With hotter and drier conditions, wildfires occur more often in our region.1 The summer of 2020, multiple wildfires across the region resulted in hazardous air quality that lasted for days and we observed increased emergency department visits for asthma. 2 Exposure to high levels of smoke increases risk of asthma as well as other types of respiratory disease, including infectious.3 4 To improve future response to increasingly frequent wildfire and smoke events, we developed a seasonal report for Washington County to identify and evaluate fire and smoke related emergency visits and loss of life from respiratory disease in relation to air quality. We then describe the percentage of visits by zip code, race, age, and sex to identify vulnerable groups. This report is meant to inform emergency preparedness and climate adaptation planning.
In this report we present information from 2016-2023 on PM2.5 to understand exposure to poor air quality during wildfire season (June-September) in Washington County. In Oregon PM2.5 typically drives air quality index values for the stages of good (PM2.5 24-hour average = 0.0-12.0 µg/m3), moderate (PM2.5 24-hour average = 12.1-35.4 µg/m3), unhealthy for sensitive groups (PM2.5 24-hour average = 35.5-55.4 µg/m3), unhealthy (PM2.5 24-hour average = 55.5-150.4 µg/m3), very unhealthy (PM2.5 24-hour average = 150.5-250.4 µg/m3), and hazardous (PM2.5 24-hour average > 250.5 µg/m3)5. Public health messaging and interventions typically begin when air quality is unhealthy for sensitive groups, therefore in this report we explore fire and smoke related emergency department and urgent care (ED) visits and respiratory deaths during wildfire season (June-September) in relation to days that have good air quality, moderate air quality or poor air quality (PM2.5 24-hour average > 35.5 µg/m3).
Data on PM2.5 24 hour averages and Fire and Smoke ED visits in Washington County came from the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) in Oregon. An average of the PM2.5 24 hour averages across Washington County weather stations was calculated. Data on respiratory deaths came from death certificates from Oregon vital statistics from 2014-2023. It is important to note that information about deaths from 2023 are subject to change due to standard review of information input into the system. Impacts of climate change are best observed over a period of decades. Our report only includes more recent years because data collection of ED visits changed significantly from 2015 to 2016 and our jurisdictions at this time only had immediate access to death certificates starting in 2014.
What are you seeing? Below are the annual number of days with poor, moderate, and good air quality from 2015-2023 in Washington County. Since 2015 about half the summers have had few to no poor air quality days, however in 2017, 2018, 2020, and 2023 there was at least a week during the summer seasons that average daily air quality was moderate to poor in Washington County. This coincides with years where there were major wildfires near the region.
What are you seeing? Maps below can be adjusted to show the number of ED visits or rate of visits per 100k population in each zip code from 2016-2023. Addresses are based on patients residence. The zip code areas surrounding Banks have the highest rates of visit per population of fire and smoke inhalation in Washington County. The Northeast part of Washington County has the highest rates of air quality-related respiratory illness visits per population.
Limitations: It is important to note that the northeast region of Washington County is more rural than the central and western regions. Therefore, higher rates are calculated from fewer cases in these settings as compared to urban regions. This means that rates may vary greatly from year to year and based on this data we cannot conclude more risk in those areas is persistent. We can apply this data, however, to identify changes overtime and explore where interventions might be better applied.
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What are you seeing? Fire and smoke ED visits more frequently occur on days with PM2.5 levels that are considered good. However in 2020 when there were a record number of wildfires in the region, most visits were on days with poor air quality.
What are you seeing? The following graph presents average number of fire and smoke related ED visits occurring on days by daily averages of PM2.5. There is a notable spike in fire and smoke inhalation ED visits when PM2.5 is 38.3μg/m3.
Limitations: We present average number of visits observed on days sharing the same PM2.5 level. It is important to note that in our region, because there are a limited number of days with unhealthy PM2.5 levels as compared to days with good to moderate air quality, the estimates on those days are more likely to be impacted by chance. Lack of data or limited data may explain the dips in average observed visits when PM2.5 is higher. Changed behavior or interventions may also play a role.
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Who is visiting the emergency department? Below is a side by side comparison of percentage of people visiting the ED for fire and smoke exposure (left) and for people visiting the ED for any reasons (right) by race/ethnicity, age, and sex. Compared to visits for all other reasons, fire and smoke-related visits are more likely to be by adults under the age of 65 years.
Limitations: It is important to note that we refer to percent visits and not percent visitors nor percent of the population. The reason for this is that the way the data is shared, we are unable to identify multiple visits by the same person. Also, we compare percent of fire and smoke visits to all visits to account for any changes in places reporting to ESSENCE.
What are the chief complaints? Below is a word cloud created from chief complaints. The larger the word, the greater its frequency in chief complaints on fire and smoke ED visit charts. While smoke and inhalation are terms that appeared most frequently, the phrase shortness of breath was also common among chief complaints. Tent also appears in the word cloud. Further analysis is needed to understand the context of the term tent (e.g.homelessness, recreational camping).
0 mentions of homelessness among 149 Emergency
Department visits for fire and smoke, 269 mentions or
0.36% among 74851 in air quality related Emergency
Department visits, and 65 mentions or 0.33%
among 19522 in asthma Emergency Department visits.
These cases included the ICD-10 code Z59 which indicates a person
experiencing homelessness.Limitations It is important to understand that homelessness is not systematically recorded among ED visits. It is likely that visits by homeless individuals are under counted. Our ability to monitor various types of houselessness is also limited and should be improved.
What are we seeing? Below annual number of respiratory and all deaths on days with good moderate and poor air quality days are presented.The proportion of respiratory and all deaths occurring on days with moderate air quality does not change much overtime. Years that coincide with major wildfires, however, include a notable number of respiratory and all cause deaths on days with poor air quality.
Among 5020 deaths by respiratory causes that happened
between 2014 and 2023, 1555 deaths or 31% were in
people with occupations typically requiring workers to be onsite. This
includes manual jobs and office jobs.
Among 5020 deaths by respiratory causes from 2014 to
2023, 522 deaths or 10% were in people with occupations
that typically require them to be outdoors, including agricultural and
construction work.Mote, P.W., J. Abatzoglou, K.D. Dello, K. Hegewisch, and D.E. Rupp, 2019: Fourth Oregon Climate Assessment Report. Oregon Climate Change Research Institute. occri.net/ocar4↩︎
Clackamas County, Multnomah County, and Washington County, 2023: Regional Climate and Health Monitoring Report. https://www.washingtoncountyor.gov/public-health/documents/2023-regional-climate-and-health-monitoring-report/download?inline.↩︎
Noah TL, Worden CP, Rebuli ME, Jaspers I. The Effects of Wildfire Smoke on Asthma and Allergy. Curr Allergy Asthma Rep. 2023 Jul;23(7):375-387. doi: 10.1007/s11882-023-01090-1. Epub 2023 May 12. PMID: 37171670; PMCID: PMC10176314.↩︎
Landguth EL, Holden ZA, Graham J, Stark B, Mokhtari EB, Kaleczyc E, Anderson S, Urbanski S, Jolly M, Semmens EO, Warren DA, Swanson A, Stone E, Noonan C. The delayed effect of wildfire season particulate matter on subsequent influenza season in a mountain west region of the USA. Environ Int. 2020 Jun;139:105668. doi: 10.1016/j.envint.2020.105668. Epub 2020 Mar 31. PMID: 32244099; PMCID: PMC7275907.↩︎
Oregon Department of Environmental Quality, 2021. Oregon Air Quality Monitoring Annual Report:2021. https://www.oregon.gov/deq/aq/Documents/2021AQMAnnualReport.pdf.↩︎
