Respiratory risks from wildfire-specific PM_2.5 across multiple countries and territories

Under a warming climate, wildfires are becoming more frequent and severe. Multicountry studies evaluating associations between wildfire fine particulate matter (PM_2.5) and respiratory hospitalizations are lacking. Here we evaluate the short-term effects of wildfire-specific PM_2.5 on respiratory hospitalizations from 1,052 communities across Australia, Brazil, Canada, Chile, New Zealand, Vietnam, Thailand and Taiwan, during 2000–2019. A 1 µg m⁻³ increase in wildfire-specific PM_2.5 was associated with increased hospitalization risks for all-cause respiratory, asthma, chronic obstructive pulmonary disease, acute upper respiratory infection, influenza and pneumonia by 0.36%, 0.48%, 0.38%, 0.42%, 0.79% and 0.36%, respectively. Higher risks were observed among populations ≤19 or ≥60 years old, from low-income or high non-wildfire PM_2.5 communities, and residing in Brazil, Thailand, Taiwan and Vietnam. Australia and New Zealand exhibited a greater hospitalization risk for asthma associated with wildfire-specific PM_2.5. Compared with non-wildfire PM_2.5, wildfire-specific PM_2.5 posed greater hospitalization risks for all respiratory diseases and a greater burden of asthma. Wildfire-specific PM_2.5 contributed to 42.4% of PM_2.5-linked respiratory hospitalizations, dominating in Thailand. Overall, the substantial contribution of wildfire-specific PM_2.5 to respiratory hospitalizations demands continued mitigation and adaptation efforts across most countries. Intervention should be prioritized for influenza, children, adolescents, the elderly and populations in low-income or high-polluted communities.