7/10/2019 Overview Minnesota Air and Health Initiative: Life and - - PDF document

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Life and Breath How air pollution affects health across Minnesota

MPHA

Kathy Raleigh, MDH Principal Epidemiologist David Bael, MPCA Economic Policy Analyst July 11, 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

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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

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Background

Original Life and Breath study

• 7‐county metro area, 2015 report of air pollution impacts on health in 2008
• In Metro area‐ PM2.5 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

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PM2.5 and ozone health impacts

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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.

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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?

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Methods and Results

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Health and death data

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Hospital discharge data

• Asthma ED visits
• Asthma hospitalizations
• Respiratory hospitalizations
• Cardiovascular hospitalizations

Vital Statistics

• All‐cause and cardiopulmonary deaths

Health outcomes ICD 9 ICD 10 Cardiopulmonary deaths N/A I00‐I79, J10‐J18, J40‐J47, J69 Asthma 496 (786.07 for Winquist et. al.,

• zone)

J45 (R062 for Winquist et. al., ozone) Chronic lung disease 490‐496 J40‐J45,J471, J479, J67 All respiratory 460‐519 J00‐J99 Cardiovascular disease 410‐414, 426‐429, 430‐438, 440‐ 448 I20‐I22, I24‐I25,I44‐I45, I47‐I50, I60‐I67, I69‐I75, I77‐I78,M30‐M31, R001, G454

Methods

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Air quality

PM2.5 in Minnesota by county, 2013 annual average (left) and ozone (average daily 8‐hour maximums) in Minnesota by county, 2013 ozone season average (right)

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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.

• 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.

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Aggregate results Minnesota 2013 annual health impacts attributable to PM2.5

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Health Effect Age group Number Percent of Total Events Attributable rate per 100,000 people All‐cause deaths 25 and older (Lepeule) 4,098 (2,098‐5,983) 10.2% (5.2%‐14.9%) 112.8 (57.8 ‐ 164.7) 30 and older (Krewski) 1,866 (1,270‐2,449) 4.7% (3.2%‐6.2%) 57.1 (38.9 ‐ 75.0) Asthma hospitalizations Under 18 (Babin) 15 (0 ‐ 75) 1.7% (0% ‐ 8.8%) 1.6 (0 ‐ 8.6) Asthma and COPD hospitalizations 18 to 64 (Moolgavkar) 64 (22 ‐ 105) 1.8% (0.6% ‐ 3.0%) 1.9 (0.7 ‐ 3.1) All respiratory hospitalizations 65 and older (Zanobetti) 249 (144 ‐ 352) 1.7% (1.0% ‐ 2.5%) 33.0 (19.1 ‐ 46.8) Asthma emergency department visits All ages (Winquist) 525 (146 ‐ 896) 2.4% (0.7% ‐ 4.1%) 9.7 (2.7 ‐ 16.5) Cardiovascular hospitalizations 65 and older (Peng) 140 (53 ‐ 226) 0.6% (0.2% ‐ 0.9%) 18.6 (7.1 ‐ 30.0)

Aggregate results Minnesota 2013 annual health impacts attributable to ozone

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Health Effect Age group Number Percent of Total Events Attributable rate per 100,000 people Cardiopulmonary deaths All ages (Huang) 57 (21.3 ‐ 91.8) 1.1% (0.4% ‐ 1.7%) 1.0 (0.4 ‐ 1.7) Asthma hospitalizations All ages (Winquist) 56 (34.4 ‐ 76.2) 4.8% (3.0% ‐ 6.6%) 1.0 (0.6 ‐ 1.4) Asthma emergency department visits All ages (Winquist) 298 (0 ‐ 648) 3.2% (0.0% ‐ 6.9%) 5.5 (0 ‐ 12.0)

Estimated benefits of AQ improvements

Reducing PM2.5 by 10% can prevent:

• Up to 470 premature deaths
• 50 hospitalizations
• 60 emergency room visits

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Reducing ozone by 10% can prevent:

• 13 premature cardiopulmonary deaths
• 17 hospitalizations from asthma
• 93 emergency room visits for asthma

Geographic analysis: PM2.5‐attributable deaths

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PM2.5 attributable and underlying all‐cause death rates per 100,000 people and attributable counts

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Health equity and environmental justice

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

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Poverty and race

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County Group PM2.5 (all‐cause, ages 25+, Lepeule) Ozone (cardiopulmonary causes, all ages) Rate per 100,000 people Attributable Rate per 100,000 people Attributable fraction Rate per 100,000 people Attributable Rate per 100,000 people Attributable fraction 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%

Poverty and race

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Air pollution‐attributable death by county poverty level and population of color and indigenous

Urban vs rural

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County Group PM2.5 (all‐cause, ages 25+, Lepeule) Ozone (cardiopulmonary causes, all ages)

