Geographical Information Systems-Based Wildfire Risk Analysis of Canadian Dialysis Facilities

People receiving in-center hemodialysis face heightened disaster vulnerability. Strengthening system resilience is essential, and a risk assessment can strategically guide these efforts. We conducted a risk analysis of Canadian dialysis facilities (DFs) from wildfires.

Using a Geographical Information Systems-based method, we integrated the location of DFs with multiple publicly available datasets to assess historical wildfire exposure, conduct a current wildfire risk assessment, and estimate patients at risk.

We mapped 341 DFs using georeferenced point data that have 5294 dialysis stations, where 23,185 patients receive in-center hemodialysis. Between 1994 and 2024, a significant increase in wildfires was noted- 8524, 12,947, and 15,994 wildfires were observed from 1994 to 2013, 2004 to 2013, and 2014 to 2024 (excluding 2020), respectively (P < 0.001). Based on historical wildfire data and current facility locations, we estimate that 29.3% (n = 100) of DFs located in 8 provinces and 1 territory were within a 5-kilometer buffer of at least 1 wildfire. Based on the current Fire Danger Risk Index, 6.2%, 29.9%, 51.3%, 10.6%, and 2.1% of DFs were in areas classified as low, moderate risk, high, very high, and extreme risk, respectively, placing 67.3% of patients at risk. There was variability in risk across provinces, and provinces with both high and low historical exposure now have DFs distributed across a wide range of risk categories.

Although these findings should be interpreted as estimates of potential exposure under the current distribution of DFs, our findings highlight the vulnerability of dialysis patients and systems to disasters, and that historical exposure does not necessarily correlate with current risks.