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Overview
Changes in air quality are strongly linked to climate change and events associated with hotter, drier conditions, such as increased wildfire activity in our region. Warmer temperatures and less high-altitude snowpack create drier, longer summers and increase the risk of wildfires[1]. This risk will likely continue to grow across Oregon, with the greatest impact in the Willamette Valley[2]. Air quality is also expected to worsen because of the increase in smoke and other harmful pollutants, like smog (ground level ozone)[3]. Asthma symptoms are commonly triggered by pollutants or allergens in the air, including smoke from wildfires, exhaust from vehicles, and pollen[4][5]. Fine particles (like PM2.5) released during wildfires and from other sources increases the risk of adverse respiratory conditions, including asthma exacerbations[6]. Warmer conditions also extend the length of pollen season and the geographic area where some plants may grow[7]. Ragweed and grass pollen are common environmental triggers influenced by regional climate changes.
Non-Infectious Respiratory Illness
This indicator measures the number of visits to hospital emergency departments and urgent care clinics (ED/UC) and deaths made by people with non-infectious respiratory illnesses. The indicator excludes data for respiratory illness caused by communicable disease such as COVID-19 and the common cold. Emergency visits for acute exacerbation of chronic obstructive pulmonary disease (COPD) or onset of asthma that can be aggravated by poor air quality are included.
Allergy
This indicator measures the number of visits to hospital emergency departments and urgent care clinics (ED/UC) made by people with symptoms of allergic disease attributed to exposure to high levels of pollen. Allergies refer to the immune system’s response to external allergens like pollen. Symptoms include sneezing, runny nose, shortness of breath, wheezing, and itchy eyes. [8]
Asthma
This indicator measures the number of visits to hospital emergency departments and urgent care clinics (ED/UC) and deaths made by people with symptoms of asthma attributed to exposure to poor air quality or pollen. Asthma is a chronic condition that leads to swelling and inflammation of the airways, making it difficult to breathe. Symptoms include coughing, shortness of breath, wheezing, and chest tightness or pain. [9]
Elevating Equity
Due to historic housing and development policies and practices, communities of color and low-income groups are more likely to live in areas with disproportionately higher exposure to air pollution, roadways, and industrial facilities. This ongoing exposure can put people at greater risk for illness during acute air pollution events, such as widespread wildfire smoke. Groups who face higher risk of health impacts from poor air quality include [10]
People with chronic lung conditions, like asthma or chronic obstructive pulmonary disease, or cardiovascular disease.
Communities of color that have experienced historic redlining, structural exclusion, or lived in areas that have not been prioritized for public works enhancements.
People experiencing houselessness that have limited access to clean indoor air.
Those living near high traffic areas or near industrial facilities.
Immigrants and communities that are culturally or linguistically isolated and may not have access to emergency communications warning of poor air quality.
References
[1] Abatzoglou, Williams, A. P. (2016). Impact of Anthropogenic Climate Change on Wildfire across Western US Forests. . Proceedings of the National Academy of Sciences of the United States of America. Accessed at: https://www.pnas.org/content/ suppl/2016/10/06/1607171113.DCSupplemental ↩︎
[2] Mote, P.W., J. Abatzoglou, K.D. Dello, K. Hegewisch, and D.E. Rupp, 2019: Fourth Oregon Climate Assessment Report. . Oregon Climate Change Research Institute. occri.net/ocar4 ↩︎
[3] USGCRP, 2018: Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment, Volume II . [Reidmiller, D.R., C.W. Avery, D.R. Easterling, K.E. Kunkel, K.L.M. Lewis, T.K. Maycock, and B.C. Stewart (eds.)]. U.S. Global Change Research Program, Washington, DC, USA, 1515 pp. doi: 10.7930/NCA4.2018. ↩︎
[4] National Heart, Lung, and Blood Institute. (2019). Asthma. Accessed at: https://www.nhlbi.nih.gov/healthtopics/asthma ↩︎
