Health Assessment and Air Pollution

Ilias G Kavouras PhDDepartment of Environmental and Occupational Health

University of Arkansas for Medical Sciences College of Public Health

Study tasksbull evaluate the relative contribution of local and regional

sources on PM10 PM25 and O3 concentrations

bull the concentration trends and spatiotemporal variations of O3 in relation to wildfires

bull produce a regional health profile for air quality related chronic and infectious diseases

bull obtain baseline information on the state of health and risks factors of the region through acquisition and analysis of available indicators Mortality and hospital admissions for COPD asthma heart failure stroke and infectious diseases (Flu pneumonia pertussis and Coccidioidomycosis)

bull estimate the relative risks for respiratory and cardiovascular diseases in Dona Ana county

bull Obtain and analyze emergency rooms visits and hospital admissions and air pollution (PM10 PM25 and O3)

0 1500 3000750 km

Uuml

Normalized residence time

asn0400

ltVALUEgt

0010881754

0010881754 - 0014

0014 - 003

003 - 007

007 - 014

014 - 028

028 - 2774847269

Air mass residence timeNormalized residence time

lt 0

007

000

7-0

014

001

4-0

03

003

- 0

07

007

- 0

14

014

- 0

28

gt 0

28

Shipping emissions (SO4 NO3)O3 and precursors

Local sources

Shipping emissions (SO4 NO3)O3 and precursors

Tracer Mass Balance model

Ci = measured concentration of the i species at the receptor siteQij = emission rate of the i species from the j source regionTij = transformation and deposition factor of the i species from the j source region to account for deposition

diffusion and chemical conversion

Nj = number of back trajectory endpoints in the j source regionEij = entrainment factor of the i species from the j source region to account for disassociation between the back

trajectories and the transport of pollutants

Assumption measured concentrations at a receptor are linearly related to the frequency of airmass transport from a source region to the receptor site

Development of the model Pitchford and Pitchford 1985 Gebhart et al 1993Application of the model Gebhart et al 2001 2006 Xu et al 2006 Huang et al 2010 Kavouras et al 2013 Chalbot et al 2013

= dust concentration (μgm3) at the receptor site on j day= contribution of region i on j day= residence time for all air parcels arriving at the receptor site over source region i on j day= regression coefficient of source region i= intercept

εij = residual of region i on j day

Source regions contributions

cen

tra

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cific

Pa

cific

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0

1

2

3

4

5

6

7

Co

ntr

ibu

tion

(in

μg

m3

for

PM

10

an

d P

M2

5

pp

bv

for

O3

)

PM10

PM25

O

19 regions four adjacent to Las Cruces (500 km)

bull The four adjacent sectors are important contributors to PM10 PM25 and O3

bull Southern California Arizona Baja California and southeast Texas are also important determinants

bull Northwest US contributes up to 8 ppbv of O3

O3 monitoring locations

Approachbull The relative (ΔCRef) differences and the coefficient of divergence (COD)of 8-hr

maximum monthly concentrations between two sites (Chiricahua National Monument was the reference site)

COD values vary from 0 to 1 with COD values close to unity being suggestive of strong spatial variation

bull Total counts of fire detectionsmonthbull Frequency gt25 25-50 50-75

gt75bull Distance from the site 0-160 160-400

400-800 800-1600 1600-3200 3200-4800 km

ሾ1198743ሿ119894 = 119886+ ൫119887119895 ∙119883119894119895൯6

119895=1

bull Ordinary least squares regression of deseasonalized monthly 8-hr maximum O3 concentrations (ldquoCensus Irdquo method)

Site code Annual trend (ppbvyr) 2010 8-hr max ΔCRef Median (σ) COD

ch 012b 74 nm1 026 79 -5 (13) 010nm2 -185a 65 -2 (16) 010nm4 -022 68 -4 (11) 006nm6 -037a 70 1 (13) 006nm7 -069a 67 -10 (8) 007nm8 -069a 81 -15 (11) 013nm9 -077a 85 -8 (7) 006nm10 -046a 70 -17 (10) 011ep1 013 88 -21 (25) 021ep3 -050a 76 -6 (16) 008ep4 -015 77 -9 (21) 014ep6 007 77 -13 (21) 011ep7 -051 71 -11 (17) 010ep8 -015b 77 -3 (16) 007cj1 -121a 79 7 (32) 021cj2 -122a 60 -10 (25) 016cj4 -100a 88 -2 (24) 011

a significant at p lt 0001 b significant at plt001

Annual and spatial trends

Fires distance and O3

bull Increasing trend is due to the decomposition of peroxyacetylnitrates (PAN)

bull Decrease of O3 for fires within 400 km may be due to NO titration of O3

bull Increase in extreme fire events within 400 km may be due to changes of NO2 and O3 photolysis rates in the smoke plume

Fires distance and O3

a Significant estimates (at p-value lt 015)

Site codeBuffer contribution (ppbv)a

gt160 km 160 -400 km 400-800 km 800-1600 km 1600-3200 km 3200-4800 kmch 3 -1 1 0 2 2nm1 -1 -1 0 -1 5 2nm2 -2 -3 1 -2 5 4nm3 0 -1 4 4 0 0nm4 -5 -1 4 1 3 4nm5 0 0 3 -1 7 -2nm6 -4 -4 6 -1 6 4nm7 -5 -6 8 -1 5 4nm8 -5 -5 7 -2 4 4nm9 -3 -4 5 -1 4 3nm10 -2 -3 6 -1 3 3ep1 -6 -7 11 1 2 5ep2 -6 -6 11 -1 5 4ep3 -4 -5 9 -2 4 3ep4 -5 -6 11 1 1 5ep5 -5 -5 8 1 3 4ep6 -4 -6 8 5 0 4ep7 -5 -4 9 -3 6 7ep8 -3 -4 5 -1 3 4cj1 -5 -8 12 0 3 4

Fires distance and O3

Fires and asthmaCOPD hospitalizations

119898= (119901 104Τ ) times 119887times 119890ሺ120573times∆1198743ሻminus1 (E 1

bull β is related to an increase of 425 (asthmaall ages) 185 (asthma children) 246 (asthma 15-64 years) and 329 (COPD all ages) for an increase of 10 ppbv of 8-hr maximum O3 concentration (Ji et al 2011)

bull p is the county population and bull b is the county baseline hospitalizations rates

Mean contributionΔO3=52 ppbv

Maximum contributionΔO3=8 ppbv

Asthma (All Ages) 219 329Asthma (Children) 097 149

Asthma (15-64 ages) 129 199COPD (All ages) 172 266

Regional Health Profilebull State of New Mexicos Department of Health Indicator Based

Information System for Public Health (NEW MEXICO-IBIS) Mortality Data

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Hospital Impatient Discharge Data (HIDD)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Behavioral Risk Factor Surveillance System (BRFSS)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Youth Risk and Resiliency Survey

bull New Mexico EnviroNew Mexicoent Department Air Quality Bureaubull US Census Bureaubull US Department of Health and Human Services Health Resources

and Services Administrationbull US Department of Labor Bureau of Labor Statisticsbull US Environmental Protection Agency Air Quality System

Total mortality

number of people who died in 2010 in relation to the population size (per 100000)

