Meta-analysis of heterogeneity in the effects of wildfire smoke exposure on respiratory health in North America
Document Type: Journal Article
Author(s): Michelle C. Kondo; Anneclaire J. De Roos; Lauren S. White; Warren E. Heilman; Miranda H. Mockrin; Carol Ann Gross-Davis; Igor Burstyn
Publication Year: 2019

Cataloging Information

  • heterogeneity
  • public health
  • ratio of relative risk
  • respiratory health
  • wildfires
Record Maintained By:
Record Last Modified: June 7, 2019
FRAMES Record Number: 57981


Epidemiological studies consistently show an association between wildfire-related smoke exposure and adverse respiratory health. We conducted a systematic review of evidence in published literature pertaining to heterogeneity of respiratory effects from this exposure in North America. We calculated the within-study ratio of relative risks (RRR) and 95% confidence intervals (CI) to examine heterogeneity of effect by population subgroup, and then summarized the RRRs using meta-analysis. We found evidence of a greater effect of wildfire smoke on respiratory health among females relative to males for asthma (RRR: 1.035, 95% CI: 1.013, 1.057) and chronic obstructive pulmonary disease (RRR: 1.018, 95% CI: 1.003, 1.032). There was evidence of a lower relative risk for all respiratory outcomes among youth compared to adults (RRR: 0.976, 95% CI: 0.963, 0.989). We also found wildfire smoke effects stratified by income, race, education, health behaviors, access to care, housing occupancy, geographic region, and urban/rural status. However, data were insufficient to quantitatively evaluate effect modification by these characteristics. While we found evidence that certain demographic subgroups of the population are more susceptible to respiratory health outcomes from wildfire smoke, it is unclear whether this information can be used to inform policy aimed to reduce health impact of wildfires.

Online Link(s):
Kondo, Michelle; De Roos, Anneclaire; White, Lauren; Heilman, Warren; Mockrin, Miranda; Gross-Davis, Carol; Burstyn, Igor. 2019. Meta-analysis of heterogeneity in the effects of wildfire smoke exposure on respiratory health in North America. International Journal of Environmental Research and Public Health 16(6):960.