objective
To evaluate the association of short-term exposure to overall fine particulate matter of <2.5 μm (PM2.5) and wildfire-specific PM2.5 with emergency department (ED) visits for headache.
Background
Studies have reported associations between PM2.5 exposure and headache risk. As climate change drives longer and more intense wildfire seasons, wildfire PM2.5 may contribute to more frequent headaches.
Methods
Our study included adult Californian members (aged ≥18 years) of a large de-identified commercial and Medicare Advantage claims database from 2006 to 2020. We identified ED visits for primary headache disorders (subtypes: tension-type headache, migraine headache, cluster headache, and “other” primary headache). Claims included member age, sex, and residential zip code. We linked daily overall and wildfire-specific PM2.5 to residential zip code and conducted a time-stratified case-crossover analysis considering 7-day average PM2.5 concentrations, first for primary headache disorders combined, and then by headache subtype.
Results
Among 9898 unique individuals we identified 13,623 ED encounters for primary headache disorders. Migraine was the most frequently diagnosed headache (N = 5534/13,623 [47.6%]) followed by “other” primary headache (N = 6489/13,623 [40.6%]). For all primary headache ED diagnoses, we observed an association of 7-day average wildfire PM2.5 (odds ratio [OR] 1.17, 95% confidence interval [CI] 0.95–1.44 per 10 μg/m3 increase) and by subtype we observed increased odds of ED visits associated with 7-day average wildfire PM2.5 for tension-type headache (OR 1.42, 95% CI 0.91–2.22), “other” primary headache (OR 1.40, 95% CI 0.96–2.05), and cluster headache (OR 1.29, 95% CI 0.71–2.35), although these findings were not statistically significant under traditional null hypothesis testing. Overall PM2.5 was associated with tension-type headache (OR 1.29, 95% CI 1.03–1.62), but not migraine, cluster, or “other” primary headaches.
Conclusions
Although imprecise, these results suggest short-term wildfire PM2.5 exposure may be associated with ED visits for headache. Patients, healthcare providers, and systems may need to respond to increased headache-related healthcare needs in the wake of wildfires and on poor air quality days.
CONFLICTS OF INTEREST
Holly Elser, Sebastian T. Rowland, Maksym S. Marek, Mathew V. Kiang, Brittany Shea, Vivian Do, Tarik Benmarhnia, Andrea L.C. Schneider, and Joan A. Casey declare no conflicts of interest.
Supporting Information
| Filename | Description |
|---|---|
| head14442-sup-0001-supinfo.docxWord 2007 document , 40 KB |
Appendix S1. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1Abatzoglou JT, Williams AP. Impact of anthropogenic climate change on wildfire across western US forests. Proc Natl Acad Sci U S A. 2016; 113(42): 11770-11775.
- 2Williams AP, Abatzoglou JT, Gershunov A, et al. Observed impacts of anthropogenic climate change on wildfire in California. Earths Future. 2019; 7(8): 892-910.
- 3Burke M, Driscoll A, Heft-Neal S, Xue J, Burney J, Wara M. The changing risk and burden of wildfire in the United States. Proc Natl Acad Sci U S A. 2021; 118(2):e2011048118.
- 4Westerling AL, Hidalgo HG, Cayan DR, Swetnam TW. Warming and earlier spring increase western US forest wildfire activity. Science. 2006; 313(5789): 940-943.
- 5Seager R, Hooks A, Williams AP, Cook B, Nakamura J, Henderson N. Climatology, variability, and trends in the US vapor pressure deficit, an important fire-related meteorological quantity. J Appl Meteorol Climatol. 2015; 54(6): 1121-1141.
- 6Li S, Banerjee T. Spatial and temporal pattern of wildfires in California from 2000 to 2019. Sci Rep. 2021; 11(1): 1-17.
- 7Liao Y, Kousky C. The fiscal impacts of wildfires on California municipalities. J Assoc Environ Resour Econ. 2022; 9(3): 455-493.
- 8Wang D, Guan D, Zhu S, et al. Economic footprint of California wildfires in 2018. Nat Sustain. 2021; 4(3): 252-260.
- 9Stone SL, Anderko L, Berger M, Butler C, Cascio W, Clune A. Wildfire Smoke: A Guide for Public Health Officials. US Environmental Protection Agency; 2019.
- 10Verma V, Polidori A, Schauer JJ, Shafer MM, Cassee FR, Sioutas C. Physicochemical and toxicological profiles of particulate matter in Los Angeles during the October 2007 southern California wildfires. Environ Sci Technol. 2009; 43(3): 954-960.
- 11Balmes JR. The changing nature of wildfires: impacts on the health of the public. Clin Chest Med. 2020; 41(4): 771-776.
