Life and Breath How air pollution affects health across Minnesota - PowerPoint PPT Presentation

Life and Breath How air pollution affects health across Minnesota MPHA Kathy Raleigh, MDH Principal Epidemiologist David Bael, MPCA Economic Policy Analyst April 12, 2019

Overview Minnesota Air and Health Initiative: Life and Breath Study • Background • MDH/PCA collaboration • Original TC metro area study • Statewide Life and Breath • methods, phases, results • Key takeaway and Discussion 6/13/19 2

Minnesota Air and Health Initiative MPCA/MDH collaboration to understand and address role of air quality in our health • Common responsibility to protect and improve public health MPCA and MDH roles • MPCA: generates air quality monitoring and modeling data, estimates risks to inform actions • MDH: conducts disease surveillance to inform disease prevention actions, including data on social, behavioral and environmental risks 3

Background Original Life and Breath study • 7-county metro area, 2015 report of air pollution impacts on health in 2008 • In Metro area- PM 2.5 and ozone contributed to approximately: • 1,000 - 2,000 premature deaths • 400 hospitalizations • 600 emergency room visits • Some sub-populations – elderly, young children, areas with higher proportions of minority populations and residents living in poverty – are particularly vulnerable to air pollution 6/13/19 4

PM 2.5 and ozone health impacts 6/13/19 5

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. 6/13/19 6

Statewide “Life and Breath II” Goals for “Life and Breath II” • What are the impacts of fine particulate matter and ozone state-wide? • Are the impacts distributed equally across the state? • What benefits can be achieved by further reducing air pollution across the state? 6/13/19 7

Methods and Results 6/13/19 8

Health and death data 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 6/13/19 9

Methods 6/13/19 10

Air quality PM 2.5 in Minnesota by county, 2013 annual average (left) and ozone (average daily 8-hour maximums) in Minnesota by county, 2013 ozone season average (right) 6/13/19 11

Aggregate findings We estimate: • Between 5-10% of all Minnesotans died prematurely, in part, due to fine particles in the air or ground-level ozone. Ø 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. Ø This translates to approximately 500 hospitalizations, and 800 emergency room visits annually. 6/13/19 12

Aggregate results Minnesota 2013 annual health impacts attributable to PM 2.5 Attributable rate per Health Effect Age group Number Percent of Total Events 100,000 people 25 and older 4,098 10.2% 112.8 (Lepeule) (2,098-5,983) (5.2%-14.9%) (57.8 - 164.7) 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) Asthma Under 18 15 1.7% 1.6 hospitalizations (Babin) (0 - 75) (0% - 8.8%) (0 - 8.6) Asthma and COPD 18 to 64 64 1.8% 1.9 hospitalizations (Moolgavkar) (22 - 105) (0.6% - 3.0%) (0.7 - 3.1) 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 525 2.4% 9.7 department visits (Winquist) (146 - 896) (0.7% - 4.1%) (2.7 - 16.5) Cardiovascular 65 and older 140 0.6% 18.6 hospitalizations (Peng) (53 - 226) (0.2% - 0.9%) (7.1 - 30.0) 6/13/19 13

Aggregate results Minnesota 2013 annual health impacts attributable to ozone Percent of Total Attributable rate Health Effect Age group Number Events per 100,000 people Cardiopulmonary All ages 57 1.1% 1.0 deaths (Huang) (21.3 - 91.8) (0.4% - 1.7%) (0.4 - 1.7) Asthma All ages 56 4.8% 1.0 hospitalizations (Winquist) (34.4 - 76.2) (3.0% - 6.6%) (0.6 - 1.4) Asthma emergency All ages 298 3.2% 5.5 department visits (Winquist) (0 - 648) (0.0% - 6.9%) (0 - 12.0) 6/13/19 14

Estimated benefits of AQ improvements Reducing PM 2.5 by 10% can prevent: Reducing ozone by 10% can prevent: • 13 premature COPD deaths • Up to 470 premature deaths • 17 hospitalizations from asthma • 50 hospitalizations • 93 emergency room visits for asthma • 60 emergency room visits 6/13/19 15