New Mexico 742USA 798

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

0 1500 3000750 km

Uuml

Normalized residence time

asn0400

ltVALUEgt

0010881754

0010881754 - 0014

0014 - 003

003 - 007

007 - 014

014 - 028

028 - 2774847269

Air mass residence timeNormalized residence time

lt 0

007

000

7-0

014

001

4-0

03

003

- 0

07

007

- 0

14

014

- 0

28

gt 0

28

Shipping emissions (SO4 NO3)O3 and precursors

Local sources

Shipping emissions (SO4 NO3)O3 and precursors

Tracer Mass Balance model

Ci = measured concentration of the i species at the receptor siteQij = emission rate of the i species from the j source regionTij = transformation and deposition factor of the i species from the j source region to account for deposition

diffusion and chemical conversion

Nj = number of back trajectory endpoints in the j source regionEij = entrainment factor of the i species from the j source region to account for disassociation between the back

trajectories and the transport of pollutants

Assumption measured concentrations at a receptor are linearly related to the frequency of airmass transport from a source region to the receptor site

Development of the model Pitchford and Pitchford 1985 Gebhart et al 1993Application of the model Gebhart et al 2001 2006 Xu et al 2006 Huang et al 2010 Kavouras et al 2013 Chalbot et al 2013

= dust concentration (μgm3) at the receptor site on j day= contribution of region i on j day= residence time for all air parcels arriving at the receptor site over source region i on j day= regression coefficient of source region i= intercept

εij = residual of region i on j day

Source regions contributions

cen

tra

l Pa

cific

Pa

cific

No

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0

1

2

3

4

5

6

7

Co

ntr

ibu

tion

(in

μg

m3

for

PM

10

an

d P

M2

5

pp

bv

for

O3

)

PM10

PM25

O

19 regions four adjacent to Las Cruces (500 km)

bull The four adjacent sectors are important contributors to PM10 PM25 and O3

bull Southern California Arizona Baja California and southeast Texas are also important determinants

bull Northwest US contributes up to 8 ppbv of O3

O3 monitoring locations

Approachbull The relative (ΔCRef) differences and the coefficient of divergence (COD)of 8-hr

maximum monthly concentrations between two sites (Chiricahua National Monument was the reference site)

COD values vary from 0 to 1 with COD values close to unity being suggestive of strong spatial variation

bull Total counts of fire detectionsmonthbull Frequency gt25 25-50 50-75

gt75bull Distance from the site 0-160 160-400

400-800 800-1600 1600-3200 3200-4800 km

ሾ1198743ሿ119894 = 119886+ ൫119887119895 ∙119883119894119895൯6

119895=1

bull Ordinary least squares regression of deseasonalized monthly 8-hr maximum O3 concentrations (ldquoCensus Irdquo method)

Site code Annual trend (ppbvyr) 2010 8-hr max ΔCRef Median (σ) COD

ch 012b 74 nm1 026 79 -5 (13) 010nm2 -185a 65 -2 (16) 010nm4 -022 68 -4 (11) 006nm6 -037a 70 1 (13) 006nm7 -069a 67 -10 (8) 007nm8 -069a 81 -15 (11) 013nm9 -077a 85 -8 (7) 006nm10 -046a 70 -17 (10) 011ep1 013 88 -21 (25) 021ep3 -050a 76 -6 (16) 008ep4 -015 77 -9 (21) 014ep6 007 77 -13 (21) 011ep7 -051 71 -11 (17) 010ep8 -015b 77 -3 (16) 007cj1 -121a 79 7 (32) 021cj2 -122a 60 -10 (25) 016cj4 -100a 88 -2 (24) 011

a significant at p lt 0001 b significant at plt001

Annual and spatial trends

Fires distance and O3

bull Increasing trend is due to the decomposition of peroxyacetylnitrates (PAN)

bull Decrease of O3 for fires within 400 km may be due to NO titration of O3

bull Increase in extreme fire events within 400 km may be due to changes of NO2 and O3 photolysis rates in the smoke plume

Fires distance and O3

a Significant estimates (at p-value lt 015)

Site codeBuffer contribution (ppbv)a

gt160 km 160 -400 km 400-800 km 800-1600 km 1600-3200 km 3200-4800 kmch 3 -1 1 0 2 2nm1 -1 -1 0 -1 5 2nm2 -2 -3 1 -2 5 4nm3 0 -1 4 4 0 0nm4 -5 -1 4 1 3 4nm5 0 0 3 -1 7 -2nm6 -4 -4 6 -1 6 4nm7 -5 -6 8 -1 5 4nm8 -5 -5 7 -2 4 4nm9 -3 -4 5 -1 4 3nm10 -2 -3 6 -1 3 3ep1 -6 -7 11 1 2 5ep2 -6 -6 11 -1 5 4ep3 -4 -5 9 -2 4 3ep4 -5 -6 11 1 1 5ep5 -5 -5 8 1 3 4ep6 -4 -6 8 5 0 4ep7 -5 -4 9 -3 6 7ep8 -3 -4 5 -1 3 4cj1 -5 -8 12 0 3 4

Fires distance and O3

Fires and asthmaCOPD hospitalizations

119898= (119901 104Τ ) times 119887times 119890ሺ120573times∆1198743ሻminus1 (E 1

bull β is related to an increase of 425 (asthmaall ages) 185 (asthma children) 246 (asthma 15-64 years) and 329 (COPD all ages) for an increase of 10 ppbv of 8-hr maximum O3 concentration (Ji et al 2011)

bull p is the county population and bull b is the county baseline hospitalizations rates

Mean contributionΔO3=52 ppbv

Maximum contributionΔO3=8 ppbv

Asthma (All Ages) 219 329Asthma (Children) 097 149

Asthma (15-64 ages) 129 199COPD (All ages) 172 266

Regional Health Profilebull State of New Mexicos Department of Health Indicator Based

Information System for Public Health (NEW MEXICO-IBIS) Mortality Data

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Hospital Impatient Discharge Data (HIDD)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Behavioral Risk Factor Surveillance System (BRFSS)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Youth Risk and Resiliency Survey

bull New Mexico EnviroNew Mexicoent Department Air Quality Bureaubull US Census Bureaubull US Department of Health and Human Services Health Resources

and Services Administrationbull US Department of Labor Bureau of Labor Statisticsbull US Environmental Protection Agency Air Quality System

Total mortality

number of people who died in 2010 in relation to the population size (per 100000)

New Mexico 742USA 798

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Tracer Mass Balance model

Ci = measured concentration of the i species at the receptor siteQij = emission rate of the i species from the j source regionTij = transformation and deposition factor of the i species from the j source region to account for deposition

diffusion and chemical conversion

Nj = number of back trajectory endpoints in the j source regionEij = entrainment factor of the i species from the j source region to account for disassociation between the back

trajectories and the transport of pollutants

Assumption measured concentrations at a receptor are linearly related to the frequency of airmass transport from a source region to the receptor site

Development of the model Pitchford and Pitchford 1985 Gebhart et al 1993Application of the model Gebhart et al 2001 2006 Xu et al 2006 Huang et al 2010 Kavouras et al 2013 Chalbot et al 2013

= dust concentration (μgm3) at the receptor site on j day= contribution of region i on j day= residence time for all air parcels arriving at the receptor site over source region i on j day= regression coefficient of source region i= intercept