- 12Masselot P, Sera F, Schneider R, et al. Differential mortality risks associated with PM2.5 components: a multi-country, multi-city study. Epidemiology. 2021; 33(2): 167-175.
- 13Wegesser TC, Pinkerton KE, Last JA. California wildfires of 2008: coarse and fine particulate matter toxicity. Environ Health Perspect. 2009; 117(6): 893-897.
- 14Reid CE, Brauer M, Johnston FH, Jerrett M, Balmes JR, Elliott CT. Critical review of health impacts of wildfire smoke exposure. Environ Health Perspect. 2016; 124(9): 1334-1343.
- 15Black C, Tesfaigzi Y, Bassein JA, Miller LA. Wildfire smoke exposure and human health: significant gaps in research for a growing public health issue. Environ Toxicol Pharmacol. 2017; 55: 186-195.
- 16Liu C, Chen R, Sera F, et al. Ambient particulate air pollution and daily mortality in 652 cities. N Engl J Med. 2019; 381(8): 705-715.
- 17Reid CE, Maestas MM. Wildfire smoke exposure under climate change: impact on respiratory health of affected communities. Curr Opin Pulm Med. 2019; 25(2): 179-187.
- 18DeFlorio-Barker S, Crooks J, Reyes J, Rappold AG. Cardiopulmonary effects of fine particulate matter exposure among older adults, during wildfire and non-wildfire periods, in the United States 2008–2010. Environ Health Perspect. 2019; 127(3):037006.
- 19Gan RW, Ford B, Lassman W, et al. Comparison of wildfire smoke estimation methods and associations with cardiopulmonary-related hospital admissions. GeoHealth. 2017; 1(3): 122-136.
- 20Bhatnagar A. Cardiovascular effects of particulate air pollution. Annu Rev Med. 2022; 73: 393-406.
- 21Holstius DM, Reid CE, Jesdale BM, Morello-Frosch R. Birth weight following pregnancy during the 2003 Southern California wildfires. Environ Health Perspect. 2012; 120(9): 1340-1345.
- 22Cândido da Silva AM, Moi GP, Mattos IE, Hacon SS. Low birth weight at term and the presence of fine particulate matter and carbon monoxide in the Brazilian Amazon: a population-based retrospective cohort study. BMC Pregnancy Childbirth. 2014; 14(1): 1-8.
- 23Szyszkowicz M, Kaplan G, Grafstein E, Rowe B. Emergency department visits for migraine and headache: a multi-city study. Int J Occup Med Environ Health. 2009; 22(3): 235-242.
- 24Szyszkowicz M, Stieb DM, Rowe BH. Air pollution and daily ED visits for migraine and headache in Edmonton, Canada. Am J Emerg Med. 2009; 27(4): 391-396.
- 25Lee H, Myung W, Cheong H-K, et al. Ambient air pollution exposure and risk of migraine: synergistic effect with high temperature. Environ Int. 2018; 121: 383-391.
- 26Chen C-C, Tsai S-S, Yang C-Y. Association between fine particulate air pollution and daily clinic visits for migraine in a subtropical city: Taipei, Taiwan. Int J Environ Res Public Health. 2015; 12(5): 4697-4708.
- 27Chiu H-F, Yang C-Y. Air pollution and daily clinic visits for migraine in a subtropical city: Taipei, Taiwan. J Toxicol Environ Health A. 2015; 78(9): 549-558.
- 28Stovner LJ, Nichols E, Steiner TJ, et al. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018; 17(11): 954-976.
- 29Lofland J. Impact of migraine headache in the United States. Adv Stud Pharm. 2007; 4: 8-10.
- 30Porter JK, Di Tanna GL, Lipton RB, Sapra S, Villa G. Costs of acute headache medication use and productivity losses among patients with migraine: insights from three randomized controlled trials. Pharmacoeconomics Open. 2019; 3(3): 411-417.
- 31Berg J, Ramadan NM. Societal Burden of the Headache. The Headaches. Lipencott & Williams; 2006: 35-42.
- 32Gilligan AM, Foster SA, Sainski-Nguyen A, Sedgley R, Smith D, Morrow P. Direct and indirect costs among United States commercially insured employees with migraine. J Occup Environ Med. 2018; 60(12): 1120-1127.
- 33Maclure M. The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol. 1991; 133(2): 144-153.
- 34Maclure M, Mittleman MA. Should we use a case-crossover design? Annu Rev Public Health. 2000; 21(1): 193-221.
- 35Armstrong BG, Gasparrini A, Tobias A. Conditional Poisson models: a flexible alternative to conditional logistic case cross-over analysis. BMC Med Res Methodol. 2014; 14(1): 1-6.