Geographic analysis: PM 2.5 -attributable deaths PM 2.5 attributable and underlying all-cause death rates per 100,000 people and attributable counts 6/13/19 16

Geographic analysis: Regions PM 2.5 attributable and underlying all-cause death rates per 100,000 people and attributable counts 6/13/19 17

Demographics Demographic Analyses: • Poverty: Percentage of residents below 200% FPL • Race: Percentage of Indigenous, Black and People of Color (IBPOC) • Age groups: Under 18, 18-44, 45-64, 65 and older • Metropolitan/Micropolitan/Rural (TC metro): • MN State Demographic Center designations (plus metro region) • Access to Health Care: Percentage of residents without health insurance 6/13/19 18

Poverty and IBPOC 6/13/19 19

Poverty and IBPOC Air pollution-attributable death by county poverty level and population of color and indigenous County Group PM 2.5 (all-cause, ages 25+, Lepeule) Ozone (cardiopulmonary causes, all ages) Rate per Attributable Attributable Rate per Attributable Attributable Rate per fraction Rate per fraction 100,000 100,000 100,000 100,000 people people people people All population 1,103.0 112.8 10.2% 70.0 0.74 1.1% Poverty (under 200% of FPL) 0-25 percent 918.3 94.4 10.3% 56.1 0.57 1.0% 25-35 percent 1,181.5 122.2 10.3% 75.7 0.82 1.1% 35 percent or more 1,421.9 125.6 8.8% 95.9 0.88 0.9% Populations of Color and Indigenous 0-10 percent 1,297.6 122.1 9.4% 91.2 0.98 1.1% 10-20 percent 1,050.1 104.5 9.9% 66.2 0.68 1.0% 20 percent or more 1,027.6 116.5 11.3% 59.4 0.63 1.1% 6/13/19 20

Urban vs rural Air ir pollu llutio ion-at attributable deat ath by MN Stat ate Dem Demogr graphic c Cen enter er Des Design gnation (M (Metropolitan Area, Mi Micr cropolitan Ar Area ea, Ru Rural, Twin Cities es Me Metro Ar Area ea) County Group PM 2.5 (all-cause, ages 25+, Ozone (cardiopulmonary causes, all Lepeule) ages) Rate per Attributable Attributable Rate per Attributable Attributable 100,000 Rate per fraction 100,000 Rate per fraction people 100,000 people 100,000 people people Rural 1,524.6 134.1 8.8% 114.5 1.21 1.1% Micropolitan 1,428.7 134.8 9.4% 103.8 1.14 1.1% Area Metropolitan 1,155.7 109.7 9.5% 73.6 0.70 1.0% Area Twin Cities 924.6 104.7 11.3% 52.4 0.57 1.1% Metro All population 1,103.0 112.8 10.2% 70.0 0.74 1.1% 6/13/19 21

Access to health care Air ir pollu llutio ion-at attributable deat ath by county leve vel of uninsured populat ation County Group PM 2.5 (all-cause, ages 25+, Ozone (cardiopulmonary Lepeule) causes, all ages) Rate per Attributable Attributable Rate per Attributable Attributable 100,000 Rate per fraction 100,000 Rate per fraction people 100,000 people 100,000 people people Low (statistically 859.4 91.6 10.7% 50.2 0.59 1.2% below state average) 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% above state average) All population 1,103.0 112.8 10.2% 70.0 0.74 1.1% 6/13/19 22

Key EJ/equity mortality findings Early deaths: • Populations most impacted across the state include counties where >25% of the population is living in poverty. • Rural areas have higher burdens of air pollution-attributable impacts (age distribution and other social and demographic structures have larger roles than air quality differences). • Areas with higher uninsured populations have higher burdens of air pollution- attributable impacts. • Young and elderly are vulnerable populations. 6/13/19 23

Age groups analysis: Premature deaths 6/13/19 24

Age groups analysis: Asthma ED visits 6/13/19 25