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Johnson - Measuring the Public Health Impacts of Air Pollution in Minnesota
1. Measuring the Public Health Impacts of Air
Pollution in Minnesota
Jean Johnson, PhD
Minnesota Department of Health
Chronic Disease and Environmental Epidemiology
Environmental Public Health Tracking and Biomonitoring
3. PM2.5 pyramid of health effects
Death
Hospital
admissions
Emergency room
visits
Doctor visits
Asthma attacks, medication
use, symptoms
Lung function changes, immune cell
responses, heart rate variability
responses
4. Increased life expectancy
Source: NEJM 2009
Air pollution controls during 1970-2000 improved health
51 metropolitan areas
15% increase in life expectancy due to pollution
reduction
Reducing PM2.5 (10µg/m3) added 7 months of life
5. Air pollution epidemiology studies
Health impacts are measurable
Large body of evidence – PM2.5
Respiratory and cardiovascular effects
Long-term effects increased risk
Short-term effects triggering/exacerbations
Effects observed even at low concentrations
6. Air pollution affects entire populations
Susceptible population is growing
2004
Aging population
Increasing obesity, diabetes rates
Effects observed in children
Lung development 2009
Asthma exacerbations
Even very small increases associated
with disease and death
Obesity in MN
7. AQI: Number of unhealthy air days in MN
Source: MN Pollution Control Agency
8. Improving air, preventing deaths
Air quality MN (2006)
improvement
scenarios
5
Estimated number
of prevented deaths
10% reduction PM2.5 78
concentrations (MSP metro)
BenMAP software
4
Source: CDC Environmental Public Health Tracking
9. Air pollution and health research at MDH
Purpose: method/indicator development
Local area analyses
Using local sources of data
Track health effects associated with changes in
air quality in MSP and Olmsted during 2003-
2009
Fine particulate matter pollution (PM2.5)
Hospitalizations and mortality
Respiratory , cardiovascular
10. MN air initiatives timeline
Heavy Duty Diesel Rule
2007
Ultra Low Sulfur Fuel
late 2006
24-hr PM2.5 NAAQS revision
Clean Air Interstate Rule
Adopted 2005; remanded 2008
2003 2004 2005 2006 2007 2008 2009
Baseline Period Early Implementation Implementation
MERP: Riverside
coal to natural gas
MERP: High Bridge
coal to natural gas
MERP: Allen S. King
emissions controls
Project Green Fleet retrofits
2005-2009 continuous
11. Measuring impacts using local area data
Reductions in Reductions in
Regulatory
Population Adverse
or Policy
Exposures Health
Changes
Outcomes
• PM2.5 • Respiratory diseases
• Cardiovascular disease
• Hospitalizations and
Deaths
13. Air pollution and health research: Results
Associations found in the MSP metro for PM2.5 and
respiratory hospitalizations
Hospitalizations Amount attributable to PM2.5 in 2003-2009
Percent # hosp. per year
Total respiratory 1.9% 224
COPD + asthma 2.3% 110
Asthma 2.3% 54
14. MN air pollution health impacts over time
Amount attributable to PM2.5
Hospitalizations Time period
Percent # hosp./yr
Total respiratory 2003-2005 3.0% 354
2006-2007 2.6% 309
2008-2009 -- --
COPD + asthma 2003-2005 3.3% 154
2006-2007 2.9% 140
2008-2009 -- --
Asthma 2003-2005 3.8% 92
2006-2007 -- --
2008-2009 -- --
15. Summary
Air pollution affects health even at low levels
Air pollution affects entire populations
Impact on a growing number of susceptible
people
All regions of MN experience poor air quality days
BUT…
MN has been making improvements in air quality
Continued efforts will lead to a healthier MN
16. Project Team
MN Dept. of Health MN Pollution Control Agency Olmsted Medical Center
Jean Johnson Greg Pratt Barbara Yawn
Chuck Stroebel Kari Palmer Peter Wollan
Allan Williams Margaret McCourtney
Naomi Shinoda Cassie McMahon
Wendy Brunner Lisa Herschberger
Paula Lindgren
Measuring the Impact of Fine Particles:
http://www.health.state.mn.us/divs/hpcd/cdee/airquality.html
Notes de l'éditeur
Over the past several decades, thousands of epidemiological studies have looked at the health impacts of air pollution.These studies have made a case for the conclusion that: these health impacts are indeed measurable, and exposure to PM2.5 has an impact on respiratory and cardiovascular health on a population level, even at low concentrations of PM2.5. The body of evidence for PM2.5 encompasses studies that look at long-term, cumulative exposures to particle pollution – they find increased risks for mortality, CVD disease, and other health outcomes due to levels of PM2.5 in the air.There are also studies that look at how short-term exposures can affect health…these studies have also consistently found associations with PM2.5 and the triggering or exacerbation of health events.
The take-home message from all of these epidemiology studies is that everyone is exposed to some amount of air pollution .But some people are more susceptible to the effects of pollution than others….this population group is growing in MN as well as nationwide.[The figures show the prevalence of obesity among adults in MN – growing prevalence.]Baseline incidence of disease is not uniform across the population but has geographic variability, thus health impact analysis will reflect geographic variation in underlying population vulnerabilities. (geographic distribution of disease not even….pockets of susceptible populations)[A “double whammy” – there are increasing rates of diabetes, obesity…and these populations are already at risk of heart disease because of those conditions. On top of that, these populations are even further at risk of adverse health because of their exposure to air pollution.]
This chart shows the number of days in a year that the Air Quality Index was above 100 in various regions in MN. An AQI of above 100 means that the PM2.5 or ozone concentration is harmful for sensitive groups (such as people with respiratory or heart disease, the elderly, and active children).In general, the Twin Cities experiences the highest number of unhealthy air quality days. However, all regions of the state can experience poor air quality.
Most recently, CDC’s Environmental Public Health Tracking Program piloted a health impact assessment approach to model the estimated number of deaths prevented given improvements in air quality. They used this to model predictions for every county in the US, and here you see the scenario using 2006 data for MN counties. These are the estimated number of deaths prevented in 2006 in a scenario where the PM2.5 concentrations are reduced by 10%.[Keep in mind that the model uses many, many assumptions…]Yellow = 0Green = more than 0 to 1Light blue = more than 1 to 2Blue = more than 2[This is based on a model that is making predictions…..different approach from what we used.]Estimated mortality = (change in PM2.5 concentration) x (concentration-response function) x (baseline death incidence rate) x (population)