7/10/2019 Overview Minnesota Air and Health Initiative: Life and Breath Study • Background • MDH/PCA collaboration Life and Breath • Original TC metro area study How air pollution affects health across • Statewide Life and Breath Minnesota • methods, phases, results • Key takeaway and Discussion MPHA Kathy Raleigh, MDH Principal Epidemiologist David Bael, MPCA Economic Policy Analyst 7/10/2019 2 July 11, 2019 1 2 Minnesota Air and Health Initiative Background Original Life and Breath study MPCA/MDH collaboration to understand and address role of air quality in our health • 7 ‐ county metro area, 2015 report of air pollution impacts on health in 2008 • Common responsibility to protect and improve public health • In Metro area ‐ PM 2.5 and ozone contributed to approximately: MPCA and MDH roles • 1,000 ‐ 2,000 premature deaths • 400 hospitalizations • MPCA: generates air quality monitoring and modeling data, estimates risks to inform actions • 600 emergency room visits • MDH: conducts disease surveillance to inform disease prevention actions, including • Some sub ‐ populations – elderly, young children, areas with higher proportions of minority data on social, behavioral and environmental risks populations and residents living in poverty – are particularly vulnerable to air pollution 3 7/10/2019 4 3 4 1
7/10/2019 PM 2.5 and ozone health impacts Air and health How can health impacts of air pollution be counted? • Epidemiological studies measure the relationships between pollutant concentrations and health. • From these relationships, we can estimate the fraction and count of adverse health impacts that may be attributed to air pollution. 7/10/2019 5 7/10/2019 6 5 6 Statewide “Life and Breath II” Goals for “Life and Breath II” • What are the impacts of fine particulate matter and ozone state ‐ wide? Methods and Results • Are the impacts distributed equally across the state? • What benefits can be achieved by further reducing air pollution across the state? 7/10/2019 7 7/10/2019 8 7 8 2
7/10/2019 Health and death data Methods Hospital discharge data Health outcomes ICD 9 ICD 10 Cardiopulmonary deaths N/A I00 ‐ I79, J10 ‐ J18, J40 ‐ J47, J69 • Asthma ED visits • Asthma hospitalizations Asthma 496 (786.07 for Winquist et. al., J45 (R062 for Winquist et. al., ozone) ozone) Chronic lung disease 490 ‐ 496 J40 ‐ J45,J471, J479, J67 • Respiratory hospitalizations All respiratory 460 ‐ 519 J00 ‐ J99 • Cardiovascular hospitalizations Cardiovascular disease 410 ‐ 414, 426 ‐ 429, 430 ‐ 438, 440 ‐ I20 ‐ I22, I24 ‐ I25,I44 ‐ I45, I47 ‐ I50, I60 ‐ I67, 448 I69 ‐ I75, I77 ‐ I78,M30 ‐ M31, R001, G454 Vital Statistics • All ‐ cause and cardiopulmonary deaths 7/10/2019 9 7/10/2019 10 9 10 Air quality Aggregate findings PM 2.5 in Minnesota by county, 2013 annual average (left) and ozone (average daily 8 ‐ hour We estimate: maximums) in Minnesota by county, 2013 ozone season average (right) • Between 5 ‐ 10% of all Minnesotans died prematurely, in part, due to fine particles in the air or ground ‐ level ozone. This translates to nearly 2,000 to more than 4,000 premature deaths annually • Between 1 ‐ 5% of all residents who went to the hospital or emergency room did so partly because of fine particle matter in the air or ground ‐ level ozone exposures. This translates to approximately 500 hospitalizations, and 800 emergency room visits annually. 7/10/2019 11 7/10/2019 12 11 12 3
7/10/2019 Aggregate results Aggregate results Minnesota 2013 annual health impacts attributable to PM 2.5 Minnesota 2013 annual health impacts attributable to ozone Attributable rate per Health Effect Age group Number Percent of Total Events 100,000 people Percent of Total Attributable rate 25 and older 4,098 10.2% 112.8 Health Effect Age group Number (Lepeule) (2,098 ‐ 5,983) (5.2% ‐ 14.9%) (57.8 ‐ 164.7) Events per 100,000 people All ‐ cause deaths 30 and older 1,866 4.7% 57.1 (Krewski) (1,270 ‐ 2,449) (3.2% ‐ 6.2%) (38.9 ‐ 75.0) Cardiopulmonary All ages 57 1.1% 1.0 Asthma Under 18 15 1.7% 1.6 deaths (Huang) (21.3 ‐ 91.8) (0.4% ‐ 1.7%) (0.4 ‐ 1.7) hospitalizations (Babin) (0 ‐ 75) (0% ‐ 8.8%) (0 ‐ 8.6) Asthma and COPD 18 to 64 64 1.8% 1.9 Asthma All ages 56 4.8% 1.0 hospitalizations (Moolgavkar) (22 ‐ 105) (0.6% ‐ 3.0%) (0.7 ‐ 3.1) hospitalizations (Winquist) (34.4 ‐ 76.2) (3.0% ‐ 