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Cited by 120Air Quality and Health ImpactsDermatology and Skin DiseasesAsthma and respiratory diseases

Association of Wildfire Air Pollution and Health Care Use for Atopic Dermatitis and Itch

Open access
Fadadu, Raj P., Grimes, Barbara, Jewell, Nicholas P., Vargo, Jason, Young, Albert T., Abuabara, Katrina, Balmes, John R., Wei, Maria L.·2021·JAMA Dermatology
DOI 10.1001/jamadermatol.2021.0179PMC PMC8060890
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Abstract

Air pollution resulting from wildfire smoke was associated with increased clinic visits for atopic dermatitis and itch and increased systemic medication prescriptions during the California Camp Fire period.

Integrity signals

Registry

Crossref · 10.1001/jamadermatol.2021.0179

Cites

63 of 63 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

5 of 26 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    An increase in the frequency and severity of wildfires is contributing to a recent increase in PM2.5 concentrations in the western US after a decades-long reduction in air pollution.

    “An increase in the frequency and severity of wildfires is contributing to a recent increase in PM 2.5 concentrations in the western US after a decades-long reduction in air pollution.4,[31][32][33][34]”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [4] 4. Clay K, Muller NZ. Recent Increases in Air Pollution: Evidence and Implications for Mortality. National Bureau of Economic Research; 2019. doi:10.3386/w26381 source

      Section 4.2 (Wildfires; page unavailable) says wildfires may account for some of the 2016–2018 PM2.5 increase in the West, but not the overall decline-and-reversal pattern. The Introduction describes the preceding decline as roughly a decade, not decades, and the paper does not establish that wildfires increased in both frequency and severity. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [31][32][33][34]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Findingreasoning

    The California Camp Fire caused a 9-fold increase in average weekly PM2.5 concentration in San Francisco during a 2-week period (November 8-21, 2018) compared with baseline before and after.

    “Due to prevailing wind patterns, the burning caused a 9-fold increase in average weekly PM 2.5 concentration in San Francisco during a 2-week period (November 8-21, 2018), compared with baseline before and after; it peaked during the second week of the fire (Figure 1).”
    Quote in the paperSubstantial claim
  • Findingown data

    The adjusted rate ratio for weekly pediatric itch visits was 1.82 (95% CI, 1.20-2.77) for fire status.

    “The adjusted rate ratios for weekly pediatric itch visits were 1.82 (95% CI, 1.20-2.77)for fire status”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Camp Fire was the primary source of the air pollution spike in San Francisco during the study period, and the comparison periods had no large wildfires near San Francisco.
    • Rests on an assumption: Patients residing in San Francisco were exposed to the air pollution measured in San Francisco.
    • Rests on an assumption: The total number of dermatology clinic visits for any skin health-related concern is a valid offset for changes in patient volume and dermatologist numbers.
    • Rests on an assumption: The 2015-2016 and 2016-2017 periods are valid controls for the 2018-2019 period.
    • Rests on an assumption: There is no unmeasured confounding of the association between wildfire-associated air pollution and health care use for AD or itch.
  • Findingown data

    The adjusted rate ratio for weekly pediatric itch visits was 1.55 (95% CI, 1.15-2.09) for average weekly smoke plume density score.

    “and 1.55 (95% CI, 1.15-2.09)for average weekly smoke plume density score.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Camp Fire was the primary source of the air pollution spike in San Francisco during the study period, and the comparison periods had no large wildfires near San Francisco.
    • Rests on an assumption: Patients residing in San Francisco were exposed to the air pollution measured in San Francisco.
    • Rests on an assumption: The total number of dermatology clinic visits for any skin health-related concern is a valid offset for changes in patient volume and dermatologist numbers.
    • Rests on an assumption: The 2015-2016 and 2016-2017 periods are valid controls for the 2018-2019 period.
    • Rests on an assumption: There is no unmeasured confounding of the association between wildfire-associated air pollution and health care use for AD or itch.
  • Findingown data

    Compared with the preceding weeks, the total number of clinic appointments for AD or itch increased during the second week of the Camp Fire and the following 4 weeks, except during the national Thanksgiving holiday week.