εij = residual of region i on j day

Source regions contributions

cen

tra

l Pa

cific

Pa

cific

No

rth

we

st

we

ste

rn R

ock

ies

no

rth

ern

Ro

ckie

s

Up

pe

r M

idw

est

cen

tra

l La

kes

sou

thw

est

US

we

ste

rn N

ew

Me

xico

ea

ste

rn N

ew

Me

xico

sou

thw

est

Ne

w M

exi

co

sou

thw

est

Te

xas

Ciu

da

d J

ua

rez

sou

the

rn P

lain

s

sou

th M

idw

est

sou

th P

aci

fic o

cea

n

Ba

ja C

alif

orn

ia

sou

thw

est

Me

xico

sou

the

ast

Te

xas

an

d M

exi

co

Gu

lf o

f Me

xico

co

ast

sou

the

rn M

exi

co

0

1

2

3

4

5

6

7

Co

ntr

ibu

tion

(in

μg

m3

for

PM

10

an

d P

M2

5

pp

bv

for

O3

)

PM10

PM25

O

19 regions four adjacent to Las Cruces (500 km)

bull The four adjacent sectors are important contributors to PM10 PM25 and O3

bull Southern California Arizona Baja California and southeast Texas are also important determinants

bull Northwest US contributes up to 8 ppbv of O3

O3 monitoring locations

Approachbull The relative (ΔCRef) differences and the coefficient of divergence (COD)of 8-hr

maximum monthly concentrations between two sites (Chiricahua National Monument was the reference site)

COD values vary from 0 to 1 with COD values close to unity being suggestive of strong spatial variation

bull Total counts of fire detectionsmonthbull Frequency gt25 25-50 50-75

gt75bull Distance from the site 0-160 160-400

400-800 800-1600 1600-3200 3200-4800 km

ሾ1198743ሿ119894 = 119886+ ൫119887119895 ∙119883119894119895൯6

119895=1

bull Ordinary least squares regression of deseasonalized monthly 8-hr maximum O3 concentrations (ldquoCensus Irdquo method)

Site code Annual trend (ppbvyr) 2010 8-hr max ΔCRef Median (σ) COD

ch 012b 74 nm1 026 79 -5 (13) 010nm2 -185a 65 -2 (16) 010nm4 -022 68 -4 (11) 006nm6 -037a 70 1 (13) 006nm7 -069a 67 -10 (8) 007nm8 -069a 81 -15 (11) 013nm9 -077a 85 -8 (7) 006nm10 -046a 70 -17 (10) 011ep1 013 88 -21 (25) 021ep3 -050a 76 -6 (16) 008ep4 -015 77 -9 (21) 014ep6 007 77 -13 (21) 011ep7 -051 71 -11 (17) 010ep8 -015b 77 -3 (16) 007cj1 -121a 79 7 (32) 021cj2 -122a 60 -10 (25) 016cj4 -100a 88 -2 (24) 011

a significant at p lt 0001 b significant at plt001

Annual and spatial trends

Fires distance and O3

bull Increasing trend is due to the decomposition of peroxyacetylnitrates (PAN)

bull Decrease of O3 for fires within 400 km may be due to NO titration of O3

bull Increase in extreme fire events within 400 km may be due to changes of NO2 and O3 photolysis rates in the smoke plume

Fires distance and O3

a Significant estimates (at p-value lt 015)

Site codeBuffer contribution (ppbv)a

gt160 km 160 -400 km 400-800 km 800-1600 km 1600-3200 km 3200-4800 kmch 3 -1 1 0 2 2nm1 -1 -1 0 -1 5 2nm2 -2 -3 1 -2 5 4nm3 0 -1 4 4 0 0nm4 -5 -1 4 1 3 4nm5 0 0 3 -1 7 -2nm6 -4 -4 6 -1 6 4nm7 -5 -6 8 -1 5 4nm8 -5 -5 7 -2 4 4nm9 -3 -4 5 -1 4 3nm10 -2 -3 6 -1 3 3ep1 -6 -7 11 1 2 5ep2 -6 -6 11 -1 5 4ep3 -4 -5 9 -2 4 3ep4 -5 -6 11 1 1 5ep5 -5 -5 8 1 3 4ep6 -4 -6 8 5 0 4ep7 -5 -4 9 -3 6 7ep8 -3 -4 5 -1 3 4cj1 -5 -8 12 0 3 4

Fires distance and O3

Fires and asthmaCOPD hospitalizations

119898= (119901 104Τ ) times 119887times 119890ሺ120573times∆1198743ሻminus1 (E 1

bull β is related to an increase of 425 (asthmaall ages) 185 (asthma children) 246 (asthma 15-64 years) and 329 (COPD all ages) for an increase of 10 ppbv of 8-hr maximum O3 concentration (Ji et al 2011)

bull p is the county population and bull b is the county baseline hospitalizations rates

Mean contributionΔO3=52 ppbv

Maximum contributionΔO3=8 ppbv

Asthma (All Ages) 219 329Asthma (Children) 097 149

Asthma (15-64 ages) 129 199COPD (All ages) 172 266

Regional Health Profilebull State of New Mexicos Department of Health Indicator Based

Information System for Public Health (NEW MEXICO-IBIS) Mortality Data

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Hospital Impatient Discharge Data (HIDD)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Behavioral Risk Factor Surveillance System (BRFSS)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Youth Risk and Resiliency Survey

bull New Mexico EnviroNew Mexicoent Department Air Quality Bureaubull US Census Bureaubull US Department of Health and Human Services Health Resources

and Services Administrationbull US Department of Labor Bureau of Labor Statisticsbull US Environmental Protection Agency Air Quality System

Total mortality

number of people who died in 2010 in relation to the population size (per 100000)

New Mexico 742USA 798

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Source regions contributions

cen

tra

l Pa

cific

Pa

cific

No

rth

we

st

we

ste

rn R

ock

ies

no

rth

ern

Ro

ckie

s

Up

pe

r M

idw

est

cen

tra

l La

kes

sou

thw

est

US

we

ste

rn N

ew

Me

xico

ea

ste

rn N

ew

Me

xico

sou

thw

est

Ne

w M

exi

co

sou

thw

est

Te

xas

Ciu

da

d J

ua

rez

sou

the

rn P

lain

s

sou

th M

idw

est

sou

th P

aci

fic o

cea

n

Ba

ja C

alif

orn

ia

sou

thw

est

Me

xico

sou

the

ast

Te

xas

an

d M

exi

co

Gu

lf o

f Me

xico

co

ast

sou

the

rn M

exi

co

0

1

2

3

4

5

6

7

Co

ntr

ibu

tion

(in

μg

m3

for

PM

10

an

d P

M2

5

pp

bv

for

O3

)

PM10

PM25

O

19 regions four adjacent to Las Cruces (500 km)

bull The four adjacent sectors are important contributors to PM10 PM25 and O3

bull Southern California Arizona Baja California and southeast Texas are also important determinants

bull Northwest US contributes up to 8 ppbv of O3

O3 monitoring locations

Approachbull The relative (ΔCRef) differences and the coefficient of divergence (COD)of 8-hr

maximum monthly concentrations between two sites (Chiricahua National Monument was the reference site)

COD values vary from 0 to 1 with COD values close to unity being suggestive of strong spatial variation

bull Total counts of fire detectionsmonthbull Frequency gt25 25-50 50-75

gt75bull Distance from the site 0-160 160-400

400-800 800-1600 1600-3200 3200-4800 km

ሾ1198743ሿ119894 = 119886+ ൫119887119895 ∙119883119894119895൯6

119895=1

bull Ordinary least squares regression of deseasonalized monthly 8-hr maximum O3 concentrations (ldquoCensus Irdquo method)

