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Life and BreathHow air pollution affects health across

MinnesotaMPHA

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

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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., ozone)

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. ØThis 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.ØThis translates to approximately 500 hospitalizations, and 800 emergency room visits

annually.

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Aggregate resultsMinnesota 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 resultsMinnesota 2013 annual health impacts attributable to ozone

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Health Effect Age group NumberPercent of Total

EventsAttributable 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 COPD 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

Geographic analysis: Regions

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

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

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Poverty and IBPOC

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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



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 Indigenous0-10 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 IBPOC

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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)







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%

Air pollution-attributable death by MN State Demographic Center Designation (Metropolitan Area, Micropolitan Area, Rural, Twin Cities Metro Area)

Access to health care

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County Group PM2.5 (all-cause, ages 25+, Lepeule)

Ozone (cardiopulmonary causes, all ages)







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%

Air pollution-attributable death by county level of uninsured population

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.

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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 quality in Minnesota currently meets federal standards, but even low and moderate levels of air pollution can contribute to serious illnesses and early death.

• Everyone can be affected by breathing polluted air, but some groups and areas of the state are more vulnerable than others.

• Because many things in addition to air impact our health – like age, health care and socioeconomic status – areas with higher underlying death and disease rates have higher health impacts from air pollution.

• Air pollution impacting health is not just a big city or metro area issue.

• 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 outcomes

• 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 RaleighMinnesota Department of [email protected]

David BaelMinnesota Pollution Control [email protected]

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