    “Compared with the preceding weeks, the total number of clinic appointments for AD or itch increased during the second week of the Camp Fire and the following 4 weeks, with the exception of the national Thanksgiving holiday week.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 19
  • May combine two claims. 17
  • The quote only partly states this claim. 2

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Tapinarof has shown promise for treatment of patients with AD.

    “Tapinarof, a new topical aryl hydrocarbon receptor modulating agent, has shown promise for treatment of patients with AD 54,55”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [54] 54. Smith SH, Jayawickreme C, Rickard DJ, et al. Tapinarof is a natural AhR agonist that resolves skin inflammation in mice and humans. J Invest Dermatol. 2017;137(10):2110-2119. doi:10.1016/j.jid.2017.05.004 source
    • cites [55] 55. Cianconi P, Betrò S, Janiri L. The impact of climate change on mental health: a systematic descriptive review. Front Psychiatry. 2020;11: 74. doi:10.3389/fpsyt.2020.00074 source

      The Materials and Methods section describes a review of climate change and mental health, not treatments for atopic dermatitis. Searches of our full-text copy for tapinarof, aryl hydrocarbon receptor, and atopic dermatitis found no passage addressing the treatment claim. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The current increased risk for wildfires in California and other areas around the world is anticipated to result in exposures to high concentrations of air pollution, even in regions where background levels are usually low.

    “The current increased risk for wildfires in California and other areas around the world is anticipated to result in exposures to high concentrations of air pollution, even in regions where background levels are usually low.63,64”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [63] 63. Cushing L, Morello-Frosch R, Wander M, Pastor M. The haves, the have-nots, and the health of everyone: the relationship between social inequality and environmental quality. Annu Rev Public Health. 2015;36(1):193-209. doi:10.1146/ annurev-publhealth-031914-122646 source

      The Within-Country Comparisons section discusses heat-risk neighborhoods and modeled air pollution, but not wildfire smoke. Searches for wildfire risk in California, high pollution exposures, and usually low background levels found no passage addressing the claim. Page numbers were not available in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [64] 64. Mikati I, Benson AF, Luben TJ, Sacks JD, Richmond-Bryant J. Disparities in distribution of particulate matter emission sources by race and poverty status. Am J Public Health. 2018;108(4): 480-485. doi:10.2105/AJPH.2017.304297 source

      The Abstract (page unavailable) identifies wildfires as natural events that contribute to ambient particulate matter. It does not address increasing wildfire risk in California or elsewhere, predict high pollution concentrations, or discuss regions with usually low background levels. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    The associations were larger for the pediatric population compared with the adult population and largest at lag 0 for all 3 exposure metrics.

    “The associations were larger for the pediatric population compared with the adult population and largest at lag 0 for all 3 exposure metrics.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    The rate of weekly AD clinic visits during the Camp Fire was 1.49 times the rate for nonwildfire weeks at lag 0 for pediatric patients (95% CI, 1.07-2.07), adjusted for temperature, relative humidity, patient age, and total patient volume.

    “The rates of weekly AD clinic visits during the Camp Fire were 1.49 (95% CI, 1.07-2.07)times the rate for nonwildfire weeks at lag 0 for pediatric patients”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Camp Fire was the primary source of the air pollution spike in San Francisco during the study period, and the comparison periods had no large wildfires near San Francisco.
    • Rests on an assumption: Patients residing in San Francisco were exposed to the air pollution measured in San Francisco.
    • Rests on an assumption: The total number of dermatology clinic visits for any skin health-related concern is a valid offset for changes in patient volume and dermatologist numbers.
    • Rests on an assumption: The 2015-2016 and 2016-2017 periods are valid controls for the 2018-2019 period.
    • Rests on an assumption: There is no unmeasured confounding of the association between wildfire-associated air pollution and health care use for AD or itch.

  • May combine two claims.

    Findingown data

    During the Camp Fire, 89% of adults who presented with itch were not previously diagnosed with AD, compared with 59% in 2015 and 51% in 2016.

    “During the Camp Fire, 89% of the adults who presented with itch were not previously diagnosed with AD, compared with patients with itch during the same 2 weeks in 2015 (59%) and 2016 (51%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For topical medication outcome, adjusted rate ratios were greater than 1 but did not reach statistical significance, except for lag 0 for the smoke plume density metric, which was 1.14 (95% CI, 1.01-1.28).

