{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:16:51Z","timestamp":1790882211226,"version":"4.1.0"},"posted":{"date-parts":[[2025,3,15]]},"group-title":"Epidemiology","reference-count":16,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,3,15]],"date-time":"2025-03-15T00:00:00Z","timestamp":1741996800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,3,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>January 2025 brought devastating wildfires to Los Angeles (LA) County, California, causing poor air quality, destroying homes and businesses, and displacing thousands of people. We used electronic health record data from 3.7 million Kaiser Permanente Southern California members to promptly determine if the 2025 LA Fires increased outpatient acute healthcare utilization. We created exposure categories using the maximum wildfire burn zone reached by an LA or Ventura County wildfire as of January 16, 2025. Highly-exposed members resided in census tracts located &lt;20km from burn zones and moderately-exposed members lived in tracts \u226520km but within LA County. We identified daily outpatient and virtual acute care visits in five categories: all-cause, cardiovascular, injury, neuropsychiatric, and respiratory. We conducted 2-stage interrupted time-series analyses using machine-learning algorithms to determine if and by how much the 2025 LA Fires increased acute healthcare utilization. Across the week following the January 7 LA Fires ignitions, virtual respiratory visits were 41% (95% empirical confidence interval [eCI]: 26%, 56%) higher and 34% (95% eCI: 17%, 52%) higher than expected in highly- and moderately-exposed groups, respectively, totaling 3,221 excess visits. Similarly, both exposure groups had approximately 35% more virtual cardiovascular visits than expected over the same period. Among highly-exposed members, outpatient and virtual injury visits and outpatient neuropsychiatric visits were \u226518% higher than expected on January 7. Substantial increases in acute healthcare utilization driven primarily by virtual care-seeking were observed following the LA Fires. As disruptive climate events increase, such data are essential to inform healthcare preparedness and response.<\/jats:p>\n                <jats:sec>\n                  <jats:title>Significance statement<\/jats:title>\n                  <jats:p>Climate hazards like the 2025 LA Fires will increasingly impact US cities. We identified increased acute outpatient and virtual care use for cardiovascular, injury, neuropsychiatric, and respiratory conditions over the week post-LA Fires ignitions from Kaiser Permanente members living &lt;20 km from a burn zone or anywhere in LA County. This included an excess of 2,424 (+35%) cardiovascular and 3,221 (+35%) respiratory virtual visits. By applying our estimates to all LA County residents, we estimated 16,171 excess cardiovascular and 21,541 excess respiratory virtual care visits occurred during the week following ignition. We identified increased acute care visits, primarily driven by virtual care-seeking, suggesting this healthcare service should be expanded during disruptive climate events.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.03.13.25323617","type":"posted-content","created":{"date-parts":[[2025,3,16]],"date-time":"2025-03-16T05:35:16Z","timestamp":1742103316000},"source":"Crossref","is-referenced-by-count":5,"title":["The 2025 Los Angeles Wildfires and Outpatient Acute Healthcare Utilization"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9809-4695","authenticated-orcid":false,"given":"Joan A.","family":"Casey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqian M.","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Schwarz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy B.","family":"Frankland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4439-3734","authenticated-orcid":false,"given":"Lauren B.","family":"Wilner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"McBrien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina M.","family":"Flores","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnab K.","family":"Dey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina S.