The Economic Consequence of Increased Health Care Resource Utilization in Maryland Associated With a Major Wildfire...

Transcontinental wildfire smoke migration originating from remote areas resulted in consecutive days of high concentrations of particulate matter with aerodynamic diameter < 2.5 μm (PM_2.5) in Maryland in June 2023.

What are the economic and cardiopulmonary effects of migrating wildfire smoke exposure during June 2023 in Maryland?

Using electronic health record data from the University of Maryland Medical System, we identified cardiopulmonary clinical encounters. We developed 2 regression models (combining a logistic regression and a generalized linear model with a gamma distribution and log link) and a nonparametric bootstrapping to estimate the incremental cost of cardiopulmonary encounters during 6 days defined by unhealthy PM_2.5 concentration (hotspot days) in June 2023 in Maryland relative to calendar-matched control days in 2018 and 2019. We also provided 10-year cost projections under different future wildfire scenarios and modeled the preventable burden using respirators.

The final sample included 5,273 cardiopulmonary encounters. The total cost accrued by increased cardiopulmonary encounters during the 6 hotspot day exposure compared with control days was $2,435,513 (95% uncertainty interval [UI], $62,452-$5,266,838). Under the expected scenario (2 wildfires in 10 years), the projected incremental cost of wildfire smoke-related cardiopulmonary encounters was $6,379,406 (95% UI, $122,412-$13,837,150). However, modeling the use of respirators with 50%, 75%, and 95% effectiveness by high-risk individuals was associated with an expected net cost saving of $758,274, $1,162,649, and $1,486,150, respectively.

Our results shows that a major medical system in Maryland experienced substantial health care economic burden over 6 days that was characterized by increased wildfire smoke. Because Maryland uses a fixed global budget system, our findings have implications for preventive strategies that mitigate economic burden incurred in the context of wildfire smoke events.