{ "abstract": "Background: To prevent wildfires, electric utilities may preemptively de-energize power lines (public safety power shutoffs [PSPS]). These PSPS events may unintentionally harm health, particularly for those with pre-existing conditions like chronic obstructive pulmonary disease (COPD) or who rely on electricity-dependent medical equipment. Health impacts may worsen further if a wildfire occurs despite the power shutoff. To assess the effect of PSPS events, wildfire fine particulate matter (PM2.5) exposure, and their co-occurrence on cause-specific healthcare utilization.\n\nMethods and findings: We identified PSPS events in California from 2013 to 2019, categorizing magnitude based on number of people without power by zip code. We leveraged zip code-level average daily wildfire PM2.5 estimates and respiratory, COPD-specific, cardiovascular, and psychiatric emergency department visits and unscheduled hospital admissions among adults aged 20+ from the California Department of Health Care Access and Information. Using a time-stratified case-crossover design, we estimated the impact of same-day and lagged PSPS events alone, wildfire PM2.5 alone, and their co-occurrence on healthcare utilization, adjusting for daily temperature.\n\nSevere PSPS events were associated with elevated odds of same-day respiratory encounters (OR = 1.06, 95% CI: 1.02, 1.11) and lag0–3 effects were similar. These associations were stronger for COPD. Compared to no PSPS or wildfire exposure, joint PSPS and 10 μg/m3 higher wildfire PM2.5 was associated with higher odds of respiratory encounters (1.16 [95% CI: 1.10, 1.22]), with evidence of multiplicative interaction. Associations were null for cardiovascular and psychiatric encounters.\n\nLimitations include exposure misclassification, because we assigned exposure at the residential zip code level, aggregating circuit-level data and not accounting for individual behavior or the potential for PSPS events to impact wildfire PM2.5 exposure.\n\nConclusions: PSPS events may increase risk of respiratory events requiring acute care utilization, especially when they co-occur with wildfire PM2.5.", "abstract_shown": true, "affiliations": [ "Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, United States of America", "Scripps Institution of Oceanography, University of California, San Diego, California, United States of America", "Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, United States of America", "Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States of America", "Physicians, Scientists and Engineers for Healthy Energy, Oakland, California, United States of America", "Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, United States of America", "Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, United States of America", "Department of Medicine, University of Washington, Seattle, Washington, United States of America", "Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States of America", "Irset Institut de Recherche en Santé, Environnement et Travail, UMR-S 1085, Inserm, University of Rennes, EHESP, Rennes, France" ], "article_type": "Research Article", "arxiv": null, "author_total": 9, "authors": [ { "affs": [ 0 ], "name": "Lauren Blair Wilner", "orcid": "0000-0003-4439-3734" }, { "affs": [ 1 ], "name": "Caitlin G. Jones-Ngo", "orcid": "0000-0002-4478-8392" }, { "affs": [ 1, 2, 3 ], "name": "Chen Chen", "orcid": "0000-0002-0632-946X" }, { "affs": [ 4 ], "name": "Bethany Kwoka", "orcid": "0009-0007-3841-2042" }, { "affs": [ 5 ], "name": "Vivian Do", "orcid": "0000-0001-6127-4361" }, { "affs": [ 0, 6, 7 ], "name": "Joel D. Kaufman", "orcid": "0000-0003-4174-9037" }, { "affs": [ 8 ], "name": "Laura C. Myers", "orcid": "0000-0002-2872-3388" }, { "affs": [ 1, 9 ], "name": "Tarik Benmahrnia", "orcid": "0000-0002-4018-3089" }, { "affs": [ 0, 5, 6 ], "name": "Joan A. Casey", "orcid": "0000-0002-9809-4695" } ], "bibtex": "https://research.draconitic.com/paper/5bn0mhdr5c32w.bib", "cited_by": 0, "doi": "10.1371/journal.pmed.1005270", "fulltext_url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005270", "id": "5bn0mhdr5c32w", "issns": [ "1549-1676", "1549-1277" ], "landing_url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005270", "language": "en", "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "hal", "0.sde" ], [ "hal", "0.sdv" ], [ "hal", "1.sdv.spee" ], [ "heading", "Age Groups" ], [ "heading", "Bioengineering" ], [ "heading", "Biology and Life Sciences" ], [ "heading", "Biotechnology" ], [ "heading", "California" ], [ "heading", "Chronic Obstructive Pulmonary Disease" ], [ "heading", "Critical Care and Emergency Medicine" ], [ "heading", "Ecology and Environmental Sciences" ], [ "heading", "Engineering and Technology" ], [ "heading", "Epidemiology" ], [ "heading", "Geographical locations" ], [ "heading", "Health Care" ], [ "heading", "Health Care Facilities" ], [ "heading", "Hospitals" ], [ "heading", "Medical Devices and Equipment" ], [ "heading", "Medical Risk Factors" ], [ "heading", "Medicine and Health Sciences" ], [ "heading", "North America" ], [ "heading", "People and Places" ], [ "heading", "People and places" ], [ "heading", "Population Groupings" ], [ "heading", "Pulmonology" ], [ "heading", "Research Article" ], [ "heading", "United States" ], [ "heading", "Wildfires" ], [ "lcc", "R" ], [ "openalex", "2307|Air Quality and Health Impacts" ], [ "plos", "/Biology and life sciences/Bioengineering/Biotechnology/Medical devices and equipment" ], [ "plos", "/Ecology and environmental sciences/Wildfires" ], [ "plos", "/Engineering and technology/Bioengineering/Biotechnology/Medical devices and equipment" ], [ "plos", "/Medicine and health sciences/Critical care and emergency medicine" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Health care/Health care facilities/Hospitals" ], [ "plos", "/Medicine and health sciences/Medical devices and equipment" ], [ "plos", "/Medicine and health sciences/Pulmonology/Chronic obstructive pulmonary disease" ], [ "plos", "/People and places/Geographical locations/North America/United States/California" ], [ "plos", "/People and places/Population groupings/Age groups" ] ], "openalex": "W7223991975", "pdf_url": "https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1005270&type=printable", "pmcid": "PMC13712598", "pmid": "42945187", "published": "2026-10-27", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/5bn0mhdr5c32w.ris", "sources": [ { "first_seen": "2026-10-30T12:17:17Z", "native_id": "10.1371/journal.pmed.1005270", "source": "plos", "url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005270" }, { "first_seen": "2026-10-31T12:23:08Z", "native_id": "PMC13712598", "source": "pmc", "url": "https://doi.org/10.1371/journal.pmed.1005270" }, { "first_seen": "2026-10-31T14:22:58Z", "native_id": "1271783b4e8d405799ac871fe4db55f5", "source": "doaj", "url": "https://doi.org/10.1371/journal.pmed.1005270" }, { "first_seen": "2026-11-02T12:20:44Z", "native_id": "hal-05848110", "source": "hal", "url": "https://ehesp.hal.science/hal-05848110v1" } ], "subjects": [ { "field": "biology", "origin": "plos:biotechnology", "subfield": "systems-synthetic" }, { "field": "earth", "origin": "hal:0.sde", "subfield": "environmental-science" }, { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" } ], "title": "Co-exposure to planned power outages and wildfire PM2.5 and acute healthcare utilization in California: A time-stratified case-crossover study", "title_text": "Co-exposure to planned power outages and wildfire PM2.5 and acute healthcare utilization in California: A time-stratified case-crossover study", "type": "peer-reviewed", "updated_at": "2026-11-04T12:20:48Z", "url": "https://research.draconitic.com/paper/5bn0mhdr5c32w", "venue": "PLOS Medicine", "versions": [] }