Lack of air conditioning elevates emergency visits amid wildfire smoke

People who have limited access to air conditioning may be at higher risk of seeking emergency care for health problems following exposure to wildfire smoke, according to a new study led by Boston University School of Public Health (BUSPH).

Posted online ahead of publication in the journal Environmental Research: Health, the study found that exposure to fine particle matter (PM2.5) from wildfire smoke in California is associated with higher rates of emergency department visits for all causes, non-accidental causes, and respiratory disease. This risk varied by age and race, but was especially high for individuals who lived in areas with lower availability of air conditioning.

The findings come at a critical time, as firefighters in Southern California continue to battle multiple wildfires that have been blazing in and around Los Angeles County since Tuesday, January 7—including the Palisades fire, which is likely the largest and most destructive wildfire in the county’s history. Health experts are urging residents who are not under evacuation orders and can safely remain in their homes to turn on air conditioners and/or air purifiers if they have access to these devices.

Despite this guidance—and the growing threat of more frequent and intense wildfires due to worsening climate change—very little research has examined how the health effects of wildfire smoke exposure may differ based on individuals’ access to air conditioning. Understanding this relationship can inform policies and interventions that mitigate barriers to air conditioners and protect vulnerable populations from the consequences of inhaling PM2.5 and other harmful pollutants from this smoke, which can permeate the air from hundreds or thousands of miles away.

“Depending on the type of system and filter used, air conditioning may modify the impact of smoke exposure on human health,” says study lead and corresponding author Dr. Jennifer Stowell, research scientist in climate and health at BUSPH, noting that the analysis only addressed the likelihood of access to air conditioning, rather than air conditioning types or actual usage. “Studies like these will become more and more relevant as wildfire exposure increases. California is, perhaps, the best example of this in the US, with bigger fires and longer fire seasons. An important next step will be to identify ways to better characterize access to air conditioning.”

For the study, Dr. Stowell and colleagues from BUSPH, Boston University College of Arts & Sciences (CAS), and the Health Effects Institute utilized a nationwide dataset of health care claims to assess more than 50,000 emergency department visits during the 2012-2019 California wildfire seasons, which occurred from May to November each year. They quantified the adverse health effects from PM2.5 exposure among all study participants, as well as subgroups of participants.

Consistent with prior research, wildfire smoke exposure was most strongly associated with emergency department visits for respiratory issues, but not cardiovascular-related complications. These visits were generally higher among children under 10 years old, adults between 20-74 years old, and among the Black population, although also elevated among White, Hispanic, and Asian/Pacific Islander populations.

People living in areas with lower availability of air conditioning had a 22-percent greater risk of visiting the emergency department for respiratory conditions associated with wildfire smoke exposure. Greater insight into air conditioning use as a pollutant-filtering tool and the barriers that certain populations face in accessing these cooling systems is critical, as wildfires are expected to occur more regularly in the Wildland-Urban Interface (WUI)—areas where human activity is in close contact with sources of dry fuel. This is exactly what is happening now in LA County, Dr. Stowell says, as the fires destroy thousands of homes and businesses near vegetation.

“WUI fires are particularly concerning due to the burning of manmade structures and the additional toxic chemicals and particulates that can be found in their smoke plume,” says Dr. Stowell. “The current fires in LA are out-of-season fires driven by severe Santa Ana winds coming from the mountains. As climate change continues, the temperature differentials between land and sea will grow and, potentially, drive stronger and stronger late-season or out-of-season wind events.”

So how may residential air conditioners help dispel PM2.5 from homes? The filters in these cooling systems can remove particulate matter, although certain filters are more effective at filtering particulate matter than others. “HEPA filters can remove the majority of particles greater than 0.3 µm, but they are significantly more expensive than fiberglass air filters, which only remove larger particles and may allow high amounts of fine particulate matter to penetrate indoors,” Dr. Stowell says. “Generic pleated air filters are also fairly efficient at filtering out most particulate matter.”

Air conditioning systems with a Minimum Efficiency Reporting Value (MERV) rating of seven or higher are thought to be the most efficient at removing particulate matter from outdoor air, but are also more expensive.

The study findings indicate a need for stronger policy measures that can reduce the health risks associated with wildfire smoke exposure.

“Many homeowners do not understand the differences between MERV ratings and how these might impact your health,” Dr. Stowell says. “Policymakers should consider delivering better information to the public—such as the types and ratings of filters that perform better—especially for those who reside in smoke-prone regions.”

Given that marginalized populations appear to be disproportionately burdened by the health effects of wildfire smoke exposure, economic assistance should also be considered, she says, particularly for low-income populations residing in smoke-prone regions. “Considering the current fires in CA, local and state governments should heighten their responses to these events and develop plans and policies to reduce exposure before the fires occur,” Dr. Stowell says.

The study’s senior author is Dr. Gregory Wellenius, professor of environmental health and director of the Center for Climate and Health at BUSPH. The study was coauthored by Dr. Ian Sue Wing, professor of earth and environment at CAS; Dr. Yasmin Romitti, staff scientist at the Health Effects Institute, and Dr. Patrick Kinney, Beverly Brown Professor of Urban Health at BUSPH.