Rate per 100,000 people Attributable Rate per 100,000 people Attributable fraction Rate per 100,000 people Attributable Rate per 100,000 people Attributable fraction

Rural 1,524.6 134.1 8.8% 114.5 1.21 1.1% Micropolitan Area 1,428.7 134.8 9.4% 103.8 1.14 1.1% Metropolitan Area 1,155.7 109.7 9.5% 73.6 0.70 1.0% Twin Cities Metro 924.6 104.7 11.3% 52.4 0.57 1.1% All population 1,103.0 112.8 10.2% 70.0 0.74 1.1%

Ai Air poll pollution‐attrib tribut utable ble dea death by by MN MN State Demog

• graph

phic ic Ce Center er De Designa gnatio ion (Metr etropo poli litan Area Area, Micr cropolit

• politan Area

Area, Rur Rural, Tw Twin Citi Cities es Me Metro Area Area)

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Access to health care

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County Group PM2.5 (all‐cause, ages 25+, Lepeule) Ozone (cardiopulmonary causes, all ages)

Rate per 100,000 people Attributable Rate per 100,000 people Attributable fraction Rate per 100,000 people Attributable Rate per 100,000 people Attributable fraction

Low (statistically below state average) 859.4 91.6 10.7% 50.2 0.59 1.2% Medium (close to state average) 1,151.1 116.3 10.1% 74.7 0.76 1.0% High (statistically above state average) 1,300.0 132.1 10.2% 84.0 0.87 1.0% All population 1,103.0 112.8 10.2% 70.0 0.74 1.1%

Ai Air poll pollution‐attrib tribut utable ble dea death by by co coun unty lev level of

• f unins

insur ured ed popula pulation tion

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.

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Age groups analysis: Premature deaths

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Age groups analysis: Asthma ED visits

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Key messages

• Air pollution impacting health is not just a big city or metro area issue.
• Air quality in Minnesota currently meets federal standards, but even low and

moderate levels of air pollution can contribute to serious illnesses and early death.

• Because many things in addition to air impact our health – like age and health care–

areas with higher underlying death and disease rates have higher health impacts from air pollution.

• In addition, structural inequities, like income, racial discrimination, transportation

patterns, community social status, education, and housing are major contributors to how health is affected by air pollution.

• To reduce the impacts of breathing polluted air, multi‐pronged policy approaches are

needed that address underlying causes of health disparities and improve air quality.

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What is being done?

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MDH action

MDH strives to:

• Work toward health systems and environmental regulations that promote a

healthy environment

• Expand linkages between communities and clinical care and prevention services
• Advance health‐based guidance for regulators on key air pollutants
• Track connections between environmental exposures, inequities, and health
• utcomes
• Identify vulnerable populations and determine sub‐groups for future risks

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MPCA action

MPCA is working with partners to:

• Reduce pollution in population centers focusing on areas of concern for

environmental justice

• Reduce vehicle emissions
• Improve understanding of air quality at the community scale
• Increase awareness about air quality forecasts, alerts, and tools for communities

and health care providers

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Community action

What can communities do to help decrease air pollution and vulnerability?

• Vehicle exhaust is the major source of air pollution in MN, whenever possible drive

less and/or car pool

• Don’t burn garbage and keep campfires small (only on non AQI days)
• Check for AQI days
• Switch to electric when possible (e.g. lawn equipment)
• Plant trees when possible!

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Thank you!

Questions/Feedback

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Kathy Raleigh Minnesota Department of Health kathy.raleigh@state.mn.us David Bael Minnesota Pollution Control Agency david.bael@state.mn.us

Methods: Inputs

Health Impact Functions: ∆

1 ∆ ∗

ΔY = Change in health impact Y0 = Baseline incidence of health impact ΔPM = Change in PM2.5 concentration Pop = Exposed population β = The effect estimate, derived from epidemiological studies

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Methods: Health outcomes and epidemiology

Concentration Response (CR)/Effect Estimate

• Health effect estimates are

based on epidemiology studies for specific health endpoints, age groups, and air pollutant

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Health Effect Outcome Definition Age Group All‐cause Death All causes 25 (or 30) and above Cardiopulmonary Death Heart attack, ischemic heart diseases, hypertensive diseases, heart failure, stroke, atherosclerosis, pneumonia and influenza, chronic obstructive pulmonary disease (COPD), asthma and pneumonitis All ages Asthma, COPD 18 to 64 Respiratory infections, pneumonia and influenza, asthma, COPD, and pneumonitis 65 and above Hospital admissions for cardiovascular conditions Heart attack, ischemic heart disease, heart failure, stroke and atherosclerosis 65 and above Hospitalizations of children for asthma Asthma 0 to 17 Hospitalizations for asthma Asthma or wheeze All ages Emergency department visits for asthma Asthma or wheeze All ages Hospital admissions for respiratory conditions

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