What question did this study set out to answer?

This study aims to investigate how socioeconomic status affects severe respiratory outcomes in children during wildfires.

March 25, 2026

When Wildfires Discriminate: Exploring the Intersection of Health Inequities and Severe Pediatric Respiratory Outcomes

AHAllison HenningStanford University DTDaniel TawfikLucile Packard Children's Hospital AWAndy WenStanford University

Key Points

This study aims to investigate how socioeconomic status affects severe respiratory outcomes in children during wildfires.
Retrospective cohort analysis of 2,417 children admitted for respiratory illnesses during wildfires
Data sourced from multiple systems and merged using zip codes
Wildfire pollution exposure defined by geographic proximity and PM2.5 levels
SES categorized using Area Deprivation Index, Social Vulnerability Index, and Child Opportunity Index
Statistical analysis performed using Fisher’s exact test and Mann-Whitney U tests to compare SES groups
Low SES patients had longer ICU length of stay by 1.3 days (p < .001)
28% of low SES children required mechanical ventilation (p < .001)
Elevated mortality risk for low SES children at 0.6% (p < .001)
Findings consistent across different SES indices

Abstract

Introduction: Wildfires are an increasing threat, exposing two billion people globally to harmful air quality. Children with higher outdoor exposure, increased air intake relative to body weight, and developing lungs are particularly vulnerable to wildfire smoke. This study examines the impact of socioeconomic status (SES) on severe lung disease exacerbations in critically ill children during wildfires. Methods: This was a retrospective cohort analysis of 2,417 children, aged 0-29 years, admitted to a quaternary Pediatric Intensive Care Unit for acute respiratory disease during wildfires from 2016 to 2023. Data were sourced from Virtual Pediatric Systems, Social Deprivation and Vulnerability Indices, Fire Information for Resource Management System, and Air Quality System, and merged using zip codes. Wildfire-related pollution exposure was defined as wildfire presence within 100 miles on satellite imagery and PM2.5 levels at least one standard deviation above the annual mean in the 10 days before admission. SES was categorized using the Area Deprivation Index (ADI), Social Vulnerability Index (SVI), and Child Opportunity Index (COI), with high and low SES defined as the highest and lowest quintiles. Fisher’s exact test and Mann-Whitney U tests compared outcomes between SES groups. Results: Using COI, patients with low SES had a significantly longer ICU LOS (1.3 days, p < .001) and higher absolute risk of requiring mechanical ventilation (28%, p < .001) during wildfires. The risk of mortality using PIM3, but not PRISM3, was also significantly elevated (0.6%, p < .001) for low SES patients. Age and gender assigned at birth were similar between the low and high SES groups across all indices. These findings were consistent across ADI and SVI. Conclusion: This study highlights disparities in outcomes for children from low SES backgrounds during wildfires, with low SES linked to more severe respiratory outcomes. Additional research and greater public health awareness can inform targeted interventions and disaster preparedness to protect these vulnerable populations.

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