    “For the topical medication outcome, the adjusted rate ratios were greater than 1 but did not reach statistical significance, except for lag 0 for the smoke plume density metric: 1.14 (95% CI, 1.01-1.28).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Camp Fire was the primary source of the air pollution spike in San Francisco during the study period, and the comparison periods had no large wildfires near San Francisco.
    • Rests on an assumption: Patients residing in San Francisco were exposed to the air pollution measured in San Francisco.
    • Rests on an assumption: The total number of dermatology clinic visits for any skin health-related concern is a valid offset for changes in patient volume and dermatologist numbers.
    • Rests on an assumption: The 2015-2016 and 2016-2017 periods are valid controls for the 2018-2019 period.
    • Rests on an assumption: There is no unmeasured confounding of the association between wildfire-associated air pollution and health care use for AD or itch.

  • The quote only partly states this claim.

    Findingown data

    The rate of weekly AD clinic visits during the Camp Fire was 1.15 times the rate for nonwildfire weeks at lag 0 for adult patients (95% CI, 1.02-1.30), adjusted for temperature, relative humidity, patient age, and total patient volume.

    “and 1.15 (95% CI, 1.02-1.30)times the rate for nonwildfire weeks at lag 0 for adults.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Camp Fire was the primary source of the air pollution spike in San Francisco during the study period, and the comparison periods had no large wildfires near San Francisco.
    • Rests on an assumption: Patients residing in San Francisco were exposed to the air pollution measured in San Francisco.
    • Rests on an assumption: The total number of dermatology clinic visits for any skin health-related concern is a valid offset for changes in patient volume and dermatologist numbers.
    • Rests on an assumption: The 2015-2016 and 2016-2017 periods are valid controls for the 2018-2019 period.
    • Rests on an assumption: There is no unmeasured confounding of the association between wildfire-associated air pollution and health care use for AD or itch.

  • May combine two claims.

    Findingown data

    The adjusted rate ratios for adult itch clinic visits during wildfire weeks were greater than 1 but did not achieve statistical significance at lag 0 for fire status (1.29; 95% CI, 0.96-1.75), smoke plume density (1.16; 95% CI, 0.94-1.43), and PM2.5 (1.03; 95% CI, 0.99-1.07).

    “At lag 0, the rate ratio for the fire status exposure was 1.29 (95% CI, 0.96-1.75),for the smoke plume density exposure was 1.16 (95% CI, 0.94-1.43),and for the PM 2.5 exposure was 1.03 (95% CI, 0.99-1.07).However, unlike the results for pediatric itch visits, these results did not achieve statistical significance (Figure 3B).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Camp Fire was the primary source of the air pollution spike in San Francisco during the study period, and the comparison periods had no large wildfires near San Francisco.
    • Rests on an assumption: Patients residing in San Francisco were exposed to the air pollution measured in San Francisco.
    • Rests on an assumption: The total number of dermatology clinic visits for any skin health-related concern is a valid offset for changes in patient volume and dermatologist numbers.
    • Rests on an assumption: The 2015-2016 and 2016-2017 periods are valid controls for the 2018-2019 period.
    • Rests on an assumption: There is no unmeasured confounding of the association between wildfire-associated air pollution and health care use for AD or itch.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Epidemiologic studies on skin diseases have primarily focused on chronic exposure to air pollution, but the association between acute exposure and common cutaneous diseases such as atopic dermatitis is becoming increasingly important to assess as environmental conditions change.

    “Epidemiologic studies on skin diseases have primarily focused on chronic exposure to air pollution, but the association between acute exposure and common cutaneous diseases, such as AD, is becoming increasingly important to assess as environmental conditions change.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    PM2.5 is considered more harmful than PM10.

    “the latter of which is considered more harmful, 58”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] 58. Tang K-T, Ku K-C, Chen D-Y, Lin C-H, Tsuang B-J, Chen Y-H. Adult atopic dermatitis and exposure to air pollutants-a nationwide population-based study. Ann Allergy Asthma Immunol. 2017;118(3):351-355. doi:10.1016/j.anai.2016.12.005 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The models included a holiday week indicator variable to account for weeks with US national holidays.

