Impact of NOx emissions reduction policy on hospitalizations for respiratory disease in New York State

Abstract

To date, only a limited number of studies have examined the impact of ambient pollutant policy on respiratory morbidities. This accountability study examined the effect of a regional pollution control policy, namely, the US Environmental Protection Agency's (EPA) nitrogen oxides (NO(x)) Budget Trading Program (NBP), on respiratory health in New York State (NYS). Time-series analysis using generalized additive models was applied to assess changes in daily hospitalizations for respiratory diseases in NYS after the implementation of the NBP policy. Respiratory end points in the summers during the baseline period (1997-2000) were compared with those during the post-intervention period (2004-2006). Stratified analyses were also conducted to examine whether health impacts of the NBP differed by socio-demographic, regional, or clinical characteristics. Following the implementation of EPA's NBP policy, there were significant reductions in mean ozone levels (-2% to -9%) throughout NYS. After adjusting for time-varying variables, PM(2.5) concentration, and meteorological factors, significant post-intervention declines in respiratory admissions were observed in the Central (-10.18, 95% confidence interval (CI): -14.18, -6.01), Lower Hudson (-11.05, 95% CI: -16.54, -5.19), and New York City Metro regions (-5.71, 95% CI: -7.39, -4.00), consistent with wind trajectory patterns. Stratified analyses suggest that admissions for asthma, chronic airway obstruction, among those 5-17 years old, self-payers, Medicaid-covered, and rural residents declined the most post-NBP. This study suggests that the NO(x) control policy may have had a positive impact on both air pollution levels statewide and respiratory health in some NYS regions. However, the effect varied by disease subgroups, region, and socio-demographic characteristics.

Environmental effects on immune responses in patients with atopy and asthma

“…93,94 Following the implementation of EPA’s nitrogen oxides (NOx) Budget Trading Program policy, there also were significant reductions in mean ozone levels ( − 2% to − 9%) throughout NY state and post-intervention declines in respiratory admissions were observed. 95 The Clean Air Act and its amendments have reduced vehicle-related pollutants significantly. 96 These examples and others highlight the opportunities that exist to decrease pollutant impacts on allergic lung disease.…”

A rapid assessment of the impact of hazard reduction burning around Sydney, May 2016

“…Similarly, recent research by Lin et al (2013) on the effect of the NO x Budget Trading Program to improve regional air quality in the Eastern United States has found that ozone levels were decreased by 2-9% in New York State during the period [2004][2005][2006]. This resulted in fewer hospital admissions for respiratory disease (up to 11% lower in some counties, including the New York City metropolitan area), although some other counties showed an increase of nearly 18%.…”

Realist review of policy intervention studies aimed at reducing exposures to environmental hazards in the United States

“…The reliance on existing datasets did not always make it possible rule out alternative explanations. For example, one study of the impact of the EPA (Environmental Protection Agency) NOx (mono-nitrogen oxides) Budget Trading Program reviewed New York state hospital discharge records for respiratory diagnoses after the implementation of the program (Lin 2013), but could not control for the simultaneous implementation of the state’s clean indoor air law, although implementation of this law would also be expected to affect levels of respiratory disease [ 18 ]. In addition, the use of existing datasets to measure exposures meant that the policy intervention may have had additional effects that could not be measured with the data that were available to researchers.…”

“…Nine of the included studies relied on environmental measures, and two used measures of effects on humans. Seven of the 11 studies reviewed data from before and after the implementation of the intervention(s) [ 16 , 19 – 24 ] and the remainder included only post-implementation measures [ 18 , 25 – 27 ].…”