6.6%) (0.6 ‐ 1.4) All respiratory 65 and older 249 1.7% 33.0 hospitalizations (Zanobetti) (144 ‐ 352) (1.0% ‐ 2.5%) (19.1 ‐ 46.8) Asthma emergency All ages 298 3.2% 5.5 Asthma emergency All ages 525 2.4% 9.7 department visits (Winquist) (146 ‐ 896) (0.7% ‐ 4.1%) (2.7 ‐ 16.5) department visits (Winquist) (0 ‐ 648) (0.0% ‐ 6.9%) (0 ‐ 12.0) Cardiovascular 65 and older 140 0.6% 18.6 hospitalizations (Peng) (53 ‐ 226) (0.2% ‐ 0.9%) (7.1 ‐ 30.0) 7/10/2019 13 7/10/2019 14 13 14 Estimated benefits of AQ improvements Geographic analysis: PM 2.5 ‐ attributable deaths PM 2.5 attributable and underlying all ‐ cause death rates per 100,000 people and attributable counts Reducing ozone by 10% can prevent: Reducing PM 2.5 by 10% can prevent: • 13 premature cardiopulmonary deaths • Up to 470 premature deaths • 17 hospitalizations from asthma • 50 hospitalizations • 93 emergency room visits for asthma • 60 emergency room visits 7/10/2019 15 7/10/2019 16 15 16 4
7/10/2019 Health equity and environmental justice Poverty and race Demographic Analyses: • Poverty: Percentage of residents below 200% FPL • Race: Percentage of Indigenous, Black and People of Color (IBPOC) • Metropolitan/Micropolitan/Rural (TC metro): • MN State Demographic Center designations (plus metro region) • Access to Health Care: Percentage of residents without health insurance 7/10/2019 17 7/10/2019 18 17 18 Poverty and race Urban vs rural Air pollution ‐ attributable death by county poverty level and population of color and indigenous Air poll Ai pollution ‐ attrib tribut utable ble dea death by by MN MN State Demog ograph phic ic Ce Center er De Designa gnatio ion County Group PM 2.5 (all ‐ cause, ages 25+, Lepeule) Ozone (cardiopulmonary causes, all ages) (Metr etropo poli litan Area Area, Micr cropolit opolitan Area Area, Rur Rural, Tw Twin Citi Cities es Me Metro Area Area) Rate per Attributable Attributable Rate per Attributable Attributable County Group PM 2.5 (all ‐ cause, ages 25+, Ozone (cardiopulmonary causes, all 100,000 Rate per fraction 100,000 Rate per fraction Lepeule) ages) people 100,000 people 100,000 Rate per Attributable Attributable Rate per Attributable Attributable 100,000 Rate per fraction 100,000 Rate per fraction people people people 100,000 people 100,000 All population 1,103.0 112.8 10.2% 70.0 0.74 1.1% people people Poverty (under 200% of FPL) Rural 1,524.6 134.1 8.8% 114.5 1.21 1.1% 0 ‐ 25 percent 918.3 94.4 10.3% 56.1 0.57 1.0% Micropolitan 1,428.7 134.8 9.4% 103.8 1.14 1.1% 25 ‐ 35 percent 1,181.5 122.2 10.3% 75.7 0.82 1.1% Area 35 percent or more 1,421.9 125.6 8.8% 95.9 0.88 0.9% Metropolitan 1,155.7 109.7 9.5% 73.6 0.70 1.0% Area Populations of Color and Indigenous 0 ‐ 10 percent 1,297.6 122.1 9.4% 91.2 0.98 1.1% Twin Cities 924.6 104.7 11.3% 52.4 0.57 1.1% Metro 10 ‐ 20 percent 1,050.1 104.5 9.9% 66.2 0.68 1.0% All population 1,103.0 112.8 10.2% 70.0 0.74 1.1% 20 percent or more 1,027.6 116.5 11.3% 59.4 0.63 1.1% 7/10/2019 19 7/10/2019 20 19 20 5
7/10/2019 Access to health care Key EJ/equity mortality findings Air poll Ai pollution ‐ attrib tribut utable ble dea death by by co coun unty lev level of of unins insur ured ed popula pulation tion Early deaths: County Group PM 2.5 (all ‐ cause, ages 25+, Ozone (cardiopulmonary Lepeule) causes, all ages) • Populations most impacted across the state include counties where >25% of Rate per Attributable Attributable Rate per Attributable Attributable the population is living in poverty. 100,000 Rate per fraction 100,000 Rate per fraction people 100,000 people 100,000 people people • Rural areas have higher burdens of air pollution ‐ attributable impacts (age Low (statistically 859.4 91.6 10.7% 50.2 0.59 1.2% below state distribution and other social and demographic structures have larger roles average) than air quality differences). Medium (close to 1,151.1 116.3 10.1% 74.7 0.76 1.0% state average) High (statistically 1,300.0 132.1 10.2% 84.0 0.87 1.0% • Areas with higher uninsured populations have higher burdens of air pollution ‐ above state attributable impacts. average) All population 1,103.0 112.8 10.2% 70.0 0.74 1.1% 7/10/2019 21 7/10/2019 22 21 22 Age groups analysis: Premature deaths Age groups analysis: Asthma ED visits 7/10/2019 23 7/10/2019 24 23 24 6
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