Health Services Utilization in Asthma Exacerbations and PM10 Levels in Rural Colorado

Rationale: The San Luis Valley in rural Colorado often has elevated levels of ambient particulate matter. To date little is known about the impact of ambient particulate matter levels and medical care utilization due to asthma exacerbation in rural communities. Objectives: We investigated the impact of ambient particulate matter concentrations on emergency/urgent visits and hospitalizations for asthma in a rural community. Methods: Daily ambient particulate matter concentrations from an air quality monitor in the San Luis Valley (2003-2012) were obtained from the state health department. Deidentified data for emergency/urgent visits with a diagnosis code for asthma were collected from the local health care system organization. A generalized linear model using splines and employing generalized estimating equations for correlated measures over time was used to examine the association between daily counts of emergency/urgent visits for asthma and 3- to 5-day averaged ambient particulate matter concentrations. Results: For each 15-mg/m(3) increase in 3-day averaged ambient particulate matter, there was an associated 3.1% increase in hospital counts for all patients with asthma (95% confidence interval, 0.3-5.9%; P = 0.03). When the 3-day average exceeded 50 mg/m(3), asthma hospital visits increased by 16.8% (P = 0.03), and when it exceeded 100 mg/m(3), visits increased by 65.8% (P = 0.002). In children, the odds of one asthma event requiring an emergency/urgent care visit increased 5.0% with each 15-mg/m(3) increase in 3-day averaged ambient particulate matter (P = 0.22). Conclusions: We observed associations between ambient air levels of particulate matter with a diameter less than 10 mm and emergency/urgent care visits and hospitalization counts in a rural U.S. community prone to dust storms and Environmental Protection Agency exceedances.