Where There’s Smoke, There Are Racial Disparities in Pediatric Asthma Emergencies

Wildfires do not discriminate. Given enough oxygen and dry fuel, 
they will gladly consume the wealthiest enclaves of Malibu or the dense vegetation of the Plumas National Forest without regard for the tax bracket, education, or racial and ethnic backgrounds of anyone in the path of their flames. The effects of the smoke and poor air quality they cause are a different story, however. Wildfires disproportionately affect our most vulnerable populations — Hispanic, Asian American and Pacific Islander, and Black children. 

In fact, according to new research, pediatric asthma exacerbations increased 76% and asthma related emergency department (ED) visits increased 27% over the 14 days following the onset of the 2018 Northern California wildfire. When stratified by race and ethnicity, the increase in asthma exacerbation rates was highest among Hispanic/Latino (+95%), followed by Asian American and Pacific Islander (+75%), and Black/African American (+63%) children. Among White children, they increased 55%.

Social Determinants of Smoke Waves
Our research brief, “Impact of Wildfire Smoke Waves on Asthma Emergencies in Children: Insights Into the Pediatric Subpopulations Most Vulnerable to the Threat of Climate Change,” draws on real-world data (RWD) from Komodo’s Healthcare Map™ to track the healthcare journeys of 1.6 million pediatric asthma patients living in the San Francisco Bay Area and nearby counties affected by the 2018 wildfire in Northern California. By analyzing asthma exacerbations and asthma-related ED visits for the 14-day period following the onset of the wildfire, and comparing those to rates that occurred during the same season during which no wildfire was present, the analysis was able to zero in on critical details of the pediatric asthma population affected. 

In addition to the concerning findings regarding the significantly higher frequency of asthma exacerbations among Hispanic and Latino children, the research also finds that children living in regions with reduced home ownership had an increased risk for asthma-related ED visits of up to 51% when compared to the overall population in the affected area. Additionally, regions with the highest proportion of residents who did not have a high school diploma had a 45% higher risk of asthma-related ED visits, and regions with the highest poverty levels had a 38% greater risk.

Spotlighting a Need for Public Health Resources
The research helps to quantify the effects of not having access to preventive care, the ability to shelter behind in-home air filtration systems, or the mobility to simply leave town until the smoke clears. Those living downwind from these massive wildfires who have the fewest options to avoid the smoke wave are also the most likely to end up in the ED with an asthma exacerbation. 

This is an important reminder of the complex string of effects that ripple through the healthcare system following natural disasters. It is also a call to action for public health officials and federal and local governments and regulators on the need for mass access to protective equipment, clean-air shelters and portable air filters in regions known to have higher poverty and less home ownership, along with community outreach and educational programs to make people aware of their exposure risks and available resources.

Read the full research brief here.

To see more articles like this, follow Komodo Health on X, LinkedIn, or YouTube, and visit Insights on our website.