    “The models also included a holiday week indicator variable that accounted for weeks that had US national holidays, such as Thanksgiving.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The models included covariates for average temperature, relative humidity, patient age, and period (2015-2016, 2016-2017, or 2018-2019).

    “Covariates in the models included average temperature, relative humidity, patient age, and period (2015-2016, 2016-2017, or 2018-2019).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Small longitudinal studies of schoolchildren in Korea found increased patient-reported AD symptom severity in association with exposure to particulate matter.

    “Small longitudinal studies of schoolchildren in Korea similarly found increased patient-reported AD symptom severity in association with exposure to particulate matter.27,28”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [27] 27. Kim J, Kim E-H, Oh I, et al. Symptoms of atopic dermatitis are influenced by outdoor air pollution. J Allergy Clin Immunol. 2013;132(2):495-8.e1. doi:10. 1016/j.jaci.2013.04.019

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [28] 28. Schnass W, Hüls A, Vierkötter A, Krämer U, Krutmann J, Schikowski T. Traffic-related air pollution and eczema in the elderly: findings from the SALIA cohort. Int J Hyg Environ Health. 2018; 221(6):861-867. doi:10.1016/j.ijheh.2018.06.002 source

  • May combine two claims.

    Premisecitation

    The epidemiologic evidence for an association between air pollution and atopic dermatitis is mixed, with some studies reporting null findings and many others reporting a positive association.

    “The epidemiologic evidence for an association between air pollution and AD is mixed; some studies report null findings, [17][18][19][20][21] but many others report a positive association.[22][23][24][25][26][27][28][29][30]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [17][18][19][20][21]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [22][23][24][25][26][27][28][29][30]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    These patients may have subclinical AD not previously diagnosed.

    “Alternatively, these patients may have subclinical AD not previously diagnosed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Air pollution contributes to AD pathogenesis through several mechanisms, including the aryl hydrocarbon receptor pathway, oxidative stress, and inflammation.

    “On a molecular level, air pollution contributes to AD pathogenesis through several mechanisms, including the aryl hydrocarbon receptor pathway, oxidative stress, and inflammation.[51][52][53]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51][52][53]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Environmental disasters cause psychosocial stress.

    “environmental disasters cause psychosocial stress, 56”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] 56. Mochizuki H, Lavery MJ, Nattkemper LA, et al. Impact of acute stress on itch sensation and scratching behaviour in patients with atopic dermatitis and healthy controls. Br J Dermatol. 2019;180(4):821-827. doi:10.1111/bjd.16921 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study was approved by the University of California, San Francisco Institutional Review Board with waiver of informed consent.

    “The study was approved by the University of California, San Francisco Institutional Review Board with waiver of informed consent.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The study used 3 different metrics to characterize pollution exposure-fire status, smoke plume density, and PM2.5-and obtained consistent results across these metrics for each outcome.

    “We used 3 different metrics to characterize pollution exposure-fire status, smoke plume density, and PM 2.5 -and obtained consistent results across these metrics for each outcome.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The highest rate ratios for all outcomes were generally seen at exposure lags 0 to 2, which is consistent with short-term exposure to air pollution being associated with rapid effects on the rates of weekly clinic visits and prescribed medications.

    “The highest rate ratios for all outcomes were generally seen at exposure lags 0 to 2, which is consistent with short-term exposure to air pollution being associated with rapid effects on the rates of weekly clinic visits and prescribed medications.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The significant associations between air pollution and number of prescribed systemic medications for adults suggest that patients with more severe skin disease were particularly affected by poor air quality or that exposure to air pollution increased the severity of existing skin disease, requiring the initiation of systemic therapy.

    “the significant associations between air pollution and number of prescribed systemic medications for adults suggest that patients with more severe skin disease were particularly affected by poor air quality or that exposure to air pollution increased the severity of existing skin disease, requiring the initiation of systemic therapy.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Area-level air pollution exposure metrics are a valid proxy for individual patient exposure to wildfire-associated air pollution.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Increased stress during a wildfire could contribute to AD symptoms.

