Overview of Maine CDC’s Work on Air Quality and Health Rebecca Lincoln, Sc.D. Toxicologist Environmental and Occupational Health Programs For Andy Smith, S.M., Sc. D. State Toxicologist and Director

Outline Air quality data on the Maine Tracking Network Research on ozone and emergency department visits for asthma Research on heat-related health effects

Maine Tracking Network Data Portal Show/explain data portal BRIEFLY describe EPHT Mention Martha is on the TAG Data are out of date but will be brought up to date (and revamped) soon Mention that AQ content doesn’t get a lot of traffic Does the group see any ways it could be better tailored to their needs? Show screenshots of Drupal landing page, air page, portal Could also show some of Nat’l portal

Question for group These data are fairly out of date – and don’t get much traffic. Are there ways they could be better tailored to meet your needs?

Ozone and Asthma in Maine Study: To determine the effect of ozone (and PM2.5) on ED visits for asthma at the ZIP-code level Published in 2008, for 2000-2003 data Case-crossover design (uses cases as their own controls) Exposure: Maximum daily 8-hour average ozone concentration Outcome: Daily count of asthma-related ED visits Remind them of our past work on ozone/ED (get images/slides from Chris) – Town-level ED visits for asthma w/ ozone (HB modeled?) Case-crossover methodology Major results – show Fig. 2. (and age-specific rates)

Effect of ozone on ED visits

Effect of ozone by age and sex

Question for group Would it be worthwhile to re-do this analysis with more/updated data?  could be a nice way of seeing whether ppl are taking precautions we suggest, etc. Do we still see a link btwn ozone and health? If not, is it b/c ppl are listening to our advice? And, levels are lower now than they were at time of original study. Do we still see an effect even at lower levels?

Heat and Health in Maine Extreme heat is a major public health threat No research on heat/health for the Northeast/New England region, but we might be vulnerable Recent research (NYC) caused the National Weather Service to lower the advisory threshold from 100F to 95F – for NYC region only No research on heat/health for the Northeast/New England region Low population density – rural or semi- rural Cooler – so less physical/structural adaptation (i.e. AC) Prior work suggests health effects below current National Weather Service advisory thresholds Preliminary analyses in ME Recent work in NYC (Metzger et al. 2010) Northeastern BRACE/EPHT grantees (ME, NH, RI, VT) began collaborating to assess regional heat effects

Regional Collaboration 15 sites in ME, NH, RI over ~2001-2010 Study design: Time-series analysis Standard method for this type of exposure/outcome – like air pollution Nonlinear Poisson models for each site Same-day and cumulative (7-day lag) Site-specific results combined in meta- analysis to obtain regional estimates

Data Exposure Daily maximum heat index (calculated from hourly NWS monitor data) Outcome Rates of daily all-cause ED visits Rates of daily heat-related illness ED visits Rates of daily all-cause mortality

Results: ED Visits (7-Day Cumulative) Cumulative risk, over a 7-day lag, is greater than risk on the same day Risk increases by 6.6% (95% CI: 5.5-7.6) on days with max HI of 95°F (as compared to 75°F) Smith, Andy E. (DHHS) 1/15/2016 you will need to explain what you mean by cumulative. I assume it is total ED visits over 7-days that can be attributed to HI on day 0, right?

Results: Deaths (Same-Day) Risk increases by 7.4% (95% CI: 3.3, 11.8) on days with max HI of 95°F (as compared to 75°F)

Results: Deaths (Same Day, by Location) Risk of all-cause death on a day with a maximum heat index of 95°F as compared to 75°F, by location

Next Steps Calculate attributable number of ED visits and deaths due to heat Bring results to National Weather Service; work together to lower threshold for issuing heat advisories and warnings Other needed research in this area?

Questions? Rebecca Lincoln, Sc.D. Toxicologist rebecca.lincoln@maine.gov 207-287-6445 Andy Smith, S.M., Sc.D. State Toxicologist andy.e.smith@maine.gov 207-287-5189 https://data.mainepublichealth.gov/tracking