Impact of Wildfire Smoke on Healthcare Utilization in a Single Quaternary Care Center in the Northeast United States
Notice bibliographique
Résumé
Abstract RATIONALE: In 2023, Philadelphia, along with much of the Northeast United States, experienced a dramatic increase in air pollution, especially particulate matter of 2.5 microns or less (PM 2.5), due to wildfires in eastern Canada. Wildfire smoke has been associated with increased healthcare utilization, including exacerbations of asthma and COPD, and cardiovascular events. We performed a retrospective chart review study to assess the impact of wildfire smoke on healthcare utilization for cardiovascular and respiratory disease in a quaternary care center in Philadelphia, PA. METHODS: Electronic medical record was queried for emergency department and inpatient encounters from June 6, 2023 – June 14, 2023, and June 28, 2023 – July 6, 2023, as well as the same dates from 2022, 2019, and 2018. 2021 and 2020 were excluded due to COVID. Encounters for cardiovascular and respiratory diagnoses were identified by ICD-10 code. For hospital admissions for pulmonary diagnoses, charts were reviewed for in-hospital mortality, length of stay (LOS) use of non-invasive ventilation (NIV), and need for intubation. Scheduled procedures were excluded from this analysis as were patients found to present frequently for non-medical issues. Pearson chi square test of independence was used to assess for statistically significant differences between years. RESULTS: In 2023, 18.8% (946 out of 5141) of encounters were for cardiovascular or respiratory diagnoses, representing a statistically significant increase from 15.5% in 2018 (p = <0.001), 16.6% in 2019 (p = 0.004), and 16.0% 2022 (p = 0.002). In 2023, admissions to the hospital for cardiovascular or respiratory diagnoses represented 7.5% (387 out of 5141) of all encounters. This was a statistically significant increase from 6.1% in 2018 (p = 0.003), 6.1% in 2019 (p = 0.003), and 6.2% 2022 (p = 0.007). Encounters for COPD, asthma, acute coronary syndrome (ACS), and stroke were similar between years. Among patients admitted for pulmonary diagnoses in 2023 compared to 2022, in-hospital mortality, LOS, use of NIV, and need for intubation were similar. CONCLUSIONS: In the weeks following increases in air pollution from the 2023 Canadian wildfires, our hospital network saw an increase in healthcare utilization for cardiovascular and respiratory diagnoses compared to prior years. The number of encounters for asthma, COPD, ACS, and stroke were similar. Patients admitted to the hospital for pulmonary diagnoses experience no increased risk of mortality, LOS, or need for mechanical ventilation. Future analyses will investigate which disease processes drove the increase in healthcare utilization.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».