Abstract
Particularly in rural settings, there has been little research regarding the health impacts of fine particulate matter (PM(2.5)) during the wildfire season smoke exposure period on respiratory diseases, such as influenza, and their associated outbreaks months later. We examined the delayed effects of PM(2.5) concentrations for the short-lag (1-4 weeks prior) and the long-lag (during the prior wildfire season months) on the following winter influenza season in Montana, a mountainous state in the western United States. We created gridded maps of surface PM(2.5) for the state of Montana from 2009 to 2018 using spatial regression models fit with station observations and Moderate Resolution Imaging Spectroradiometer (MODIS) aerosol optical thickness data. We used a seasonal quasi-Poisson model with generalized estimating equations to estimate weekly, county-specific, influenza counts for Montana, associated with delayed PM(2.5) concentration periods (short-lag and long-lag effects), adjusted for temperature and seasonal trend. We did not detect an acute, short-lag PM(2.5) effect nor short-lag temperature effect on influenza in Montana. Higher daily average PM(2.5) concentrations during the wildfire season was positively associated with increased influenza in the following winter influenza season (expected 16% or 22% increase in influenza rate per 1 μg/m(3) increase in average daily summer PM(2.5) based on two analyses, p = 0.04 or 0.008). This is one of the first observations of a relationship between PM(2.5) during wildfire season and influenza months later.