    “this increased stress during a wildfire could contribute to AD symptoms.57”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] 57. California Air Resources Board. Inhalable particulate matter and health (PM2.5 and PM10). Accessed September 1, 2020. https://ww2.arb.ca. gov/resources/inhalable-particulate-matter-and- health 59. Kim E-H, Kim S, Lee JH, et al. Indoor air pollution aggravates symptoms of atopic dermatitis in children. PLoS One. 2015;10(3):e0119501. doi:10. 1371/journal.pone.0119501

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Each model included an offset variable, the logarithm of the weekly total number of dermatology clinic visits for any skin health-related concern, to account for changes in the number of practicing dermatologists and total weekly patient volume both within and across years.

    “In addition, each model included an offset variable, the logarithm of the weekly total number of dermatology clinic visits for any skin health-related concern, to account for changes in the number of practicing dermatologists and total weekly patient volume both within and across years.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Systemic treatment for asthma flares triggered by wildfire smoke could additionally treat symptoms of AD, mitigating patients' need to seek dermatologic care and possibly resulting in this study capturing underestimated associations between wildfires and skin health.

    “Systemic treatment for asthma flares triggered by wildfire smoke could additionally treat symptoms of AD, mitigating patients' need to seek dermatologic care and possibly resulting in this study capturing underestimated associations between wildfires and skin health.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Area-level air pollution exposure metrics are a valid proxy for individual patient exposure to wildfire-associated air pollution.

  • May combine two claims.

    Study design and conductown data

    We analyzed 3 exposure metrics and found consistent results for all 3 metrics.

    “we analyzed 3 exposure metrics and found consistent results for all 3 metrics.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Observed associations may be greater at clinics closer to the origin.

    “observed associations may be greater at clinics closer to the origin.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Area-level air pollution exposure metrics are a valid proxy for individual patient exposure to wildfire-associated air pollution.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    We focused on patients with AD or itch seen at dermatology clinics and did not include patients at primary care clinics.

    “We also focused on patients with AD or itch seen at dermatology clinics and did not include patients at primary care clinics.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This study did not include environmental exposure data on an individual patient level.

    “This study did not include environmental exposure data on an individual patient level”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Our findings support studies on long-term PM2.5 exposure and AD, including indoor air pollution and AD severity in children, AD prevalence among adults, and prenatal pollution exposure.

    “Our findings also support studies on long-term PM 2.5 exposure and AD, including indoor air pollution and AD severity in children, 59 AD prevalence among adults, 60 and prenatal pollution exposure.25”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [59] 59. Guo Q, Liang F, Tian L, Schikowski T, Liu W, Pan X. Ambient air pollution and the hospital outpatient visits for eczema and dermatitis in Beijing: a time-stratified case-crossover analysis. Environ Sci Process Impacts. 2019;21(1):163-173. doi:10.1039/ C8EM00494C source
    • cites [60] 60. Li A, Fan L, Xie L, Ren Y, Li L. Associations between air pollution, climate factors and outpatient visits for eczema in West China Hospital, Chengdu, south-western China: a time series analysis. J Eur Acad Dermatol Venereol. 2018;32(3): 486-494. doi:10.1111/jdv.14730 source
    • cites [25] 25. Morgenstern V, Zutavern A, Cyrys J, et al; GINI Study Group; LISA Study Group. Atopic diseases, allergic sensitization, and exposure to traffic-related air pollution in children. Am J Respir Crit Care Med. 2008;177(12):1331-1337. doi:10.1164/ rccm.200701-036OC source
    • Rests on an assumption: Area-level air pollution exposure metrics are a valid proxy for individual patient exposure to wildfire-associated air pollution.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The composition of PM2.5 during the Camp Fire may not match that of PM2.5 from other wildfires, which may limit generalizability of this study's results.

    “the composition of PM 2.5 during the Camp Fire may not match that of PM 2.5 from other wildfires, which may also limit generalizability of this study's results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    This study suggests that clinics serving affected communities may experience increased visits for certain skin disease exacerbations that decrease patient quality of life and increase health care expenditures.

    “This study suggests that clinics serving affected communities may experience increased visits for certain skin disease exacerbations that decrease patient quality of life and increase health care expenditures.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Area-level air pollution exposure metrics are a valid proxy for individual patient exposure to wildfire-associated air pollution.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    People of color and from low-income communities experience disproportionately increased exposure to air pollution.