Site code Annual trend (ppbvyr) 2010 8-hr max ΔCRef Median (σ) COD

ch 012b 74 nm1 026 79 -5 (13) 010nm2 -185a 65 -2 (16) 010nm4 -022 68 -4 (11) 006nm6 -037a 70 1 (13) 006nm7 -069a 67 -10 (8) 007nm8 -069a 81 -15 (11) 013nm9 -077a 85 -8 (7) 006nm10 -046a 70 -17 (10) 011ep1 013 88 -21 (25) 021ep3 -050a 76 -6 (16) 008ep4 -015 77 -9 (21) 014ep6 007 77 -13 (21) 011ep7 -051 71 -11 (17) 010ep8 -015b 77 -3 (16) 007cj1 -121a 79 7 (32) 021cj2 -122a 60 -10 (25) 016cj4 -100a 88 -2 (24) 011

a significant at p lt 0001 b significant at plt001

Annual and spatial trends

Fires distance and O3

bull Increasing trend is due to the decomposition of peroxyacetylnitrates (PAN)

bull Decrease of O3 for fires within 400 km may be due to NO titration of O3

bull Increase in extreme fire events within 400 km may be due to changes of NO2 and O3 photolysis rates in the smoke plume

Fires distance and O3

a Significant estimates (at p-value lt 015)

Site codeBuffer contribution (ppbv)a

gt160 km 160 -400 km 400-800 km 800-1600 km 1600-3200 km 3200-4800 kmch 3 -1 1 0 2 2nm1 -1 -1 0 -1 5 2nm2 -2 -3 1 -2 5 4nm3 0 -1 4 4 0 0nm4 -5 -1 4 1 3 4nm5 0 0 3 -1 7 -2nm6 -4 -4 6 -1 6 4nm7 -5 -6 8 -1 5 4nm8 -5 -5 7 -2 4 4nm9 -3 -4 5 -1 4 3nm10 -2 -3 6 -1 3 3ep1 -6 -7 11 1 2 5ep2 -6 -6 11 -1 5 4ep3 -4 -5 9 -2 4 3ep4 -5 -6 11 1 1 5ep5 -5 -5 8 1 3 4ep6 -4 -6 8 5 0 4ep7 -5 -4 9 -3 6 7ep8 -3 -4 5 -1 3 4cj1 -5 -8 12 0 3 4

Fires distance and O3

Fires and asthmaCOPD hospitalizations

119898= (119901 104Τ ) times 119887times 119890ሺ120573times∆1198743ሻminus1 (E 1

bull β is related to an increase of 425 (asthmaall ages) 185 (asthma children) 246 (asthma 15-64 years) and 329 (COPD all ages) for an increase of 10 ppbv of 8-hr maximum O3 concentration (Ji et al 2011)

bull p is the county population and bull b is the county baseline hospitalizations rates

Mean contributionΔO3=52 ppbv

Maximum contributionΔO3=8 ppbv

Asthma (All Ages) 219 329Asthma (Children) 097 149

Asthma (15-64 ages) 129 199COPD (All ages) 172 266

Regional Health Profilebull State of New Mexicos Department of Health Indicator Based

Information System for Public Health (NEW MEXICO-IBIS) Mortality Data

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Hospital Impatient Discharge Data (HIDD)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Behavioral Risk Factor Surveillance System (BRFSS)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Youth Risk and Resiliency Survey

bull New Mexico EnviroNew Mexicoent Department Air Quality Bureaubull US Census Bureaubull US Department of Health and Human Services Health Resources

and Services Administrationbull US Department of Labor Bureau of Labor Statisticsbull US Environmental Protection Agency Air Quality System

Total mortality

number of people who died in 2010 in relation to the population size (per 100000)

New Mexico 742USA 798

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

O3 monitoring locations

Approachbull The relative (ΔCRef) differences and the coefficient of divergence (COD)of 8-hr

maximum monthly concentrations between two sites (Chiricahua National Monument was the reference site)

COD values vary from 0 to 1 with COD values close to unity being suggestive of strong spatial variation

bull Total counts of fire detectionsmonthbull Frequency gt25 25-50 50-75

gt75bull Distance from the site 0-160 160-400

400-800 800-1600 1600-3200 3200-4800 km

ሾ1198743ሿ119894 = 119886+ ൫119887119895 ∙119883119894119895൯6

119895=1

bull Ordinary least squares regression of deseasonalized monthly 8-hr maximum O3 concentrations (ldquoCensus Irdquo method)

Site code Annual trend (ppbvyr) 2010 8-hr max ΔCRef Median (σ) COD

ch 012b 74 nm1 026 79 -5 (13) 010nm2 -185a 65 -2 (16) 010nm4 -022 68 -4 (11) 006nm6 -037a 70 1 (13) 006nm7 -069a 67 -10 (8) 007nm8 -069a 81 -15 (11) 013nm9 -077a 85 -8 (7) 006nm10 -046a 70 -17 (10) 011ep1 013 88 -21 (25) 021ep3 -050a 76 -6 (16) 008ep4 -015 77 -9 (21) 014ep6 007 77 -13 (21) 011ep7 -051 71 -11 (17) 010ep8 -015b 77 -3 (16) 007cj1 -121a 79 7 (32) 021cj2 -122a 60 -10 (25) 016cj4 -100a 88 -2 (24) 011

a significant at p lt 0001 b significant at plt001

Annual and spatial trends

Fires distance and O3

bull Increasing trend is due to the decomposition of peroxyacetylnitrates (PAN)

bull Decrease of O3 for fires within 400 km may be due to NO titration of O3

bull Increase in extreme fire events within 400 km may be due to changes of NO2 and O3 photolysis rates in the smoke plume

Fires distance and O3

a Significant estimates (at p-value lt 015)

Site codeBuffer contribution (ppbv)a

gt160 km 160 -400 km 400-800 km 800-1600 km 1600-3200 km 3200-4800 kmch 3 -1 1 0 2 2nm1 -1 -1 0 -1 5 2nm2 -2 -3 1 -2 5 4nm3 0 -1 4 4 0 0nm4 -5 -1 4 1 3 4nm5 0 0 3 -1 7 -2nm6 -4 -4 6 -1 6 4nm7 -5 -6 8 -1 5 4nm8 -5 -5 7 -2 4 4nm9 -3 -4 5 -1 4 3nm10 -2 -3 6 -1 3 3ep1 -6 -7 11 1 2 5ep2 -6 -6 11 -1 5 4ep3 -4 -5 9 -2 4 3ep4 -5 -6 11 1 1 5ep5 -5 -5 8 1 3 4ep6 -4 -6 8 5 0 4ep7 -5 -4 9 -3 6 7ep8 -3 -4 5 -1 3 4cj1 -5 -8 12 0 3 4

Fires distance and O3

Fires and asthmaCOPD hospitalizations

119898= (119901 104Τ ) times 119887times 119890ሺ120573times∆1198743ሻminus1 (E 1

bull β is related to an increase of 425 (asthmaall ages) 185 (asthma children) 246 (asthma 15-64 years) and 329 (COPD all ages) for an increase of 10 ppbv of 8-hr maximum O3 concentration (Ji et al 2011)

bull p is the county population and bull b is the county baseline hospitalizations rates