[5] 33 George, M, Bruzzese, J., Matura, L. (2017). Climate Change Effects on Respiratory Health. . Journal of Nursing Scholarship. 49(6) p. 644-652. ↩︎
[6] Fann, N., T. Brennan, P. Dolwick, J.L. Gamble, V. Ilacqua, L. Kolb, C.G. Nolte, T.L. Spero, and L. Ziska, 2016: Ch. 3: Air Quality Impacts. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. . U.S. Global Change Research Program, Washington, DC, 69–98. http://dx.doi. org/10.10.7930/J0GQ6VP6 ↩︎
[7] Barnese, C. S., Alexis, N. E., Bernstein, J. A., Cohn, J. R., Demain, J. G., Horner, E., Levetin, E., Nel, A., Phipatanakul, W. (2013) Climate Change and Our Environment: The Effect on Respiratory and Allergic Disease.. Journal of Allergy Clinical Immunology Practice. 1(2) p. 137-141 ↩︎
[8] Schuler Iv CF, Montejo JM. Allergic rhinitis in children and adolescents. . Pediatr Clin North Am. 2019;66(5):981–93. ↩︎
[9] Asthma and Allergy Foundation of America. (n.d.). Asthma information and facts. Accessed at: https://aafa.org/asthma/ ↩︎
[10] American Lung Association. (2020). Disparities in the Impact of Air Pollution. Accessed at: https://www.lung.org/clean-air/ outdoors/who-is-at-risk/disparities. ↩︎
Trends
This section looks at Emergency Department and Urgent Care (ED/UC) visits, hospitalizations, and deaths due to non-infectious respiratory illness, allergies, and asthma. Exposure to poor air quality for long periods can be harmful to health. During wildfire events or other prolonged exposures to air pollutants, people may be exposed to air quality that is considered hazardous for multiple days in a row. Using the EPA’s Air Quality Index can help track poor air quality days and measure risk to health. The calendar presented below shows the number of days during the warm seasons (May 1 – September 30) from 2018 to 2024 in the tri-county area by Air Quality Index category.
Air Quality
In recent years there have been more days with unhealthy to hazardous air quality and more consecutive days of poor air quality. Source: Environmental Protection Agency (EPA).
Calendar showing the highest air quality index for each day during the 2018 to 2024 warm seasons in the tri-county area.
The rate of ED/UC visits for non-infectious respiratory illness increased from 2023 to 2024, but remained lower than its peak in 2020.
Number of ED/UC visits for non-infectious respiratory illness per 100,000 total visits by county and year during the warm season from 2016 to 2024.
Rates of hospitalizations for non-infectious respiratory illness have gradually increased across all counties from 2016 to 2024.
Rates of hospitalizations for non-infectious respiratory illness per 100,000 total hospitalizations by county and year during 2016 to 2024 warm sesons.
The rate of non-infectious respiratory illness deaths peaked in 2021 across the tri-county and has not returned to pre-2021 rates.
Rates of non-infectious respiratory illness deaths per 100,000 total deaths by county and year for 2016-2024 warm seasons.
After a notable decrease in 2020, asthma-like illness ED/UC visits have been increasing to previous levels across the counties.
Rates of asthma-like illness ED/UC visits per 100,000 total visits by county and year during warm season 2016-2024.
Asthma-related hospitalization rates have been increasing across all counties since 2018.
Rates of asthma-related hospitalizations per 100,000 total hospitalizations by county and year during warm seasons 2016-2024.
Asthma-related death rates have been increasing in the Tricounty since 2021.
Rates of asthma-related deaths per 100,000 total deaths by county and year for 2016-2024 warm seasons.
Demographics
This section looks at demographic information for the region through Emergency Department and Urgent Care (ED/UC) visits, hospitalizations, and deaths. Percentage of visits from 2019 – 2024 are presented by age, sex, and race.
Non-infectious respiratory illness ED/UC visits are more likely to be by people over 65 years compared to all ED/UC visits.
Demographic comparison of ED/UC visits for non-infectious respiratory illness and all visits during 2021 – 2024 warm season in the tri-counties.
Hospitalization for non-infectious respiratory illness are more often by people 65 years and older and of white race compared to all hospitalizations.
