Air pollution related adverse respiratory health outcomes in California’s San Joaquin Valley: evidence from 2016 linked emergency department and hospital Records

Introduction: The San Joaquin Valley (SJV) of California has been consistently identified as having one of the highest levels of air pollution in the US. Despite federal and state standards, the SJV has been in non-attainment status for daily PM2.5 concentrations, extreme non-attainment for 8-hour O3 levels, and attainment for NO2. Methods: An epidemiological time-stratified case-crossover design was used to estimate the relationship between exposure to NO2, O3, PM2.5 and adverse health outcomes in asthma and upper respiratory infections (URIs). This study compared pollutant exposure effects for each case during limited time intervals and adjusted for seasonality. Results: Elevated concentrations of three criteria outdoor air pollutants are associated with increased asthma and URI-related ED visits and hospitalizations in the SJV for all ages. NO2 exposure increased the odds of having an ED visit by 2.4% in lag 1 (95% CI: 1.017, 1.031). Lags 2, 3, 4, 5, 7, 9, and 14 were statistically significant. O3 modestly increased the odds of ED visits by 0.3% (95% CI:1.000, 1.006) after immediate exposure in the warm season. In the cold season, PM2.5 estimates were significant for all lags except for lags 4 and 12. The two-week lag increased the odds by 28% (95% CI:1.218, 1.345) for ED visits, and 16.5% (95% CI:1.009, 1.345) increased the odds of being hospitalized after cumulative exposure to PM2.5. Discussion: Findings suggest that SJV residents experience adverse health effects due to elevated exposure to NO2 despite attainment of federal pollutant standards. Conclusion: This study provides new evidence about the effects of three criteria air pollutants and adverse health outcomes in the SJV region. The air quality regulatory and public health governing bodies should consider revisions to regional pollutant thresholds and local public health strategies to prevent adverse health outcomes during short and prolonged periods of air pollution exposure.