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarik","family":"Benmarhnia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara Y.","family":"Tartof","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2025032002411710000_2025.03.13.25323617v1.1","unstructured":"CALFIRE. Current Emergency Incidents, <https:\/\/www.fire.ca.gov\/Incidents> (2025)."},{"key":"2025032002411710000_2025.03.13.25323617v1.2","unstructured":"South Coast Air Quality Management District. AQ Details - Historical Data, < https:\/\/xappp.aqmd.gov\/aqdetail\/AirQuality\/HistoricalData> (2025)."},{"key":"2025032002411710000_2025.03.13.25323617v1.3","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1146\/annurev-med-052422-020909","article-title":"Health Effects of Wildfire Smoke Exposure","volume":"75","year":"2024","journal-title":"Annu Rev Med"},{"key":"2025032002411710000_2025.03.13.25323617v1.4","doi-asserted-by":"crossref","first-page":"e230","DOI":"10.1017\/dmp.2024.150","article-title":"Global Health Impacts of Wildfire Disasters From 2000 to 2023: A Comprehensive Analysis of Mortality and Injuries","volume":"18","year":"2024","journal-title":"Disaster Med Public Health Prep"},{"key":"2025032002411710000_2025.03.13.25323617v1.5","doi-asserted-by":"crossref","first-page":"126","DOI":"10.3390\/bs11090126","article-title":"The impact of wildfires on mental health: A scoping review","volume":"11","year":"2021","journal-title":"Behavioral Sciences"},{"key":"2025032002411710000_2025.03.13.25323617v1.6","unstructured":"Los Angeles County Department of Public Health. RESPWatch: Respiratory Illness Surveillance, <http:\/\/ph.lacounty.gov\/acd\/respwatch\/#Viruses>("},{"key":"2025032002411710000_2025.03.13.25323617v1.7","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyad032"},{"key":"2025032002411710000_2025.03.13.25323617v1.8","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.1409277"},{"key":"2025032002411710000_2025.03.13.25323617v1.9","doi-asserted-by":"crossref","unstructured":"Gould, C. F. et al.. Health Effects of Wildfire Smoke Exposure. Annual Review of Medicine 75 (2023).","DOI":"10.1146\/annurev-med-052422-020909"},{"key":"2025032002411710000_2025.03.13.25323617v1.10","doi-asserted-by":"publisher","DOI":"10.1038\/s44220-024-00210-8"},{"key":"2025032002411710000_2025.03.13.25323617v1.11","unstructured":"Aguilera R, N. A. , Corringham T , Benmarhnia T , Casey JA . Motor vehicle crashes during wildfire smoke events in California (2010-2020). Under review (2025)."},{"key":"2025032002411710000_2025.03.13.25323617v1.12","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/S0140-6736(25)00241-7","article-title":"Health-care system adaptability during wildfire disasters: crucial insights from LA County","volume":"405","year":"2025","journal-title":"Lancet"},{"key":"2025032002411710000_2025.03.13.25323617v1.13","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1093\/aje\/kwx141","article-title":"Who among the elderly is most vulnerable to exposure to and health risks of fine particulate matter from wildfire smoke?","volume":"186","year":"2017","journal-title":"Am J Epidemiol"},{"key":"2025032002411710000_2025.03.13.25323617v1.14","doi-asserted-by":"crossref","first-page":"e2023GH000997","DOI":"10.1029\/2023GH000997","article-title":"Spatial Heterogeneity of the Respiratory Health Impacts of Wildfire Smoke PM2. 5 in California","volume":"8","year":"2024","journal-title":"GeoHealth"},{"key":"2025032002411710000_2025.03.13.25323617v1.15","unstructured":"Mahoney, A. Generational Black Homes in LA Reduced to Ash Amid Growing Wildfires, <https:\/\/capitalbnews.org\/california-wildfires-black-home\/> ("},{"key":"2025032002411710000_2025.03.13.25323617v1.16","unstructured":"Burke, M. & Kreutz, L. What we know about the victims killed in the California wildfires, <https:\/\/www.nbcnews.com\/news\/us-news\/california-wildfires-what-we-know-victims-killed-rcna188240> (2025)."}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2025.03.13.25323617","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T20:30:50Z","timestamp":1768509050000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2025.03.13.25323617"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,15]]},"references-count":16,"URL":"https:\/\/doi.org\/10.1101\/2025.03.13.25323617","relation":{},"subject":[],"published":{"date-parts":[[2025,3,15]]},"subtype":"preprint"}}