Estimating the Public Health Impact of Air Pollution for Informing Policy in the Twin Cities: A Minnesota Tracking Collaboration.

OBJECTIVE: The Minnesota Department of Health and the Minnesota Pollution Control Agency used local air pollution and public health data to estimate the impacts of particulate matter and ozone on population health, to identify disparities, and to inform decisions that will improve health. SETTING: While air quality in Minnesota currently meets federal standards, urban communities are concerned about the impact of air pollution on their health. The Twin Cities (Minneapolis-St Paul) metropolitan area includes 7 counties where fine particulate levels and rates of asthma exacerbations are elevated in some communities. DESIGN: We used the Environmental Protection Agency's BenMAP (Environmental Benefits Mapping and Analysis Program) software, along with local PM2.5 (fine particulate) and ozone ambient concentrations, census and population health data, to calculate impacts for 2008 at the zip code level. The impacts were summed across all zip codes for area-wide estimates. American Community Survey data were used to stratify zip codes by poverty and race for assessment of disparities. MAIN OUTCOME MEASURES: Attributable fraction, attributable rate and counts for all-cause mortality, asthma and chronic obstructive pulmonary disease hospitalizations, asthma emergency department (ED) visits, and cardiovascular disease hospitalizations. RESULTS: In the Twin Cities (2008), air pollution was a contributing cause for an estimated 2% to 5% of respiratory and cardiovascular hospitalizations and ED visits and between 6% and 13% of premature deaths. The elderly (aged 65+ years) experienced the highest air pollution-attributable rates of death and respiratory hospitalizations; children experienced the highest asthma ED visit rates. Geographical and demographic differences in air pollution-attributable health impacts across the region reflected the differences in the underlying morbidity and mortality rates. CONCLUSIONS: Method was effective in demonstrating that changes in air quality can have quantifiable health impacts across the Twin Cities. Key messages and implications from this work were shared with the media, community groups, legislators and the public. The results are being used to inform initiatives aimed at reducing sources of air pollution and to address health disparities in urban communities.

The Economic Impact for Farm Injury in Minnesota, 2004-2010.

Only 2% of Minnesota's employed population worked in agriculture between the years 2005 and 2012. However, this small portion of the state's employed population accounted for 31% of total work-related deaths in the state during that same time period. During a similar time period, 2007-2013, the contribution of agriculture to Minnesota's gross domestic product increased from approximately 1.5% to about 2.3%. This article describes the economic impact of injuries related to farm work between the years 2004 and 2010. Using hospital discharge data and the Census of Fatal Occupational Injuries (CFOI), estimates of the number of injuries and fatalities related to agricultural work were compiled. A cost of illness model was applied to these injury and fatality estimates to calculate the related indirect and direct costs in 2010 dollars. Estimated total costs, in 2010 dollars, ranged between $21 and $31 million annually over the 7-year study period. The majority of the costs were attributable to indirect costs, such as lost productivity at work and home. Fatal injuries accrued the largest proportion of the estimated costs followed by hospitalized and nonhospitalized injuries. A sensitivity analysis was performed to evaluate the impact each selected data source had upon the cost estimate. The magnitude of the costs associated with these injuries argues for better surveillance of injury related to agriculture to prioritize resources and evaluate intervention and prevention programs.

Incidence Rates and Trend of Serious Farm-Related Injury in Minnesota, 2000-2011.

Only about 2% of Minnesota's workers were employed in agriculture for the years 2005-2012, this small portion of the workforce accounted for 31% of the 563 work-related deaths that occurred in Minnesota during that same time period. Agricultural fatalities in Minnesota and elsewhere are well documented; however, nonfatal injuries are not. To explore the burden of injury, Minnesota hospital discharge data were used to examine rates and trends of farm injury for the years 2000-2011. Cases were identified through the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), injury codes and external cause of injury codes (E codes). Probable cases were defined as E code E849.1 (occurred on a farm) or E919.0 (involving agricultural machinery). Possible cases were based on five less specific E codes primarily involving animals or pesticides. Multiple data sources were used to estimate the agricultural population. An annual average of over 500 cases was identified as probable, whereas 2,000 cases were identified as possible. Trend analysis of all identified cases indicated a small but significant average annual increase of 1.5% for the time period 2000-2011. Probable cases were predominantly male (81.5%), whereas possible cases were predominantly female (63.9%). The average age of an injury case was 38.5 years, with the majority of injuries occurring in late summer and fall months. Despite the undercount of less serious injuries, hospital discharge data provide a meaningful data source for the identification and surveillance of nonfatal agricultural injuries. These methods could be utilized by other states for ongoing surveillance for nonfatal agricultural injuries.

Asthma among rural Minnesota adolescents.

This study examined the prevalence of and risk factors for wheezing and asthma in rural Minnesota adolescents. A survey querying about wheezing, asthma, farm residence, and other respiratory-related factors was administered to all 9th to 11th grade students (N = 13,490) in a stratified, random sample of high schools in rural Minnesota. Nearly one in 8 (12.6%) students reported ever-diagnosed asthma, and 9.2% reported current asthma. Students living on farms reported less wheezing and asthma than rural non-farm students. Obesity and smoking were associated with wheezing and asthma in all rural adolescents. Asthma rates increased with age among girls and may be largely accounted for by simultaneous increases in smoking rates. Despite the apparent protective effect of farm residence, asthma remains a significant public health issue among rural Minnesota adolescents.

Changes in smoking status affect women more than men: results of the Lung Health Study.

Lung Health Study participants were smokers aged 35-60 years with mild lung function impairment who participated in a 5-year, 10-center (nine in the United States, one in Canada) clinical trial in 1986-1994. The authors compared the relation of randomized treatment assignments and of smoking history during the study with changes in lung function between men and women. Spirometry was performed annually, and 3,348 men and 1,998 women attended the follow-up clinic visit that included spirometry at year 5. This paper reports on an analysis of changes in lung function by gender, treatment group, and three smoking history categories: sustained quitters, intermittent quitters, and continuing smokers. Among participants who quit smoking in the first year, mean forced expiratory volume in 1 second (FEV(1)) expressed as a percentage of the predicted value of FEV(1 )given the person's age, height, gender, and race (FEV(1)%) increased more in women (3.7% of predicted) than in men (1.6% of predicted) (p < 0.001). Across the 5-year follow-up period, among sustained quitters, women gained more in FEV(1)% of predicted than did men. Methacholine reactivity was more strongly related to rates of decline in women than in men (p < 0.001). Therefore, among persons at risk for chronic obstructive pulmonary disease, smoking cessation has an even clearer advantage for women than it does for men.