Demographic comparison of patients who were hospitalized for non-infectious respiratory illness and all hospitalizations during 2021 – 2024 warm season in the tri-counties.
Those who died from non-infectious respiratory illness were more likely to be older (65+) than those who died from any cause.
Demographic comparison of deaths caused by non-infectious respiratory illness and all deaths from during 2021 – 2024 warm seasons in the tri-counties.
Rates of ED/UC visits for non-infectious respiratory illness decreased for all age groups except preschool (0 – 4 years). Visit rates increased slightly for Native Hawaiian/Pacific Islander and Asian groups, but declined for other racial groups. Rates are lower than in previous years for all sex. 2019–2022 and 2023–2024
Rates of ED/UC visits for non-infectious respiratory illness per 100,000 total visits during the warm seasons of 2019–2022 compared with 2023–2024, by patient age, race/ethnicity and sex in the tri-counties.
Rates of non-infectious respiratory illness hospitalizations increased for all age groups between 2019–2022 and 2023–2024, except among older adults 45-64 years. Rates increased for all race groups except among American Indians and Alaska Natives and Native Hawaiians and Pacific Islanders. Rates are highest among American Indians and Alaska Natives, White, and Black/African American groups.
Rates of non-infectious respiratory illness hospitalizations per 100,000 total hospitalizations during the 2019–2022 and 2023–2024 warm seasons by patient age, sex, and race in the tri-counties
Rates of non-infectious respiratory illness deaths were highest among seniors (ages 65 – 74), older seniors (ages 75+), and older adults (ages 45 – 64). Rates increased most in recent years for preschool age children (0-4 years) and people age 75+. Rates of deaths increased most among American Indian and Alaskan Native groups. 2019–2022 and 2023–2024
Rates of non-infectious respiratory illness deaths per 100,000 total deaths during the 2019–2022 and 2023–2024 warm seasons by patient age, race/ethnicity, and sex in the tri-counties.
Allergy-related ED/UC visits are more likely to be school-aged (ages 5 – 17), younger adults (ages 18 – 44), and of Hispanic ethnicity than all ED/UC patients.
Demographic comparison of allergy-related ED/UC visits and all visits during the 2021 – 2024 warm seasons in the tri-counties.
Hospitalizations for allergies were more likely to be seniors (ages 65-74), female, and of white race, compared to all hospitalizations.
Demographic comparison of allergy-related hospitalizations and all hospitalizations during the warm seasons of 2021 – 2024 warm seasons in the tri-counties.
From 2019–2022 to 2023–2024, allergy-related ED/UC visit rates increased for all age groups. Visit rates increased for men and women. Visits for all race and ethnicity groups increased except for American Indian or Alaska Natives.
Rate of allergy-related ED/UC visits per 100,000 total visits by patient age, race/ethnicity and sex during the warm seasons of 2019–2022 and 2023–2024 in the tri-counties.
Rates of allergy-related hospitalizations increased the most for children (ages 5 – 9), and decreased for adolescents (ages 10 – 17), older adults (ages 45 – 64), and younger adults (ages 18 – 44). American Indian and Alaska Native, white, and Hispanic/Latino people saw increases in rates of allergy-related hospitalizations, while Black and Asian people saw decreases in rates. Rates increased for all sex groups. 2019–2022 and 2023–2024
Rates of allergy-related hospitalizations per 100,000 total hospitalizations during the 2019–2022 and 2023–2024 warm seasons by patient age, race/ethnicity, and sex in the tri-counties.
Rates of asthma-like illness ED/UC visits decreased in all age groups except preschool age (ages 0-4). Rates of visits decreased for all race groups except Native Hawaiian and Pacific Islanders and Asian people. Rates decreased for both sexes from 2019–2022 to 2023–2024
Rates of asthma-like illness ED/UC visits per 100,000 total visits during the 2019–2022 and 2023–2024 warm seasons by patient age, race/ethnicity and sex in the tri-counties.
