The hidden infectious disease-related sepsis risk of wildfire-specific PM_2.5

Wildfire smoke is a major source of fine particulate matter (PM_2.5) and may increase vulnerability to severe infectious outcomes such as sepsis, a condition responsible for an estimated 49 million cases and 11 million deaths annually. Despite this global burden, to our knowledge, no prior epidemiological study has specifically examined the association between wildfire-specific PM_2.5 exposure and infectious disease-related sepsis. We conducted a multi-country time-series analysis across 1024 communities in seven countries/territories (2000-2019). Daily hospitalizations for infectious disease-related sepsis were identified using ICD-10 codes, restricted to explicit sepsis diagnoses. Wildfire-specific PM_2.5 was estimated using the GEOS-Chem chemical transport model combined with machine learning calibration and linked to hospitalization data. Associations between wildfire-specific PM_2.5 and sepsis hospitalizations were estimated using quasi-Poisson regression with distributed lag non-linear models over lag 0-7 days. Community-specific estimates were pooled using random-effects meta-analysis. Across all communities, we identified 2.3 million infectious disease-related sepsis hospitalizations, with the highest burden among older adults and in Brazil. Each 10 μg/m³ increase in wildfire-specific PM_2.5 was associated with a 1.5% increase in sepsis hospitalizations (Relative Risk [RR]: 1.015, 95% Confidence Interval [CI]: 1.007-1.024), nearly double the effect of non-wildfire PM_2.5 (0.8%). Strongest associations were found among children aged <5 years (RR: 1.063, 95%CI: 1.029-1.097) and those aged 5-19 years (1.093, 1.050-1.138), in moderately populated communities, and in New Zealand and Brazil. Sensitivity analyses confirmed the robustness of the findings. Short-term exposure to wildfire-specific PM_2.5 was associated with increased risk of hospitalization for infectious disease-related sepsis, particularly greater risks in adolescents and young children. These findings underscore the need of further research to clarify underlying mechanisms and long-term impacts.