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Air Quality and Asthma in the US Wright State University CORE Scholar Master of Public Health Program Student Publications Master of Public Health Program 2016 Is the Breeze Making you Wheeze? Air Quality and Asthma in the US Gaurav A. Nagar Wright State University - Main Campus Follow this and additional works at: https://corescholar.libraries.wright.edu/mph Part of the Public Health Commons Repository Citation Nagar, G. A. (2016). Is the Breeze Making you Wheeze? Air Quality and Asthma in the US. Wright State University, Dayton, Ohio. This Master's Culminating Experience is brought to you for free and open access by the Master of Public Health Program at CORE Scholar. It has been accepted for inclusion in Master of Public Health Program Student Publications by an authorized administrator of CORE Scholar. For more information, please contact library- [email protected]. Running head: AIR QUALITY AND ASTHMA IN THE US 1 Is the breeze making you wheeze? Air Quality and Asthma in the US Gaurav A Nagar Wright State University 28th March, 2016 AIR QUALITY AND ASTHMA IN THE US 2 Acknowledgements I would like to express my deepest gratitude to my parents for their sacrifices. Thanks to Prof. Naila Khalil M.B.B.S., M.P.H., Ph.D. for her assistance and guidance during this project. Thanks to Prof. Ramzi Nahhas, Ph.D. for his advice as a co-chair. Thanks to Dr. Nikki Rogers, Ph.D. for her support throughout the duration of the Culminating Experience. My heart felt gratitude to the faculty and staff at Center for Global Health, Wright State University, for their support and encouragement during my journey through the MPH program. And last but not least, a special thanks to my wife and daughter for their support and encouragement. AIR QUALITY AND ASTHMA IN THE US 3 Table of Contents Abstract ............................................................................................................................................4 Introduction ......................................................................................................................................5 Statement of Purpose .......................................................................................................................6 Research Questions ..........................................................................................................................6 Review of Literature ........................................................................................................................6 Methods..........................................................................................................................................14 Results ............................................................................................................................................15 Discussion ......................................................................................................................................19 Conclusion .....................................................................................................................................20 References ......................................................................................................................................21 Appendices .....................................................................................................................................25 Appendix A - Table 2 Values from Individual States ........................................................25 Appendix B - List of Public Health Competencies Met in CE ..........................................28 AIR QUALITY AND ASTHMA IN THE US 4 Abstract Objective: A secular trend towards increased current and lifetime asthma prevalence has been observed in the US. The current study compared ambient Air Quality Index (AQI) data and asthma prevalence data from all fifty US states. Methods: Air pollution is measured as AQI by the US Environmental Protection Agency (EPA). County level AQI data are available at the EPA website. Asthma prevalence data for each state are available on the Centers for Disease Control and Prevention (CDC) website. Data from 50 US states (2011-2013) were analyzed for AQI and asthma prevalence. The average of proportions for all counties in each state was used to obtain a mean value for good air quality days (“Good Days”) in each year. An Analysis of Variance (ANOVA) was conducted to evaluate if 1) asthma prevalence and 2) AQI differences across 2011, 2012 and 2013. A regression analysis was conducted to assess the association between AQI and asthma prevalence. Results: The analysis showed a reduction in air pollution from 2011 to 2013. The ANOVA revealed that this decrease in AQI was significant, F (2, 147) = 5.7678, p = 0.0039. While an increase in