title: Peat bog wildfire smoke exposure in rural North Carolina is associated with cardiopulmonary emergency department visits assessed through syndromic surveillance.
abstract: BACKGROUND
  In June 2008, burning peat deposits produced haze and air pollution far in excess of National Ambient Air Quality Standards, encroaching on rural communities of eastern North Carolina. Although the association of mortality and morbidity with exposure to urban air pollution is well established, the health effects associated with exposure to wildfire emissions are less well understood.
  
  
  OBJECTIVE
  We investigated the effects of exposure on cardiorespiratory outcomes in the population affected by the fire.
  
  
  METHODS
  We performed a population-based study using emergency department (ED) visits reported through the syndromic surveillance program NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool). We used aerosol optical depth measured by a satellite to determine a high-exposure window and distinguish counties most impacted by the dense smoke plume from surrounding referent counties. Poisson log-linear regression with a 5-day distributed lag was used to estimate changes in the cumulative relative risk (RR).
  
  
  RESULTS
  In the exposed counties, significant increases in cumulative RR for asthma [1.65 (95% confidence interval, 1.25-2.1)], chronic obstructive pulmonary disease [1.73 (1.06-2.83)], and pneumonia and acute bronchitis [1.59 (1.07-2.34)] were observed. ED visits associated with cardiopulmonary symptoms [1.23 (1.06-1.43)] and heart failure [1.37 (1.01-1.85)] were also significantly increased.
  
  
  CONCLUSIONS
  Satellite data and syndromic surveillance were combined to assess the health impacts of wildfire smoke in rural counties with sparse air-quality monitoring. This is the first study to demonstrate both respiratory and cardiac effects after brief exposure to peat wildfire smoke.
authors.affiliation: Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA. rappold.ana@epa.gov
authors.forename: Ana G
authors.initials: AG
authors.lastname: Rappold
authors.forename: Susan L
authors.initials: SL
authors.lastname: Stone
authors.forename: Wayne E
authors.initials: WE
authors.lastname: Cascio
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Neas
authors.forename: Vasu J
authors.initials: VJ
authors.lastname: Kilaru
authors.forename: Martha Sue
authors.initials: MS
authors.lastname: Carraway
authors.forename: James J
authors.initials: JJ
authors.lastname: Szykman
authors.forename: Amy
authors.initials: A
authors.lastname: Ising
authors.forename: William E
authors.initials: WE
authors.lastname: Cleve
authors.forename: John T
authors.initials: JT
authors.lastname: Meredith
authors.forename: Heather
authors.initials: H
authors.lastname: Vaughan-Batten
authors.forename: Lana
authors.initials: L
authors.lastname: Deyneka
authors.forename: Robert B
authors.initials: RB
authors.lastname: Devlin
mesh_terms: D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000633:toxicity*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D012906:Smoke / Q000009:adverse effects*; D012987:Soil; D055815:Young Adult
chemical_list: D000393:Air Pollutants; D012906:Smoke; D012987:Soil