776 - Health Disparities in Severe Respiratory Illness During Wildfire Crises

Publication Number: 776.5154

Allison Henning, Stanford University School of Medicine, Palo Alto, CA, United States; Andy Y. Wen, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States; Daniel Tawfik, Stanford University School of Medicine, Palo Alto, CA, United States; Anna Lin, Stanford School of Medicine, Stanford, CA, United States; Melanie Stroud, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States

Background: Wildfires increasingly threaten children's health in the United States, affecting over 7.4 million children annually. Due to their increased outdoor exposure, higher air intake relative to body weight, and developing respiratory systems, children are particularly susceptible to the harmful effects of wildfire smoke. Socioeconomic status (SES) may influence these health outcomes, and understanding the impact of SES on severe respiratory disease in critically ill children during wildfires can help identify at-risk groups and guide targeted interventions.

Objective: This study examines whether children from low SES backgrounds admitted to an intensive care unit (ICU) during wildfires, experience worse respiratory outcomes compared to those from high SES backgrounds.

Design/Methods: This retrospective, cohort study analyzed children admitted to a quaternary ICU for acute respiratory disease during wildfires from 2016 to 2023. Several datasets—Virtual Pediatric Systems, Social Deprivation and Vulnerability Indices, Fire Information for Resource Management System, and Air Quality System—were merged using zip code data. Wildfire-related pollution exposure was defined as the presence of wildfire within 100 miles on satellite imagery and PM2.5 levels in the 10 days prior to admission being at least 1 standard deviation above the annual mean.
SES was categorized using the Area Deprivation Index (ADI), Social Vulnerability Index (SVI), and Child Opportunity Index (COI), with high and low SES defined as the highest and lowest quintiles. Fisher’s exact test and Mann-Whitney U tests compared outcomes between SES groups.

Results: Using COI (see Table 1), patients with low SES had a statistically significant longer ICU LOS (1.3 days) and higher absolute risk of requiring mechanical ventilation (28%) during wildfires. Risk of mortality using PIM3, but not PRISM3, was also significantly elevated (0.6% increase) for low SES patients. The low SES group had a higher proportion of non-English speaking patients (29% vs 20%). Age and gender assigned at birth were similar between the low and high SES groups across all indices. These findings were consistent across ADI and SVI (see Tables 2 and 3).

Conclusion(s): This study highlights stark disparities in outcomes for children from low SES backgrounds during wildfire events, with low SES linked to more severe respiratory outcomes from wildfire-related pollution. Greater public health awareness, targeted interventions, and resource reallocation are urgently needed to protect these vulnerable pediatric populations.

Table 1. Quintiles determined by Child Opportunity Index


Table 2. Quintiles determined by Area Deprivation Index


Table 3. Quintile determined by Social Vulnerability Index


Table 1. Quintiles determined by Child Opportunity Index


Table 2. Quintiles determined by Area Deprivation Index


Table 3. Quintile determined by Social Vulnerability Index