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Health Impacts of Wildfire Smoke on Children and Adolescents: A Systematic Review and Meta-analysis

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Abstract

Purpose of Review

Wildfire smoke is associated with human health, becoming an increasing public health concern. However, a comprehensive synthesis of the current evidence on the health impacts of ambient wildfire smoke on children and adolescents, an exceptionally vulnerable population, is lacking. We conduct a systematic review of peer-reviewed epidemiological studies on the association between wildfire smoke and health of children and adolescents.

Recent Findings

We searched for studies available in MEDLINE, EMBASE, and Scopus from database inception up to October 11, 2022. Of 4926 studies initially identified, 59 studies from 14 countries were ultimately eligible. Over 33.3% of the studies were conducted in the USA, and two focused on multi-countries. The exposure assessment of wildfire smoke was heterogenous, with wildfire-specific particulate matters with diameters ≤ 2.5 µm (PM2.5, 22.0%) and all-source (22.0%) PM2.5 during wildfire period most frequently used. Over half of studies (50.6%) focused on respiratory-related morbidities/mortalities. Wildfire smoke exposure was consistently associated with enhanced risks of adverse health outcomes in children/adolescents. Meta-analysis results presented a pooled relative risk (RR) of 1.04 (95% confidence interval [CI], 0.96-1.12) for all-cause respiratory morbidity, 1.11 (95% Ci: 0.93-1.32) for asthma, 0.93 (95% CI, 0.85–1.03) for bronchitis, and 1.13 (95% CI, 1.05–1.23) for upper respiratory infection, whilst − 21.71 g for birth weight (95% CI, − 32.92 to − 10.50) per 10 µg/m3 increment in wildfire-specific PM2.5/all-source PM2.5 during wildfire event.

Summary

The majority of studies found that wildfire smoke was associated with multiple adverse health outcomes among children and adolescents, with respiratory morbidities of significant concern. In-utero exposure to wildfire smoke may increase the risk of adverse birth outcomes and have long-term impacts on height. Higher maternal baseline exposure to wildfire smoke and poor family-level baseline birthweight respectively elevated risks in preterm birth and low birth weight associated with wildfire smoke. More studies in low- and middle-income countries and focusing on extremely young children are needed. Despite technological progress, wildfire smoke exposure measurements remain uncertain, demanding improved methodologies to have more precise assessment of wildfire smoke levels and thus quantify the corresponding health impacts and guide public mitigation actions.

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Data Availability

All data generated or analysed  during this study are included  in this published article and its supplementary information files.

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Acknowledgements

The editors would like to thank Ruth Etzel for handling the review of this manuscript.

Funding

TY and WH are supported by China Scholarship Council funds (TY: 201906320051; WH: 202006380055). RX is supported by Monash Faculty of Medicine Nursing and Health Science (FMNHS) Bridging Postdoctoral Fellowships 2022 and VicHealth Postdoctoral Research Fellowships 2022. YG is supported by Career Development Fellowship (GNT1163693) and Leader Fellowship (GNT2008813) of the Australian National Health and Medical Research Council. SL is supported by an Emerging Leader Fellowship (GNT2009866) of the Australian National Health and Medical Research Council. This study is supported by Australian Research Council (DP210102076), and Australian National Health & Medical Research Council (APP2000581). YZ is supported by NHMRC e-Asia Joint Research Program Grant (GNT2000581).

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  1. Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St. Kilda Road, Melbourne, VIC, 3004, Australia

    Yiwen Zhang, Ye Tingting, Wenzhong Huang, Pei Yu, Gongbo Chen, Rongbin Xu, Yuming Guo & Shanshan Li

  2. Monash Biomedicine Discovery Institute, Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Australia

    Jiangning Song

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Contributions

S.L. and Y.G. developed the review premise. Y.Z. and T.Y. reviewed all identified abstracts and reviewed all identified articles in consultation with S.L. and Y.G.. Y.Z. and T.Y. completed the data extraction. Y.Z. and T.Y. appraised the study quality of included articles and checked. Y.Z. performed the meta-analysis. YZ prepared the figures and tables and draft the manuscript. T.Y., W.H., P.Y., G.C., R.X., J.S., Y.G. and S.L. contributed to the reviewing and editing of the paper. All authors approved the final version of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Shanshan Li.

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Zhang, Y., Tingting, Y., Huang, W. et al. Health Impacts of Wildfire Smoke on Children and Adolescents: A Systematic Review and Meta-analysis. Curr Envir Health Rpt 11, 46–60 (2024). https://doi.org/10.1007/s40572-023-00420-9

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