- 36Wichmann J, Ketzel M, Ellermann T, Loft S. Apparent temperature and acute myocardial infarction hospital admissions in Copenhagen, Denmark: a case-crossover study. Environ Health. 2012; 11(1): 1-12.
- 37Kyobutungi C, Grau A, Stieglbauer G, Becher H. Absolute temperature, temperature changes and stroke risk: a case-crossover study. Eur J Epidemiol. 2005; 20(8): 693-698.
- 38Buckley JP, Richardson DB. Seasonal modification of the association between temperature and adult emergency department visits for asthma: a case-crossover study. Environ Health. 2012; 11(1): 1-6.
- 39Abatzoglou JT. Development of gridded surface meteorological data for ecological applications and modelling. Int J Climatol. 2013; 33(1): 121-131.
- 40Aguilera R, Luo N, Basu R, Wu J, Gershunov A, Benmarhnia T. Using Machine Learning to Estimate Wildfire PM2.5 at California ZIP Codes (2006–2020). ChemRxiv; 2021.
- 41Mittleman MA, Mostofsky E. Exchangeability in the case-crossover design. Int J Epidemiol. 2014; 43(5): 1645-1655.
- 42Mittleman MA. Optimal referent selection strategies in case-crossover studies: a settled issue. Epidemiology. 2005; 16(6): 715-716.
- 43Chen G, Guo Y, Yue X, et al. Mortality risk attributable to wildfire-related PM2.5 pollution: a global time series study in 749 locations. Lancet Planet Health. 2021; 5(9): e579-e587.
- 44Gutiérrez-Avila I, Rojas-Bracho L, Riojas-Rodríguez H, Kloog I, Just AC, Rothenberg SJ. Cardiovascular and cerebrovascular mortality associated with acute exposure to PM2.5 in Mexico City. Stroke. 2018; 49(7): 1734-1736.
- 45 United States Environmental Protection Agency. National Ambient Air Quality Standards (NAAQS) for PM. EPA; 2022 Accessed October 1, 2022. https://www.epa.gov/pm-pollution/national-ambient-air-quality-standards-naaqs-pm
- 46Achilleos S, Kioumourtzoglou M-A, Wu C-D, Schwartz JD, Koutrakis P, Papatheodorou SI. Acute effects of fine particulate matter constituents on mortality: a systematic review and meta-regression analysis. Environ Int. 2017; 109: 89-100.
- 47Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United States: relation to age, income, race, and other sociodemographic factors. JAMA. 1992; 267(1): 64-69.
- 48Rasmussen BK. Epidemiology of headache. Cephalalgia. 1995; 15(1): 44-67.
- 49Peterlin BL, Gupta S, Ward TN, MacGregor A. Sex matters: evaluating sex and gender in migraine and headache research. Headache. 2011; 51: 839-842.
- 50Silberstein S. The role of sex hormones in headache. Neurology. 1992; 42(3 Suppl 2): 37-42.
- 51Kaufman JS, MacLehose RF. Which of these things is not like the others? Cancer. 2013; 119(24): 4216-4222.
- 52Shi X, Miao W, Tchetgen ET. A selective review of negative control methods in epidemiology. Curr Epidemiol Rep. 2020; 7(4): 190-202.
- 53Lipsitch M, Tchetgen ET, Cohen T. Negative controls: a tool for detecting confounding and bias in observational studies. Epidemiology. 2010; 21(3): 383-388.
- 54Greenland S, Senn SJ, Rothman KJ, et al. Statistical tests, P values, confidence intervals, and power: a guide to misinterpretations. Eur J Epidemiol. 2016; 31(4): 337-350.
- 55Wei Y, Wang Y, Di Q, et al. Short term exposure to fine particulate matter and hospital admission risks and costs in the Medicare population: time stratified, case crossover study. BMJ. 2019; 367:16258.
- 56Shah AS, Lee KK, McAllister DA, et al. Short term exposure to air pollution and stroke: systematic review and meta-analysis. BMJ. 2015; 350:h1295.
- 57Cheng J, Xu Z, Bambrick H, et al. Cardiorespiratory effects of heatwaves: a systematic review and meta-analysis of global epidemiological evidence. Environ Res. 2019; 177:108610.
- 58Xu R, Yu P, Abramson MJ, et al. Wildfires, global climate change, and human health. N Engl J Med. 2020; 383(22): 2173-2181.
- 59Vardoulakis S, Jalaludin BB, Morgan GG, Hanigan IC, Johnston FH. Bushfire smoke: urgent need for a national health protection strategy. Med J Aust. 2020; 212(8): 349-353.e1.
- 60Makkonen U, Hellén H, Anttila P, Ferm M. Size distribution and chemical composition of airborne particles in South-Eastern Finland during different seasons and wildfire episodes in 2006. Sci Total Environ. 2010; 408(3): 644-651.