Mean contributionΔO3=52 ppbv

Maximum contributionΔO3=8 ppbv

Asthma (All Ages) 219 329Asthma (Children) 097 149

Asthma (15-64 ages) 129 199COPD (All ages) 172 266

Regional Health Profilebull State of New Mexicos Department of Health Indicator Based

Information System for Public Health (NEW MEXICO-IBIS) Mortality Data

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Hospital Impatient Discharge Data (HIDD)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Behavioral Risk Factor Surveillance System (BRFSS)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Youth Risk and Resiliency Survey

bull New Mexico EnviroNew Mexicoent Department Air Quality Bureaubull US Census Bureaubull US Department of Health and Human Services Health Resources

and Services Administrationbull US Department of Labor Bureau of Labor Statisticsbull US Environmental Protection Agency Air Quality System

Total mortality

number of people who died in 2010 in relation to the population size (per 100000)

New Mexico 742USA 798

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Approachbull The relative (ΔCRef) differences and the coefficient of divergence (COD)of 8-hr

maximum monthly concentrations between two sites (Chiricahua National Monument was the reference site)

COD values vary from 0 to 1 with COD values close to unity being suggestive of strong spatial variation

bull Total counts of fire detectionsmonthbull Frequency gt25 25-50 50-75

gt75bull Distance from the site 0-160 160-400

400-800 800-1600 1600-3200 3200-4800 km

ሾ1198743ሿ119894 = 119886+ ൫119887119895 ∙119883119894119895൯6

119895=1

bull Ordinary least squares regression of deseasonalized monthly 8-hr maximum O3 concentrations (ldquoCensus Irdquo method)

Site code Annual trend (ppbvyr) 2010 8-hr max ΔCRef Median (σ) COD

ch 012b 74 nm1 026 79 -5 (13) 010nm2 -185a 65 -2 (16) 010nm4 -022 68 -4 (11) 006nm6 -037a 70 1 (13) 006nm7 -069a 67 -10 (8) 007nm8 -069a 81 -15 (11) 013nm9 -077a 85 -8 (7) 006nm10 -046a 70 -17 (10) 011ep1 013 88 -21 (25) 021ep3 -050a 76 -6 (16) 008ep4 -015 77 -9 (21) 014ep6 007 77 -13 (21) 011ep7 -051 71 -11 (17) 010ep8 -015b 77 -3 (16) 007cj1 -121a 79 7 (32) 021cj2 -122a 60 -10 (25) 016cj4 -100a 88 -2 (24) 011

a significant at p lt 0001 b significant at plt001

Annual and spatial trends

Fires distance and O3

bull Increasing trend is due to the decomposition of peroxyacetylnitrates (PAN)

bull Decrease of O3 for fires within 400 km may be due to NO titration of O3

bull Increase in extreme fire events within 400 km may be due to changes of NO2 and O3 photolysis rates in the smoke plume

Fires distance and O3

a Significant estimates (at p-value lt 015)

Site codeBuffer contribution (ppbv)a

gt160 km 160 -400 km 400-800 km 800-1600 km 1600-3200 km 3200-4800 kmch 3 -1 1 0 2 2nm1 -1 -1 0 -1 5 2nm2 -2 -3 1 -2 5 4nm3 0 -1 4 4 0 0nm4 -5 -1 4 1 3 4nm5 0 0 3 -1 7 -2nm6 -4 -4 6 -1 6 4nm7 -5 -6 8 -1 5 4nm8 -5 -5 7 -2 4 4nm9 -3 -4 5 -1 4 3nm10 -2 -3 6 -1 3 3ep1 -6 -7 11 1 2 5ep2 -6 -6 11 -1 5 4ep3 -4 -5 9 -2 4 3ep4 -5 -6 11 1 1 5ep5 -5 -5 8 1 3 4ep6 -4 -6 8 5 0 4ep7 -5 -4 9 -3 6 7ep8 -3 -4 5 -1 3 4cj1 -5 -8 12 0 3 4

Fires distance and O3

Fires and asthmaCOPD hospitalizations

119898= (119901 104Τ ) times 119887times 119890ሺ120573times∆1198743ሻminus1 (E 1

bull β is related to an increase of 425 (asthmaall ages) 185 (asthma children) 246 (asthma 15-64 years) and 329 (COPD all ages) for an increase of 10 ppbv of 8-hr maximum O3 concentration (Ji et al 2011)

bull p is the county population and bull b is the county baseline hospitalizations rates

Mean contributionΔO3=52 ppbv

Maximum contributionΔO3=8 ppbv

Asthma (All Ages) 219 329Asthma (Children) 097 149

Asthma (15-64 ages) 129 199COPD (All ages) 172 266

Regional Health Profilebull State of New Mexicos Department of Health Indicator Based

Information System for Public Health (NEW MEXICO-IBIS) Mortality Data

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Hospital Impatient Discharge Data (HIDD)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Behavioral Risk Factor Surveillance System (BRFSS)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Youth Risk and Resiliency Survey

bull New Mexico EnviroNew Mexicoent Department Air Quality Bureaubull US Census Bureaubull US Department of Health and Human Services Health Resources

and Services Administrationbull US Department of Labor Bureau of Labor Statisticsbull US Environmental Protection Agency Air Quality System

Total mortality

number of people who died in 2010 in relation to the population size (per 100000)

New Mexico 742USA 798

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Site code Annual trend (ppbvyr) 2010 8-hr max ΔCRef Median (σ) COD

ch 012b 74 nm1 026 79 -5 (13) 010nm2 -185a 65 -2 (16) 010nm4 -022 68 -4 (11) 006nm6 -037a 70 1 (13) 006nm7 -069a 67 -10 (8) 007nm8 -069a 81 -15 (11) 013nm9 -077a 85 -8 (7) 006nm10 -046a 70 -17 (10) 011ep1 013 88 -21 (25) 021ep3 -050a 76 -6 (16) 008ep4 -015 77 -9 (21) 014ep6 007 77 -13 (21) 011ep7 -051 71 -11 (17) 010ep8 -015b 77 -3 (16) 007cj1 -121a 79 7 (32) 021cj2 -122a 60 -10 (25) 016cj4 -100a 88 -2 (24) 011

a significant at p lt 0001 b significant at plt001

Annual and spatial trends

Fires distance and O3

bull Increasing trend is due to the decomposition of peroxyacetylnitrates (PAN)

bull Decrease of O3 for fires within 400 km may be due to NO titration of O3

bull Increase in extreme fire events within 400 km may be due to changes of NO2 and O3 photolysis rates in the smoke plume

Fires distance and O3

a Significant estimates (at p-value lt 015)

Site codeBuffer contribution (ppbv)a

gt160 km 160 -400 km 400-800 km 800-1600 km 1600-3200 km 3200-4800 kmch 3 -1 1 0 2 2nm1 -1 -1 0 -1 5 2nm2 -2 -3 1 -2 5 4nm3 0 -1 4 4 0 0nm4 -5 -1 4 1 3 4nm5 0 0 3 -1 7 -2nm6 -4 -4 6 -1 6 4nm7 -5 -6 8 -1 5 4nm8 -5 -5 7 -2 4 4nm9 -3 -4 5 -1 4 3nm10 -2 -3 6 -1 3 3ep1 -6 -7 11 1 2 5ep2 -6 -6 11 -1 5 4ep3 -4 -5 9 -2 4 3ep4 -5 -6 11 1 1 5ep5 -5 -5 8 1 3 4ep6 -4 -6 8 5 0 4ep7 -5 -4 9 -3 6 7ep8 -3 -4 5 -1 3 4cj1 -5 -8 12 0 3 4