asthma prevalence was observed from 2011 to 2013,the ANOVA revealed that the increased asthma prevalence was not significant, F (2, 147) = 0.2794, p = 0.7566. Regression analysis showed no significant association between AQI and asthma prevalence (p>0.05). Conclusion: US Asthma prevalence did not change significantly despite significant AQI reduction from 2011 to 2013; AQI was not related to asthma prevalence. Keywords: AQI, Allergy, Allergic Asthma, Bronchial Asthma, Pollution AIR QUALITY AND ASTHMA IN THE US 5 Is the breeze making you wheeze? Air Quality and Asthma in the US Public health professionals have been intrigued by the increasing incidence of reported asthma cases in the United States (US). Behavioral Risk Factor Surveillance System (BRFSS) is a state-based system of health surveys in the US. BRFSS is one of the major sources for data on asthma prevalence in the US. According to BRFSS lifetime prevalence of asthma in the US has steadily increased from 7% to 8% between years 2000 and 2010. The Centers for Disease Control and Prevention (CDC) notes that 1 in 12 people (about 26 million) had asthma in 2010, compared with 1 in 14 (about 20 million) in 2001 (Centers for Disease Control and Prevention [CDC], 2015). Current asthma prevalence has increased from 8.6% to 9.6% during the same period (CDC, 2015). In a report published by Global Asthma Network (GAN) in 2014, in general, asthma became more common throughout the world, especially in children, from 1993 to 2003. However, there is inadequate data to accurately access the local and regional trends in asthma prevalence globally. This is especially true in middle and low income countries. There is a need to close the data gap in these countries in order to encourage evidence based decision making in public health. Therefore, the GAN has undertaken assessment of asthma as a key responsibility of the organization (Global Asthma Network [GAN], 2014). There could be many possible reasons for the increase in asthma prevalence including air pollution, race, income, gender and location. While factors such as race, income and gender can explain higher rates of asthma in certain communities, they do not explain the secular trend towards increased incidence of asthma. Air pollution is a known risk factor for asthma. Is there a correlation between increased asthma incidence and outdoor air pollution? AIR QUALITY AND ASTHMA IN THE US 6 Statement of Purpose The purpose of this research project was to explore the relationship between outdoor air pollution and asthma prevalence. Research Questions • Hypothesis 1) The prevalence of asthma is increasing over time in 50 states of the US. • Hypothesis 2) The Air Quality Index (AQI) is increasing over time in 50 states of the US. • Hypothesis 3) There is a correlation between AQI and asthma. Review of Literature Signs and Symptoms of Asthma Asthma is a chronic inflammatory disease of the airways. The inflammation causes the airways to become unusually sensitive and hyper-reactive to various irritants (allergens). The airways constrict and produce excessive mucus and swelling. This causes difficulty in breathing. The patient may cough and show signs of shortness of breath. There is a characteristic “wheeze” on expiration, due to narrowing of the airways. Etiology of Asthma Asthma is thought to be caused by a combination of environmental, genetic and epigenetic factors (Dietert, 2011). (See Figure 1) AIR QUALITY AND ASTHMA IN THE US 7 Allergen Virus Air Exercise Pollution Foods/ Cold Air Additives Emotional Drugs stress Asthma Figure 1. Various factors affecting Asthma prevalence. Outdoor air pollution is considered a major environmental factor in the exacerbation of asthma. Daily air quality is measured and reported as Air Quality Index (AQI) by the Environmental Protection Agency (EPA) (2015). AQI is a number from 0 to 500. A higher AQI number means more polluted air (Table 1). Table 1 Air Quality Index chart guide (EPA.gov) Air Quality Index (AQI) Level of health concern Color coding Values When AQI is in this …air quality …as symbolized range… conditions are: by this color: 0-50 Good Green 51-100 Moderate Yellow 101-150 Unhealthy for sensitive groups Orange 151-200 Unhealthy Red 201-250 Very Unhealthy Purple 251-300 Hazardous Maroon AIR QUALITY AND ASTHMA IN THE US 8 EPA also calculates the AQI for five major air pollutants, separately. These pollutants are regulated by the Clean Air Act (CAA) (2015). The CAA is a Federal Law that regulates air emissions from stationary and mobile sources. A salient feature of the Law is that it authorizes EPA to establish National Ambient Air Quality Standards to protect health and welfare of the public and to regulate emissions of hazardous air pollutants (Clean Air Act [CAA], 2015). The five major
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