    “people of color and from low-income communities experience disproportionately increased exposure to air pollution.65,66”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [65]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [66]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Study design and conductreasoning

    The population was restricted to patients living in San Francisco and seeking care at dermatology clinics affiliated with one health care system, which limits the generalizability of our results.

    “The population was restricted to patients living in San Francisco and seeking care at dermatology clinics affiliated with one health care system, which limits the generalizability of our results.”
    Quote in the paperNot a substantial claim
33 of 33

  • The paper relies on this without support.

    Health care use rates (clinic visits for AD or itch and prescribed medications) reflect exacerbations of AD and itch symptoms.

    “Overall, our findings indicated that both pediatric and adult patients experienced exacerbations of AD and itch symptoms, as measured by health care use rates, in association with short-term exposure to increased air pollution.”

  • The paper relies on this without support.

    The Camp Fire was the primary source of the air pollution spike in San Francisco during the study period, and the comparison periods had no large wildfires near San Francisco.

    “Data were collected for 18 weeks encompassing the time before, during, and after the Camp Fire (October 2018-February 2019) as well as for the corresponding dates from previous years when there were no large wildfires close to San Francisco (October 2015-February 2016 and October 2016-February 2017).”

  • The paper relies on this without support.

    Patients residing in San Francisco were exposed to the air pollution measured in San Francisco.

    “Patients were excluded if they resided outside San Francisco (approximately 20% of the original group).”

  • The paper relies on this without support.

    The total number of dermatology clinic visits for any skin health-related concern is a valid offset for changes in patient volume and dermatologist numbers.

    “In addition, each model included an offset variable, the logarithm of the weekly total number of dermatology clinic visits for any skin health-related concern, to account for changes in the number of practicing dermatologists and total weekly patient volume both within and across years.”

  • The paper relies on this without support.

    The 2015-2016 and 2016-2017 periods are valid controls for the 2018-2019 period.

    “Data were collected for 18 weeks encompassing the time before, during, and after the Camp Fire (October 2018-February 2019) as well as for the corresponding dates from previous years when there were no large wildfires close to San Francisco (October 2015-February 2016 and October 2016-February 2017).”

  • The paper relies on this without support.

    There is no unmeasured confounding of the association between wildfire-associated air pollution and health care use for AD or itch.

    “The results from the generalized Poisson regression, adjusting for temperature, humidity, and patient age, demonstrated statistically significant associations between exposure to wildfire-associated air pollution and weekly clinic visits for AD in both adult and pediatric patients (Figure 2).”

  • The paper relies on this without support.

    Area-level air pollution exposure metrics are a valid proxy for individual patient exposure to wildfire-associated air pollution.

    “This study did not include environmental exposure data on an individual patient level; however, we analyzed 3 exposure metrics and found consistent results for all 3 metrics.”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Following the California Camp Fire in November 2018, San Francisco experienced a surge in air pollutants such as PM2.5, which triggered a heightened demand for healthcare services for AD and pruritus.

    “Following the fire, San Francisco experienced a surge in air pollutants such as PM2.5, which triggered a heightened demand for healthcare services for AD and pruritus [26].”

    From The Burden of Air Pollution on Skin Health: a Brief Report and Call to Action (2024) · cites this paper as [26]

    The Environmental Conditions section reports a ninefold rise in San Francisco’s weekly PM2.5 concentration during the Camp Fire and an increase in AD or itch appointments. The Discussion reports increased health care use associated with wildfire air pollution, but the study establishes an association, not that pollution triggered the visits. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Studies have shown increased clinic visits during a wildfire for atopic dermatitis and itch in the pediatric population and adults 65 years and older, but not in adults 18-64.