Fires distance and O3

Fires and asthmaCOPD hospitalizations

119898= (119901 104Τ ) times 119887times 119890ሺ120573times∆1198743ሻminus1 (E 1

bull β is related to an increase of 425 (asthmaall ages) 185 (asthma children) 246 (asthma 15-64 years) and 329 (COPD all ages) for an increase of 10 ppbv of 8-hr maximum O3 concentration (Ji et al 2011)

bull p is the county population and bull b is the county baseline hospitalizations rates

Mean contributionΔO3=52 ppbv

Maximum contributionΔO3=8 ppbv

Asthma (All Ages) 219 329Asthma (Children) 097 149

Asthma (15-64 ages) 129 199COPD (All ages) 172 266

Regional Health Profilebull State of New Mexicos Department of Health Indicator Based

Information System for Public Health (NEW MEXICO-IBIS) Mortality Data

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Hospital Impatient Discharge Data (HIDD)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Behavioral Risk Factor Surveillance System (BRFSS)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Youth Risk and Resiliency Survey

bull New Mexico EnviroNew Mexicoent Department Air Quality Bureaubull US Census Bureaubull US Department of Health and Human Services Health Resources

and Services Administrationbull US Department of Labor Bureau of Labor Statisticsbull US Environmental Protection Agency Air Quality System

Total mortality

number of people who died in 2010 in relation to the population size (per 100000)

New Mexico 742USA 798

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Fires distance and O3

bull Increasing trend is due to the decomposition of peroxyacetylnitrates (PAN)

bull Decrease of O3 for fires within 400 km may be due to NO titration of O3

bull Increase in extreme fire events within 400 km may be due to changes of NO2 and O3 photolysis rates in the smoke plume

Fires distance and O3

a Significant estimates (at p-value lt 015)

Site codeBuffer contribution (ppbv)a

gt160 km 160 -400 km 400-800 km 800-1600 km 1600-3200 km 3200-4800 kmch 3 -1 1 0 2 2nm1 -1 -1 0 -1 5 2nm2 -2 -3 1 -2 5 4nm3 0 -1 4 4 0 0nm4 -5 -1 4 1 3 4nm5 0 0 3 -1 7 -2nm6 -4 -4 6 -1 6 4nm7 -5 -6 8 -1 5 4nm8 -5 -5 7 -2 4 4nm9 -3 -4 5 -1 4 3nm10 -2 -3 6 -1 3 3ep1 -6 -7 11 1 2 5ep2 -6 -6 11 -1 5 4ep3 -4 -5 9 -2 4 3ep4 -5 -6 11 1 1 5ep5 -5 -5 8 1 3 4ep6 -4 -6 8 5 0 4ep7 -5 -4 9 -3 6 7ep8 -3 -4 5 -1 3 4cj1 -5 -8 12 0 3 4

Fires distance and O3

Fires and asthmaCOPD hospitalizations

119898= (119901 104Τ ) times 119887times 119890ሺ120573times∆1198743ሻminus1 (E 1

bull β is related to an increase of 425 (asthmaall ages) 185 (asthma children) 246 (asthma 15-64 years) and 329 (COPD all ages) for an increase of 10 ppbv of 8-hr maximum O3 concentration (Ji et al 2011)

bull p is the county population and bull b is the county baseline hospitalizations rates

Mean contributionΔO3=52 ppbv

Maximum contributionΔO3=8 ppbv

Asthma (All Ages) 219 329Asthma (Children) 097 149

Asthma (15-64 ages) 129 199COPD (All ages) 172 266

Regional Health Profilebull State of New Mexicos Department of Health Indicator Based

Information System for Public Health (NEW MEXICO-IBIS) Mortality Data

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Hospital Impatient Discharge Data (HIDD)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Behavioral Risk Factor Surveillance System (BRFSS)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Youth Risk and Resiliency Survey

bull New Mexico EnviroNew Mexicoent Department Air Quality Bureaubull US Census Bureaubull US Department of Health and Human Services Health Resources

and Services Administrationbull US Department of Labor Bureau of Labor Statisticsbull US Environmental Protection Agency Air Quality System

Total mortality

number of people who died in 2010 in relation to the population size (per 100000)

New Mexico 742USA 798

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Fires distance and O3

a Significant estimates (at p-value lt 015)

Site codeBuffer contribution (ppbv)a

gt160 km 160 -400 km 400-800 km 800-1600 km 1600-3200 km 3200-4800 kmch 3 -1 1 0 2 2nm1 -1 -1 0 -1 5 2nm2 -2 -3 1 -2 5 4nm3 0 -1 4 4 0 0nm4 -5 -1 4 1 3 4nm5 0 0 3 -1 7 -2nm6 -4 -4 6 -1 6 4nm7 -5 -6 8 -1 5 4nm8 -5 -5 7 -2 4 4nm9 -3 -4 5 -1 4 3nm10 -2 -3 6 -1 3 3ep1 -6 -7 11 1 2 5ep2 -6 -6 11 -1 5 4ep3 -4 -5 9 -2 4 3ep4 -5 -6 11 1 1 5ep5 -5 -5 8 1 3 4ep6 -4 -6 8 5 0 4ep7 -5 -4 9 -3 6 7ep8 -3 -4 5 -1 3 4cj1 -5 -8 12 0 3 4

Fires distance and O3

Fires and asthmaCOPD hospitalizations

119898= (119901 104Τ ) times 119887times 119890ሺ120573times∆1198743ሻminus1 (E 1

bull β is related to an increase of 425 (asthmaall ages) 185 (asthma children) 246 (asthma 15-64 years) and 329 (COPD all ages) for an increase of 10 ppbv of 8-hr maximum O3 concentration (Ji et al 2011)

bull p is the county population and bull b is the county baseline hospitalizations rates

Mean contributionΔO3=52 ppbv

Maximum contributionΔO3=8 ppbv

Asthma (All Ages) 219 329Asthma (Children) 097 149

Asthma (15-64 ages) 129 199COPD (All ages) 172 266

Regional Health Profilebull State of New Mexicos Department of Health Indicator Based

Information System for Public Health (NEW MEXICO-IBIS) Mortality Data

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Hospital Impatient Discharge Data (HIDD)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Behavioral Risk Factor Surveillance System (BRFSS)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Youth Risk and Resiliency Survey

bull New Mexico EnviroNew Mexicoent Department Air Quality Bureaubull US Census Bureaubull US Department of Health and Human Services Health Resources

and Services Administrationbull US Department of Labor Bureau of Labor Statisticsbull US Environmental Protection Agency Air Quality System

Total mortality

number of people who died in 2010 in relation to the population size (per 100000)

New Mexico 742USA 798

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Fires distance and O3

Fires and asthmaCOPD hospitalizations

119898= (119901 104Τ ) times 119887times 119890ሺ120573times∆1198743ሻminus1 (E 1

bull β is related to an increase of 425 (asthmaall ages) 185 (asthma children) 246 (asthma 15-64 years) and 329 (COPD all ages) for an increase of 10 ppbv of 8-hr maximum O3 concentration (Ji et al 2011)

bull p is the county population and bull b is the county baseline hospitalizations rates

