title: Forest fires are associated with elevated mortality in a dense urban setting.
abstract: OBJECTIVE
  The climate and vegetation of the greater Athens area (population over three million) make forest fires a real threat to the environment during the summer. A few studies have reported the adverse health effects of forest fires, mainly using morbidity outcomes. The authors investigated the short-term effects of forest fires on non-accidental mortality in the population of Athens, Greece, during 1998-2004.
  
  
  METHODS
  The authors used generalised additive models to investigate the effect of forest fires on daily mortality, adjusting for time trend and meteorological variables, taking into account air pollution as measured from fixed monitors. Forest fires were classified by size according to the area burnt.
  
  
  RESULTS
  Small fires do not have an effect on mortality. Medium sized fires are associated with an increase of 4.9% (95% CI 0.3% to 9.6%) in the daily total number of deaths, 6.0% (95% CI -0.3% to 12.6%) in the number of cardiovascular deaths and 16.2% (95% CI 1.3% to 33.4%) in the number of respiratory deaths. Cardiovascular effects are larger in those aged <75 years, while respiratory effects are larger in older people. The corresponding effects of the one large fire are: 49.7% (95% CI 37.2% to 63.4%), 60.6% (95% CI 43.1% to 80.3%) and 92.0% (95% CI 47.5% to 150.0%). These effects cannot be completely explained by an increase in ambient particle concentrations.
  
  
  CONCLUSIONS
  Forest fires have an immediate effect on mortality, not associated with accidental deaths, which is a significant public health problem, especially if the fire occurs near a densely populated area.
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, 75, Mikras Asias Street, 115 27 Athens, Greece. aanalit@med.uoa.gr
authors.forename: Antonis
authors.initials: A
authors.lastname: Analitis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Georgiadis
authors.forename: Klea
authors.initials: K
authors.lastname: Katsouyanni
mesh_terms: D000367:Age Factors; D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects; D000397:Air Pollution / Q000009:adverse effects / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000401:mortality*; D005390:Fires / Q000706:statistics & numerical data*; D006115:Greece / Q000453:epidemiology; D006801:Humans; D009026:Mortality / Q000639:trends; D012140:Respiratory Tract Diseases / Q000401:mortality*; D014197:Trees; D014504:Urban Health
chemical_list: D000393:Air Pollutants