    “Studies have shown increased clinic visits during a wildfire for atopic dermatitis and itch in the pediatric population and adults 65 years and older, but not in adults 18–64 [11, 67]”

    From Wildfires and Atopic Diseases: A Review (2026) · cites this paper as [11]

    The Key Points and Air Pollution and AD Visits sections report increased atopic dermatitis visits in pediatric and adult patients; the Abstract also reports a significant increase in pediatric itch visits. The paper analyzes adults as one group, not separately as ages 18–64 and 65 or older, so it does not support the claimed age-specific contrast. It also does not establish a significant increase in adult itch visits. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • A 10-μg/m3 increase in average PM2.5 concentration was associated with a 5.1% (95% CI, 0.8%-9.7%) increase in the average weekly pediatric AD clinic visits and a 7.7% (95% CI, 1.9%-13.7%) increase in weekly pediatric itch clinic visits during a short-term (2-week) exposure to wildfire air pollution.

    “A study exploring the association between a short‐term (2‐week) exposure to wildfire air pollution and health care utilization for AD or itch found a 10‐μg/m3 increase in average PM2.5 concentration was associated with a 5.1% (95% CI, 0.8%–9.7%) increase in the average weekly pediatric AD clinic visits and a 7.7% (95% CI, 1.9%–13.7%) increase in weekly pediatric itch clinic visits.”

    From Wildfires and Atopic Diseases: A Review (2026) · cites this paper as [11]

  • Among adults, the adjusted rate ratios for AD and itch clinic visits were 1.15 (95% CI, 1.02-1.30) and 1.29 (95% CI, 0.96-1.75) times higher compared to non-fire weeks.

    “Among adults, the adjusted rate ratios for AD and itch clinic visits were 1.15 (95% CI, 1.02–1.30) and 1.29 (95% CI, 0.96–1.75) times higher compared to non‐fire weeks.”

    From Wildfires and Atopic Diseases: A Review (2026) · cites this paper as [11]

  • The adjusted rate ratio for prescribed systemic medications was 1.45 (95% CI, 1.03-2.05) for adults during the fire time interval, compared with non-fire intervals.

    “Additionally, the adjusted rate ratio for prescribed systemic medications was 1.45 (95% CI, 1.03–2.05) for adults during the fire time interval, compared with non‐fire intervals [11].”

    From Wildfires and Atopic Diseases: A Review (2026) · cites this paper as [11]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Pediatric itch confidence-interval endpoint differs between sections

    Minor

    The abstract gives the upper endpoint as 2.78, while the Results section gives 2.77 for the same adjusted rate ratio.

  • Pediatric female count differs from the sum across periods

    Minor

    The period-specific pediatric female counts sum to 369, rather than the reported combined count of 363.

    Reported 363 · recomputed 369

2 of 2

Cites

Flagged first, then by citations

2 of the 65 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Healthcare Cost and Utilization Project (HCUP), 2019, Wildfires in California: Emergency Department Visits Around November 2018., 65
  2. Ruminski, 2007, Use of Environmental Satellite Imagery for Smoke Depiction and Transport Model Initialization., 16

Cited by

Sorted by citations

Related

Authors
Fadadu, R. P., Grimes, B., Jewell, N. P., Vargo, J., Young, A. T., Abuabara, K., Balmes, J. R., & Wei, M. L.
Affiliations
  • San Francisco VA Medical Center (US)
  • University of California, San Francisco (US)
  • London School of Hygiene & Tropical Medicine (GB)
  • California Department of Public Health (US)
Corresponding author
Wei, Maria L.
ORCID
Venue
JAMA Dermatology
Publisher
American Medical Association (AMA)
Published
2021-06-01
Volume
157
Issue
6
Pages
658
ISSN
2168-6068 (ISSN-L)
DOI
10.1001/jamadermatol.2021.0179
PMC
PMC8060890
OpenAlex
W3155248034
Cited by
120
References
65
Citations by year
2026: 15 · 2025: 24 · 2024: 27 · 2023: 33 · 2022: 14 · 2021: 7
FWCI
8.02
Type
journal article
Language
en
Open access
Locations
  • JAMA Dermatology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Topics
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
  • Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
Keywords
atopic dermatitis, pruritus, PM2.5, prescription drugs, pediatric patients, adult patients, inflammatory skin diseases, San Francisco, wildfire smoke exposure, topical corticosteroids, antihistamines, phototherapy
MeSH terms
Wildfires, Adult, Air Pollution, Child, Cross-Sectional Studies, Delivery of Health Care, Dermatitis, Atopic, Environmental Exposure, Female, Humans, Particulate Matter

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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