Mean contributionΔO3=52 ppbv

Maximum contributionΔO3=8 ppbv

Asthma (All Ages) 219 329Asthma (Children) 097 149

Asthma (15-64 ages) 129 199COPD (All ages) 172 266

Regional Health Profilebull State of New Mexicos Department of Health Indicator Based

Information System for Public Health (NEW MEXICO-IBIS) Mortality Data

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Hospital Impatient Discharge Data (HIDD)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Behavioral Risk Factor Surveillance System (BRFSS)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Youth Risk and Resiliency Survey

bull New Mexico EnviroNew Mexicoent Department Air Quality Bureaubull US Census Bureaubull US Department of Health and Human Services Health Resources

and Services Administrationbull US Department of Labor Bureau of Labor Statisticsbull US Environmental Protection Agency Air Quality System

Total mortality

number of people who died in 2010 in relation to the population size (per 100000)

New Mexico 742USA 798

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Fires and asthmaCOPD hospitalizations

119898= (119901 104Τ ) times 119887times 119890ሺ120573times∆1198743ሻminus1 (E 1

bull β is related to an increase of 425 (asthmaall ages) 185 (asthma children) 246 (asthma 15-64 years) and 329 (COPD all ages) for an increase of 10 ppbv of 8-hr maximum O3 concentration (Ji et al 2011)

bull p is the county population and bull b is the county baseline hospitalizations rates

Mean contributionΔO3=52 ppbv

Maximum contributionΔO3=8 ppbv

Asthma (All Ages) 219 329Asthma (Children) 097 149

Asthma (15-64 ages) 129 199COPD (All ages) 172 266

Regional Health Profilebull State of New Mexicos Department of Health Indicator Based

Information System for Public Health (NEW MEXICO-IBIS) Mortality Data

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Hospital Impatient Discharge Data (HIDD)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Behavioral Risk Factor Surveillance System (BRFSS)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Youth Risk and Resiliency Survey

bull New Mexico EnviroNew Mexicoent Department Air Quality Bureaubull US Census Bureaubull US Department of Health and Human Services Health Resources

and Services Administrationbull US Department of Labor Bureau of Labor Statisticsbull US Environmental Protection Agency Air Quality System

Total mortality

number of people who died in 2010 in relation to the population size (per 100000)

New Mexico 742USA 798

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Regional Health Profilebull State of New Mexicos Department of Health Indicator Based

Information System for Public Health (NEW MEXICO-IBIS) Mortality Data

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Hospital Impatient Discharge Data (HIDD)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Behavioral Risk Factor Surveillance System (BRFSS)

bull State of New Mexicos Department of Health Indicator Based Information System for Public Health (NEW MEXICO-IBIS) Youth Risk and Resiliency Survey

bull New Mexico EnviroNew Mexicoent Department Air Quality Bureaubull US Census Bureaubull US Department of Health and Human Services Health Resources

and Services Administrationbull US Department of Labor Bureau of Labor Statisticsbull US Environmental Protection Agency Air Quality System

Total mortality

number of people who died in 2010 in relation to the population size (per 100000)

New Mexico 742USA 798

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Total mortality

number of people who died in 2010 in relation to the population size (per 100000)

New Mexico 742USA 798

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Male Female

White 8912 7065

Hispanic 865 5446

AfAmer 8056 10123

Native Amer 6122 380

AsianPIsa 10022 3438

Total mortality per race and age

bull Males higher than femalesbull Race patterns

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Leading causes of death

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Heart failure mortality

Male Female

White 201 216

Hispanic 159 154

AfAmer 178a 75a

Native Amer 44a 67a

AsianPIs 304a

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Heart failure hospital admissions

bull primary diagnosis is the condition to be responsible for the admission of the patient to the hospital

bull secondary diagnosis includes the condition that coexist at the time of inpatient admission which affect the treatment received andor length of stay

bull Data from federal facilities (military and veteranrsquos affairs hospitals) and Indian health service facilities are not included

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

COPD mortality

Male Female

White 695 564Hispanic 303 218AfAmer 129a 208a

Native Amer 142a 67a

AsianPIs 9a

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

COPD hospital admissions

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Asthma mortality

Male FemaleWhite 18 17Hispanica 08 13

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Asthma hospital admissionsMiddle- and high-school students

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Stroke mortality

Male Female

White 353 336

Hispanic 346 343

AfAmer 613a 32a

Native Amer 44a 134a

AsianPIs 304a

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Stroke hospital admissions

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Flu and pneumonia

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Pertussis and Coccidioidomycosis

Mortalitybull Pertussis six deaths are reported in New Mexico one death in

Hidalgo Countybull Coccidioidomycosis ten deaths were reported in New Mexico

none of them within the border Counties in 1999-2010 period

Hospitalizationsbull Pertussis 254 are reported in New Mexico 16 in 2010

bull 30 in study area (15 in Dona Ana eight in Otero County four in Grant County two in Luna County and one in Sierra County)

bull 26 children 24 of them gt 1 years old (17 boys and 7 girls)bull Coccidioidomycosis 131 are reported in New Mexico 13 in 2010

bull 47 in study area (33 in Dona Ana four in Otero County four in Grant County seven in Luna County and three in Sierra County)

bull 35-44 years ols (56 males and 44 females)in 1999-2010 period

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

O3 PM25 PM10

4th highest 8-hr moving average lt75 ppbv

Annual average lt 15 μgm3

2nd highest 24-hr concentration lt 150 μgm3

Las Cruces

Las Cruces 63

Solano 65

Holman Road Did Not Meet (Exceeded in 2005)

West Mesa Did Not Meet (Exceeded in 2004 2008)

Paso del Norte

Anthony Did Not Meet (Exceeded in 2003 2006)

Chaparral 69 (below since 1991) Did Not Meet (Exceeded in 2005)

Desert View 76 (above since 1996) Did Not Meet (Exceeded in 2008)

La Union 70 (below since 2004)

Santa Teresa 72 (below since 2004)

Sunland Park 69 (below since 2004) 105 Met Design Value (Exceeded in 2003)

Southwestern New Mexico

Deming Airp 58 Did not meet (Exceeded in 2003 2008)

Hurley 64

Silver City 54

Air pollution indicators

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Health Status

bull Behavioral Risk Factor Surveillance System (BRFSS)

bull Youth Risk and Resiliency Surveybull 2006-2010

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Blood pressure and cholesterol

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

SmokingMiddle- and high-school students

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Health facilities and accessDona Ana County

Memorial Medical Center in Las Cruces with 293 bedsMountainView Regional Medical Center in Las Cruces with 142 bedsAdvanced Care Hospital of Southern New Mexico in Las Cruces with 20 bedsRehabilitation Hospital of Southern New Mexico in Las Cruces with 40 bedsMesilla Valley a psychiatric facility in Las Cruces with 120 bedsOtero CountyGeneral Champion Memorial Hospital In Alamogordo with 90 bedsMescalero Indian Hospital in Mescalero with 13 bedsSierra CountySierra Vista Hospital in Truth or Consequences with 23 bedsGrant CountyGila Regional Medical Center in Silver City with 68 bedsLuna CountyMimbres Memorial Hospital in Deming with 115 beds