Rates of asthma-related hospitalizations increased in all age groups, both sexes, and for all race groups from 2019–2022 to 2023–2024
Rates of asthma-related hospitalizations per 100,000 total hospitalizations during the 2019–2022 and 2023–2024 warm seasons by patient age, race/ethnicity, and sex in the tri-counties
Rates of asthma-related deaths increased in all age groups except seniors (ages 65 – 74). Rates of deaths decreased in Asian and white groups, but increased for Black or African American and Hispanic or Latino groups. Rates of deaths increased for both sexes from 2019–2022 to 2023–2024
Rates of asthma-related deaths per 100,000 total deaths during the 2019–2022 and 2023–2024 warm seasons by patient age, race/ethnicity, and sex in the tri-counties.
Notes
Data details
Daily data on Air Quality Index (AQI) comes from the Environmental Protection Agency (EPA).The number of Emergency Department and Urgent Care visits (ED/UC) for asthma, non-infectious respiratory illness, and allergies came from the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) in Oregon. The number of hospitalizations was obtained by request from the Office of Health Analytics at Oregon Health Authority Health Policy and Analytics Division. Data on deaths came from death certificates from Oregon Vital Statistics. This data was for the months of May-September from 2019-2024.
Measures of AQI 24-hour averages were taken from all air monitor stations and results from the air monitor with the highest daily index were included in this dashboard.
Methods
We pulled non-infectious respiratory illness,allergy, and asthma emergency and urgent care visits/hospitalizations/deaths that occurred during the warm season and presented annual number of visits/hospitalizations/deaths for the region and each county in bar graphs. We calculated percentages of non-infectious respiratory illness-related/asthma/allergy ED/UC visits/hospitalizations/deaths among all ED/UC visits/hospitalizations/deaths per season and presented a line graph to identify trends over time. We did not calculate visit/hospitalizations/deaths percentages or rates by census population data because multiple visits may be by the same person, and facilities choosing to report to ESSENCE can change over time. Therefore, the percentage of non-infectious respiratory illness/allergy/asthma among all ED/UC visits/hospitalizations/deaths provides a consistent way to track changes in the burden of climate-related care over time and identify differences between who typically seek care.
Air Quality Health Indicators
Health Outcome
Data Source
Query Details
Asthma (ED/UC visit) This query refers to a variety of lung conditions that cause wheezing, breathlessness, chest tightness and coughing.
Oregon ESSENCE (Electronic Surveillance System for the Early Notification of Community-Based Epidemics)
Common terms that people or clinicians might use:
• "asthma" (including misspellings like "asma," "asthmae," "asthmia")
• "bronchospasm" (tightening of the muscles around the airways)
• "reactive airway disease"
• "airway disease"
ICD and SNOMED codes:
• Asthma (J45) and many SNOMED concept codes for various types of asthma
• Other diagnoses and clinical terms related to asthma or airway reactivity
Terms That Are Excluded
Any record that explicitly says: "not asthma". This ensures the system doesn't count people whose symptoms were ruled out as asthma.
Non-Infectious Respiratory Illness (ED/UC visit) This query looks for words and codes for non-infectious respiratory illnesses, including asthma and chronic obstructive pulmonary disease, and words like "wheezing" and "shortness of breath." While these illnesses can be exacerbated by worsening air quality, this query does not specifically include search terms for air quality.
Breathing problems and symptoms such as:
• "difficulty breathing"
• "breathing problem"
• "shortness of breath"
• "dyspnea"
• "chest tightness"
• "chronic cough"
• "wheezing" (but only if not clearly linked to a cold, cough, or congestion)
Excluded Conditions: To focus only on non-infectious causes, this search filters out:
• Fever-related conditions, such as:
- "fever," "febrile," "high temp"
- ICD codes R50.9, 780.60 (general fever codes)
• Wheezing cases clearly related to infection, if they also mention:
- "cough"
- "cold"
- "congestion"
Seasonal Allergies (ED/UC visit) This query looks for chief complaints containing the text string "ALLERG" without any indication of severe allergic reaction or mention of other allergy-inducing agents.