- 61Shaposhnikov D, Revich B, Bellander T, et al. Mortality related to air pollution with the Moscow heat wave and wildfire of 2010. Epidemiology. 2014; 25(3): 359-364.
- 62Liu JC, Peng RD. The impact of wildfire smoke on compositions of fine particulate matter by ecoregion in the Western US. J Expo Sci Environ Epidemiol. 2019; 29(6): 765-776.
- 63Alves C, Vicente A, Nunes T, et al. Summer 2009 wildfires in Portugal: emission of trace gases and aerosol composition. Atmos Environ. 2011; 45(3): 641-649.
- 64Korontzi S, Ward DE, Susott RA, et al. Seasonal variation and ecosystem dependence of emission factors for selected trace gases and PM2.5 for southern African savanna fires. J Geophys Res Atmos. 2003; 108(D24). doi:10.1029/2003JD003730
10.1029/2003JD003730 Google Scholar
- 65Mukamal KJ, Wellenius GA, Suh HH, Mittleman MA. Weather and air pollution as triggers of severe headaches. Neurology. 2009; 72(10): 922-927.
- 66Vodonos A, Novack V, Zlotnik Y, Ifergane G. Ambient air pollution, weather and daily emergency department visits for headache. Cephalalgia. 2015; 35(12): 1085-1091.
- 67Özsaraç M, Uluer H, Ersel M, Kıyan S, Yürüktümen A, Ersan E. Effects of particulate air pollution on emergency department visits for headache as chief complaint. Turk J Emerg Med. 2009; 9(3): 105-108.
- 68Chiu H-F, Weng Y-H, Chiu Y-W, Yang C-Y. Air pollution and daily clinic visits for headache in a subtropical city: Taipei, Taiwan. Int J Environ Res Public Health. 2015; 12(2): 2277-2288.
- 69Dales RE, Cakmak S, Vidal CB. Air pollution and hospitalization for headache in Chile. Am J Epidemiol. 2009; 170(8): 1057-1066.
- 70Chang C-C, Chiu H-F, Yang C-Y. Fine particulate air pollution and outpatient department visits for headache in Taipei, Taiwan. J Toxicol Environ Health A. 2015; 78(8): 506-515.
- 71Szyszkowicz M, Kousha T. Air pollution and emergency department visits for headache and migraine. Health Scope. 2016; 5(3):e35122.
10.17795/jhealthscope-35122 Google Scholar
- 72Elser H, Morello-Frosch R, Jacobson A, et al. Air pollution, methane super-emitters, and oil and gas wells in northern California: the relationship with migraine headache prevalence and exacerbation. Environ Health. 2021; 20(1): 1-14.
- 73Li W, Bertisch SM, Mostofsky E, Buettner C, Mittleman MA. Weather, ambient air pollution, and risk of migraine headache onset among patients with migraine. Environ Int. 2019; 132:105100.
- 74Gelfand AA, Goadsby PJ. A neurologist's guide to acute migraine therapy in the emergency room. Neurohospitalist. 2012; 2(2): 51-59.
- 75Nesbitt AD, Goadsby PJ. Cluster headache. BMJ. 2012; 344:e2407.
- 76Arnold M. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders. Cephalalgia. 2018; 38(1): 1-211.
- 77Bahra A, May A, Goadsby PJ. Cluster headache: a prospective clinical study with diagnostic implications. Neurology. 2002; 58(3): 354-361.
- 78Leone M, D'amico D, Frediani F, et al. Verapamil in the prophylaxis of episodic cluster headache: a double-blind study versus placebo. Neurology. 2000; 54(6): 1382-1385.
- 79Lipton RB, Bigal ME, Diamond M, Freitag F, Reed M, Stewart WF. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007; 68(5): 343-349.
- 80Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American migraine study II. Headache. 2001; 41(7): 646-657.
- 81Kizer KW. Extreme wildfires—a growing population health and planetary problem. JAMA. 2020; 324(16): 1605-1606.
- 82Masri S, Scaduto E, Jin Y, Wu J. Disproportionate impacts of wildfires among elderly and low-income communities in California from 2000–2020. Int J Environ Res Public Health. 2021; 18(8): 3921.
- 83Belleville G, Ouellet M-C, Lebel J, et al. Psychological symptoms among evacuees from the 2016 Fort McMurray wildfires: a population-based survey one year later. Front Public Health. 2021; 9: 444.
- 84Brown MR, Pazderka H, Agyapong VI, et al. Mental health symptoms unexpectedly increased in students aged 11–19 years during the 3.5 years after the 2016 Fort McMurray wildfire: findings from 9,376 survey responses. Front Psych. 2021; 12:676256.
Citing Literature