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Epidemiological analysis

119897119900119892119864 [119884 119905 ]=1205730+119887 ∙ (119875119900119897119897119906119905119886119899119905 )119905+119904 (119905119894119898119890119905 119896 )+119904 (119905119890119898119901119905 119896 )+119904 (11989711988611989216 (119905119890119898119901119905 ) 119896 )+[ h119900119905 119890119903119904 ]

Daily emergency room (ER) visits and hospital admissions from the Memorial Medical Center (MMC) 2007 to 2011 for the adult population (ge 18 years of age) were retrieved bull 675 of hospital beds (293) and 65 (35939) of emergency room visits in Dona Ana County

PM10 PM25 and O 3 measurements from the US Environmental Protection Agency (EPA) Air Quality System (AQS) based on the completeness of the datasets bull 24-hr PM10 and PM25 mass concentrations and the daily 8-hr maximum O3 concentration

were used as metrics of ambient exposures

bull E[Yt] is the expected value Yt indicating the daily visits or admissions count on day t with Var(Yt)=φE[Yt] with φ being the over-dispersion parameter

bull tempt is the value of mean temperature on day t bull lag16(tempt) is its lagged effect over the previous six days andbull (Pollutant)t is the pollutantrsquos level on day t

bull on the previous day (lag1) on the average of the same and previous days (lags01) bull S are the natural splines smoothing functions to capture the non-linear relationship between the time-varying

covariates and calendar time and daily admissions with three df for temperature on the day of the admission and with two df for the previous days

bull controlled for season and long-term trend with a natural cubic regression spline with 15 degrees of freedom (df) for each season and year (corresponding to six df per year)

bull two- pollutant models using the previous day pollutants concentrations

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Mean (min-max) Median (25th-75th percentile) TotalEmergency room visits

Respiratory visits All ages 324 (0-13) 3 (2-4) 4739 18-65 years 283 (0-12) 3 (1-4) 4140 65+ years 041 (0-4) 0 (0-1) 599COPD all ages 032 (0-3) 0 (0-1) 471Cardiovascular visits All ages 139 (0-7) 1 (0-2) 2031 18-65 years 075 (0-5) 1 (0-1) 1090 65+ years 064 (0-4) 0 (0-1) 941Stroke all ages 004 (0-2) 0 (0-0) 63

Hospital admission

Respiratory admissions All ages 163 (0-9) 1 (1-2) 2381 18-65 years 068 (0-4) 0 (0-1) 999 65+ years 095 (0-7) 1 (0-2) 1382COPD all ages 044 (0-4) 0 (0-1) 640Cardiovascular admissions All ages 353 (0-12) 3 (2-5) 5161 18-65 years 140 (0-8) 1 (0-2) 2046 65+ years 213 (0-9) 2 (1-3) 3115Stroke all ages 032 (0-4) 0 (0-1) 468

ER and hospital admissions

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

-10

0

10

20

30

40

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in E

R v

isits

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Percent increase in ER visits

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Percent increase in hospital admissions

10 μgm3 of PM10 PM25 and 10 ppbv of O 3

-10

0

10

20

PM10 PM

25 O

3

All ages65+18-65

COPDRespiratory

Per

cent

incr

ease

in h

ospi

tal a

dmis

sion

s

per

10 μ

gm

3 of

PM

10 a

nd P

M2

5 an

d 10

ppb

v of

O3

CVD

All ages65+18-65All ages

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Seasonal effect

Morbidity Outceom PollutantPercent Increase (95 CI)

Lag1 Annual Effects Percent Increase

Cold Hot

Emergencies

CVD

PM25 236 (-637 1190) 1242 (-346 3092) 453 (-425 1411)PM25-10 031 (-265 335) 310 (-051 685)() 235 (-197 687)PM10 061 (-203 332) 280 (-024 592)() 361 (-037 775)()

O3 261 (-903 1573) 603 (-374 1680)

Respiratorydagger

PM25 147 (-430 759) 059 (-1043 1297) 523 (-052 1132)()

PM25-10 -071 (-277 140) -021 (-351 321) 221 (-062 512)PM10 -039 (-228 154) -003 (-278 280) 324 (053 602)()

O3 -537 (-1275 262) 328 (-385 1094)

Admissions

CVD

PM25 -130 (-705 481) -128 (-1023 857) -283 (-817 281)PM25-10 048 (-161 262) -024 (-277 234) -069 (-340 209)PM10 068 (-125 265) -056 (-266 158) -011 (-262 247)O3 -080 (-838 741) 072 (-489 665)

Respiratorydagger

PM25 412 (-301 1178) -593 (-1967 1014) 079 (-639 852)PM25-10 106 (-104 321) -099 (-515 336) 142 (-219 516)PM10 133 (-058 328) -093 (-430 257) 085 (-259 440)O3 653 (-372 1787) 092 (-856 1138)

dagger Without influenza control () Significant at 5 (middot) Significant at 10

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Conclusions Sources within 500 km southern California Baja California southern Arizona southeast

Texas and north Mexico are responsible for most of PM10 PM25 and O3

Wildfires within 400-800 km and more than 1600 km may contribute up to 11 ppbv of O3 and trigger an increase of up to 33 in asthma hospitalizations

More than 70 of residents in the border Counties reported at least one behavioral risk factor (smoking high blood pressure or cholesterol) for chronic diseases

The levels of particulate matter are among the highest in the Nation and exceed the threshold concentrations set by US EPA for the protection of human health For ozone threshold concentrations were exceeded in the past current levels are slightly below the threshold value

Cancer and heart diseases are the primary causes of death for adults chronic respiratory diseases are among the top six causes of death in the border Counties

Mortality and hospitalization due to COPD and asthma are above the Statersquos average and they are increasing

Childhood asthma is a concern with about 50 of high school students being active smokers

One-third of hospitalized cases of coccidioidomycosis in New Mexico since 1999 were observed in border Counties however none of them died

Positive but not significant associations were observed for asthma COPD and heart disease

An increase of 3-5 (statistically significant) was computed for emergency cardiovascular and respiratory symptoms for a 10 μgm3 increase in PM mass in the summer

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements

Acknowledgements

bull Paul Dulin NM DOH

bull Dave DuBois Erin Ward and all study partners

bull Bruce D San Filippo and MMC staff

bull Marie-Cecile Chalbot Sophia Rodopoulou and Evi Samoli

• Health Assessment and Air Pollution
• Study tasks
• Air mass residence time
• Tracer Mass Balance model
• Source regions contributions
• O3 monitoring locations
• Approach
• Annual and spatial trends
• Fires distance and O3
• Fires distance and O3 (2)
• Fires distance and O3 (3)
• Fires and asthmaCOPD hospitalizations
• Regional Health Profile
• Total mortality
• Total mortality per race and age
• Leading causes of death
• Heart failure mortality
• Heart failure hospital admissions
• COPD mortality
• COPD hospital admissions
• Asthma mortality
• Asthma hospital admissions
• Stroke mortality
• Stroke hospital admissions
• Flu and pneumonia
• Pertussis and Coccidioidomycosis
• Air pollution indicators
• Health Status
• Blood pressure and cholesterol
• Smoking
• Health facilities and access
• Epidemiological analysis
• ER and hospital admissions
• Percent increase in ER visits
• Percent increase in hospital admissions
• Seasonal effect
• Conclusions
• Acknowledgements