Oregon ESSENCE Source: Stein, Z. Syndromic surveillance for monitoring health impacts of pollen exposure. APHA 2021
Included
• Any mention of "allergy" or "allergies"
This helps identify patients who might be reacting to pollen, dust, or seasonal environmental allergens (e.g., grasses, trees, weeds).
Excluded
• Severe allergic reactions: "anaphylaxis," "allergic reaction," "allergy RX"
• Insect or animal-related allergies: "sting," "insect," "bee," "wasp," "bug," "bite"
• Poison plants: "poison ivy"
• Food allergies: "shrimp," "fish," "nut," "peanut"
• Skin or contact allergies: "soap," "lotion," "detergent," "rash"
• Swelling in sensitive areas (suggesting a more serious allergic reaction):
- Any swelling or "swol" of the lip, face, eye, or tongue
Asthma-related hospitalization among Tricounty residents and Deaths that occurred in the Tricounty
Office of Health Analytics: Hospital Reporting Program Oregon Vital Statistics
ICD 10 Codes:J45, J46, R06.2
Respiratory-related hospitalizations among Tricounty residents Deaths that occurred in the Tricounty
Office of Health Analytics: Hospital Reporting Program Oregon Vital Statistics
Seasonal Allergy hospitalizations among Tricounty residents and Deaths that occurred in the Tricounty
Office of Health Analytics: Hospital Reporting Program Oregon Vital Statistics
ICD 10 Codes:J30.0, J30.1, J30.2
Note: All queries were conducted for the period May to September, 2016-2024
Air Quality Overview
Changes in air quality are strongly linked to climate change and events associated with hotter, drier conditions, such as increased wildfire activity in our region. Warmer temperatures and less high-altitude snowpack create drier, longer summers and increase the risk of wildfires. This risk will likely continue to grow across Oregon, with the greatest impact in the Willamette Valley.Air quality is also expected to worsen because of the increase in smoke and other harmful pollutants, like smog (ground level ozone). Asthma symptoms are commonly triggered by pollutants or allergens in the air, including smoke from wildfires, exhaust from vehicles, and pollen. Fine particles (like PM2.5) released during wildfires and from other sources increases the risk of adverse respiratory conditions, including asthma exacerbations. Warmer conditions also extend the length of pollen season and the geographic area where some plants may grow. Ragweed and grass pollen are common environmental triggers influenced by regional climate changes.
Non-Infectious Respiratory Disease
This indicator measures the number of visits to hospital emergency departments and urgent care clinics (ED/UC) made by people with non-infectious respiratory illnesses. The indicator excludes data for respiratory illness caused by communicable diseases such as COVID-19 and the common cold. Emergency visits for acute exacerbation of chronic obstructive pulmonary disease (COPD) or onset of asthma that can be aggravated by poor air quality are included.
Allergy
This indicator measures the number of visits to hospital emergency departments and urgent care clinics (ED/UC) made by people with symptoms of allergic disease attributed to exposure to high levels of pollen. Allergies refer to the response of the immune system to external allergens like pollen. Symptoms include sneezing, runny nose, shortness of breath, wheezing, and itchy eyes.
Asthma
This indicator measures the number of visits to hospital emergency departments and urgent care clinics (ED/UC) made by people with symptoms of asthma attributed to exposure to poor air quality or pollen. Asthma is a chronic condition that leads to swelling and inflammation of the airways, making it difficult to breathe. Symptoms include coughing, shortness of breath, wheezing, and chest tightness or pain.
Elevating Equity
Due to historic housing and development policies and practices, communities of color and low-income groups are more likely to live in areas with disproportionately higher exposure to air pollution, roadways, and industrial facilities. This ongoing exposure can put people at greater risk for illness during acute air pollution events, such as widespread wildfire smoke. Groups who face higher risk of health impacts from poor air quality include:
People with chronic lung conditions, like asthma or chronic obstructive pulmonary disease, or cardiovascular disease.
Communities of color that have experienced historic redlining, structural exclusion, or lived in areas that have not been prioritized for public works enhancements.
People experiencing houselessness have limited access to clean indoor air.
Those living near high traffic areas or near industrial facilities.
