Air Quality and the Demand for Health Services in New Hampshire

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1 Air Quality and the Demand for Health Services in New Hampshire Aïchatou Hassane, MA, Robert Woodward, PhD Ross Gittell, PhD Whittemore School of Business and Economics University of New Hampshire Cameron Wake, PhD Institute for the Study of Earth, Oceans and Space University of New Hampshire

2 Outline Goals and Objectives Previous Studies Data and Methodology Findings Future Work

3 Objectives GOAL: Investigate the link between hospital respiratory and cardiovascular services and air quality indicators in New Hampshire. Specific Objectives: Identify magnitude and timing of seasonal patterns in seacoast hospital asthma services. Link seasonal patterns with variations in air quality. Develop a regional prediction model for the demand for health services based on air quality.

Previous Studies: Fall Peak in Maryland Blaisdell et al (22) Figure 3. Median weekly asthma admissions by age group, 1986 1999, in Maryland. Plot of weekly admissions for 4, 5 14, and 15 18 year olds.

4 Previous Studies: Fall Peak in Maryland Blaisdell et al (22) Figure 3. Median weekly asthma admissions by age group, , in Maryland. Plot of weekly admissions for 4, 5 14, and year olds. Asthma admissions increase four- to eightfold in the fall compared to the summer (weeks 26 38). From Blaisdell, C. J., S. R. Weiss, et al. (22). "Using seasonal variations in asthma hospitalizations in children to predict hospitalization frequency." J Asthma 39(7):

5 Previous Studies: Fall Peak in Maine Langley-Turnbaugh et al. (24)

6 Previous Studies: Fall Peak in Canada Johnston et al. (25)

7 Asthma Seasonality in NH, seacoast area 23 Daily Services 16 Asthma Services /1 1/31 3/1 3/31 4/3 5/3 6/29 7/29 8/28 9/27 1/27 11/26 12/26 Cardiovascular Services 2 1 1/1 1/31 3/1 3/31 4/3 5/3 6/29 7/29 8/28 9/27 1/27 11/26 12/26

8 Asthma Seasonality in NH, seacoast area Cumulative Daily Cardiovascular Services 2 1 cardiovascular services asthma services Cumulative Daily Asthma Services 1/1 1/31 3/1 3/31 4/3 5/3 6/29 7/29 8/28 9/27 1/27 11/26 12/26

9 Previous Studies: Air Quality and Asthma Various studies have shown a relationship between asthma and criteria pollutants. In our analysis CO,SO 2,O 3 did not correlate with the fall kink. Ragweed Pollen peaks in September and may explain the fall asthma kink.

10 Location Map Thompson Farm, UNH Air Quality Monitoring Station

11 Data Three NH Seacoast Hospital Services asthma services Air Pollutants from Thompson Farm, UNH Pollen : ragweed

12 Methodology Clearly identify the day of the asthma kink using regression analysis select the day with the highest R-squared Compare the timing of the asthma kink with the timing of the peak in ragweed pollen.

13 18 Asthma Seasonality in NH-seacoast, 22 Regression line: cum_asthma=f (intercept, day, fall_dummy, day*fall_dummy) C u m u la tiv e D a ily A s th m a S e rv ic e s 12 6 FALL KINK 1/1 1/31 3/1 3/31 4/3 5/3 6/29 7/29 8/28 9/27 1/27 11/26 12/26

14 FALL KINK All Asthma Services Sept 18 Sept 2 Sept 14 Outpatient Asthma Services (9% of all services) Sept 16 Aug 3 Sept 14 Inpatient Asthma Services (1% of all services) Oct 5 Sept 12 Sept 22

15 9 Ragweed Pollen Count : August and September /1 8/7 8/13 8/19 8/25 8/31 9/6 9/12 9/18 9/24 9/ /1 8/7 8/13 8/19 8/25 8/31 9/6 9/12 9/18 9/24 9/ /1 8/7 8/13 8/19 8/25 8/31 9/6 9/12 9/18 9/24 9/3

16 Cumulative Asthma Services (In-and Out-patient), 22 Pollen Count 9 6 ragweed asthma 4-day ragweed peak count: 149 Cumulative Daily Services fall 'kink': 9/18/ /1 3/1 4/3 6/29 8/28 1/27 12/26

17 Cumulative Asthma Services (In-and Out-patient), 23 Pollen Count 9 ragweed asthma Cumulative Daily Services day ragweed peak count: fall 'kink': 9/2/ /1 3/1 4/3 6/29 8/28 1/27 12/26

18 Cumulative Asthma Services (In-and Out-patient), 24 Pollen Count 9 Cumulative Daily Services 18 ragweed asthma 6 4-day ragweed peak count: Fall 'kink': 9/14/24 6 1/1 1/31 3/1 3/31 4/3 5/3 6/29 7/29 8/28 9/27 1/27 11/26 12/26

19 Three NH Hospital Daily Inpatient Asthma Admissions, 22 Cumulative Daily Services /1 1/31 3/1 3/31 4/3 5/3 6/29 7/29 8/28 9/27 1/27 11/26 12/26

20 18 Three NH Hospital Daily Outpatient Asthma Visits, 22 Cumulative Daily Services /1 1/31 3/1 3/31 4/3 5/3 6/29 7/29 8/28 9/27 1/27 11/26 12/26

21 Fall Asthma Rise and Pollen Total Asthma increase per day Outpatient Asthma increase per day Inpatient Asthma increase per day

22 Cost of Hospital Services in NH-seacoast Cost per Admission day $2,96 $2,859 $3,379 Cost per Visit $52 $535 $585 Average Length of Stay 3.4 days 3.7 days 4.2 days

23 Cost of Fall Asthma Rise in NH-seacoast Additional Inpatient Costs $67,98 $161,8 $141,92 Additional Outpatient Costs $68,35 $87,1 $121,15 Total Cost of Fall Peak $136,33 $248,9 $263,7

24 Future Work Extend the analysis to more years of data Collaboration with local hospital Pollen monitoring Network Test different hypothesis for fall increase School start date/labor day Air pollutants Develop a regional prediction model for demand for health services which will help improve public health by: Providing warning to population at risk Assist hospital management teams in anticipated demand for services

25 The End Thank You

The Influenza Epidemiological Reporting Form

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