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Wildfires in Northern California: Emergency Department Visits, 2017

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Wildfires in Northern California: Emergency Department Visits, 2017 Wildfires in Northern California: Emergency Department Visits in 2017 We wish to acknowledge the HCUP Partner organization from the California Office of Statewide Health Planning and Development (OSHPD) that contributed to the HCUP State Databases used in this study. May 29, 2019 Recommended Citation: Wildfires in Northern California: Emergency Department Visits in 2017. Healthcare Cost and Utilization Project. ONLINE. August 19, 2019. Agency for Healthcare Research and Quality. Available: www.hcup-us.ahrq.gov/reports.jsp. Table of Contents Overview ....................................................................................................................................................... 1 Air Quality Index ........................................................................................................................................... 1 Methods ........................................................................................................................................................ 2 Groupings of California Counties .............................................................................................................. 2 Air Quality Data ......................................................................................................................................... 4 HCUP Databases ........................................................................................................................................ 4 Conditions of Interest ............................................................................................................................... 4 Results ........................................................................................................................................................... 5 Smoke Inhalation ...................................................................................................................................... 6 Initial Encounter for Exposure or Toxic Effect of Fire and Smoke ............................................................ 9 Initial Encounter for Burns (Including but not Limited to Fire Burns) .................................................... 12 Respiratory Conditions Other than Smoke Inhalation ............................................................................ 15 Initial Encounter for Injury (Including Burns) .......................................................................................... 18 All Conditions .......................................................................................................................................... 21 Appendix A. Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) .............................................................................................. A-1 Appendix B. Clinical Coding Definitions .................................................................................................... B-1 Smoke Inhalation ................................................................................................................................... B-1 Initial Encounter for Exposure or Toxic Effect of Fire and Smoke ......................................................... B-1 Initial Encounter for Burns (Including but not Limited to Fire Burns) ................................................... B-2 All Respiratory Conditions Other Than Smoke Inhalation ..................................................................... B-2 Initial Encounter for Injury (Including Burns) ....................................................................................... B-12 (HCUP 05/29/2019) i 2017 Northern California Wildfires Analysis OVERVIEW This descriptive analysis looks at emergency department (ED) utilization for select conditions (e.g., smoke inhalation and burns) from September–November 2017 in California. The focus of the analysis is the Bay Area of California during October 2017 when numerous active fires in Northern California affected the air quality. AIR QUALITY INDEX Many of the October 2017 Northern California fires started on October 8th. Air quality, as measured by PM2.5 AQI (an air quality index for inhalable particulate matter with diameters generally 2.5 micrometers and smaller), was in the ‘Good’ to ‘Moderate’ range (0-100) for all Bay Area zones until October 9th. On October 9th, it entered the ‘unhealthy’ range in the Northern Zone for 4 out of 5 measurement stations. The peak PM2.5 AQI measurement (281/’Very Unhealthy’) was reached on October 10th in the Northern Zone at the Napa Valley College station. By October 19th all zones returned to the ‘Good’ range. Figure 1 shows daily air quality measurements from 17 San Francisco Bay Area stations in October 2017. Figure 1. California Bay Area Air Quality, October 2017 Source: Air Monitoring Data for October 2017, Bay Area Air Quality Management District online query tool (http://www.baaqmd.gov/about-air-quality/current-air-quality/air-monitoring- data?DataViewFormat=monthly&DataView=aqi&StartDate=10/1/2017&ParameterId=316), Accessed May 21, 2019. (HCUP 05/29/2019) 1 2017 Northern California Wildfires Analysis METHODS Groupings of California Counties The nine counties around the San Francisco Bay with measurement stations were combined into three groups–North Bay (Marin, Napa, Sonoma, and Solano counties), San Francisco Bay (Alameda, Contra Costa, and San Francisco counties), and South Bay (San Mateo and Santa Clara counties). Figure 2 shows a map of the three Bay Area county groups and the air quality measurement stations within each group. Figure 2. Air Quality Measurement Stations Within Three Bay Area County Groups North Bay Stations Napa Napa Valley College San Rafael Sebastopol Sonoma Vallejo Napa SF Bay Stations Solano Berkeley Aquatic Park Marin Laney College Contra Costa Oakland East SF Oakland West San Alameda San Francisco – Arkansas St. Mateo San Pablo – Rumrill Santa Clara Concord Livermore – Rincon Ave. South Bay Stations Redwood City Gilroy San Jose – Jackson St. San Jose – Knox Ave. Source: Facility Data Maps, Bay Area Air Quality Management District (www.baaqmd.gov) (HCUP 05/29/2019) 2 2017 Northern California Wildfires Analysis All other California counties were grouped into ten areas based on climate zones1 and the presence of hospitals (at least seven hospitals are in each group). Figure 3 shows a map of all California county groups used in this analysis. Please note that the names used for each county groupings in this analysis was indicative of the location relative to the Bay Area and may differ from community-specific names commonly used by government agencies in the State of California and its residents. Figure 3. County Groupings Used to Report Estimates of Daily Emergency Department Utilization Northern Border North West North East North Bay East SF Bay South Bay East Central South West South East Central Valley Greater LA Southern Border 1 Climate zones were defined by the California Energy Commission and are based on energy use, temperature, weather and other factors. Climate zones are defined by ZIP Code and cross county borders. More information is available at https://www.energy.ca.gov/maps/renewable/building_climate_zones.html. Accessed May 21, 2017. (HCUP 05/29/2019) 3 2017 Northern California Wildfires Analysis Air Quality Data We extracted three months (September–November 2017) of daily PM2.5 data for the 17 measurement stations in the Bay Area from the Bay Area Air Quality Management District online query tool. This air quality data was aggregated into a single daily measurement for each of the three county groups by using the maximum air quality measurement for the county group on each day. For the ten county groups outside the Bay Area, where air quality data was unavailable, a daily baseline measurement was created using the minimum air quality measurement available from the Bay Area stations. HCUP Databases ED utilization data was extracted from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) for California. The analysis file includes all SEDD records, which capture ED visits that do not result in admission to the same hospital, and a subset of SID records, those which indicate ED visits that result in admission to the same hospital. Together, this encompasses 3.6 million ED visits in California between September and November 2017. Additional information on HCUP is available in Appendix A. The data were aggregated by county of patient residence, as assigned from patient ZIP Code, with the following exceptions: • Hospital county was used if the patient was homeless, foreign, or the ZIP Code was missing/invalid. • Hospital county was used for out-of-state patients if their ZIP Code was greater than 250 miles away from the ZIP Code of the California hospital. This excludes those living near the California border but includes patients who were most likely traveling to California during the time of the fire. Conditions of Interest ED visits were selected based on six condition groups of interest. The condition groups are not mutually exclusive; a patient with multiple conditions will be counted in each category. Condition groups were defined using all-listed International Classification of Diseases, 10th Revision, Clinical Modification (ICD- 10-CM) diagnosis codes (i.e., both principal diagnosis and secondary diagnoses). The ICD-10-CM coding definitions for each condition
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