Abstract
We have explored differences in rates of emergency room (ER) visits for respiratory diseases in the counties of New York State (NYS) in relation to levels of air pollution, poverty, and smoking. Air pollution information was derived from the National Emissions Inventory, which provides information on road, non-road, point, and non-point sources of 12 different air pollutants. This information is only available at the county level. Four types of respiratory diseases were considered: asthma, chronic obstructive pulmonary disease (COPD), acute lower respiratory diseases, and acute upper respiratory diseases. Asthma ER visits were elevated in counties with greater total air pollution. All forms of respiratory diseases were elevated in counties with a greater rate of poverty, although this may reflect the fact that poor people often use ERs for routine care. There was a very strong association between rates of smoking for COPD and acute lower respiratory diseases. There was an apparent negative association between smoking and asthma ER visits, but this must reflect the fact that smoking was much more common in upstate counties while asthma was more common in the New York City area, where air pollution is high. Air pollution was much greater in urban than in rural areas. Our evidence indicates that air pollution is the greatest risk factor for asthma attacks, whereas smoking is the greatest risk factor for chronic obstructive pulmonary disease (COPD) and lower respiratory disease. Poor people are more vulnerable to all forms of respiratory diseases.