Immigrants and communities that are culturally or linguistically isolated and may not have access to emergency communications warning of poor air quality.
Trends
This section looks at Emergency Department and Urgent Care (ED/UC) visits, hospitalizations, and deaths due to air quality related conditions, allergies, and asthma. Exposure to poor air quality for extended periods of time can be harmful to health. During wildfire events or other prolonged exposures to air pollutants, people may be exposed to air quality that is considered hazardous for multiple days in a row. Using the EPA’s Air Quality Index can help track poor air quality days and measure risk to health. The calendar presented below shows the number of days during the warm seasons (May 1 – September 30) from 2018 to 2024 in the tri-county area by Air Quality Index category.
Key Takeaway: “In recent years there have been more days with unhealthy to hazardous air quality and more consecutive days of poor air quality. Source: Environmental Protection Agency (EPA)”
Alt Text: “Time-series heat map shows the number of days in each Air Quality Index category during the warm season (May-September) for the region from 2018 to 2024.”
Non-Infectious Respiratory Disease
Non-Infectious Respiratory Disease Annual Counts
Non-Infectious Respiratory Disease Emergency Department and Urgent Care Visits
Key Takeaway: “The number of ED/UC visits in 2024 is the highest in the past 5 years for all counties.” Alt Text: “Bar graph showing the number of ED/UC visits for non-infectious respiratory illness during the warm season for each county and the tri-counties from 2020 to 2024.”
Key Takeaway: “The number of hospitalizations for non-infectious respiratory illness continued to increase across the tri-counties from 2020 to 2024.”
Alt Text: “Bar graph showing the number of hospitalizations for non-infectious respiratory illness during the warm season for each county and the tri-counties from 2020 to 2024.”
Non-Infectious Respiratory Disease Deaths
Key Takeaway: “The number of deaths due to non-infectious respiratory illness peaked in 2021 due to the heat dome and has since dropped and been stable.”
Alt Text: “Bar graph showing the number of deaths for non-infectious respiratory illness duriing the warm season for each county and the region from 2020 to 2024.”
Non-Infectious Respiratory Disease Rates
Non-Infectious Respiratory Disease Emergency Department and Urgent Care Visits
Key Takeaway: “The rate of ED/UC visits for non-infectious respiratory illness increased from 2023 to 2024, but remained lower than its peak in 2020.”
Alt Text: “Line graph showing the rate of ED/UC visits for non-infectious respiratory illness per 100,000 total visits for each county and the region from 2016 to 2024 warm seasons.”
Key Takeaway: “Rates of hospitalizations for non-infectious respiratory illness have gradually increased across all counties from 2016 to 2024.”
Alt Text: “Line graph showing the rates of hospitalizations for non-infectious respiratory illness per 100,000 total hospitalizations for each county and the region from 2016 to 2024 warm seasons.”
Non-Infectious Respiratory Disease Deaths
Key Takeaway: “The rate of non-infectious respiratory illness deaths peaked in 2021 across the tri-county and has not returned to pre-2021 rates.”
Alt Text: “Line graph showing the rates of non-infectious respiratory illness deaths per 100,000 emergency deaths for each county and the region from 2016 to 2024 warm seasons.”
Allergy
Allergy Annual Counts
Allergy Emergency Department and Urgent Care Visits
Key Takeaway: “The number of allergy-related ED/UC visits in all counties have increased in recent years.”
Alt Text: “Bar graph showing the number of ED/UC visits for allergy-related exposure for each county and the region from 2020 to 2024 warm seasons.”
Allergy Hospitalizations
Key Takeaway: “The number of allergy-related hospitalizations in the tri-counties was highest in 2023 and decreased in 2024.”
Alt Text: “Bar graph showing the number of hospitalizations for allergy-related exposure for each county and the region from 2020 to 2024 warm seasons.”
Allergy Rates
Allergy Emergency Department and Urgent Care Visits
Key Takeaway: “After a noticeable decrease in allergy-related ED/UC visits in 2020, the number of visits have been gradually increasing across the counties.”
Alt Text: “Line graph showing the rates of allergy-related ED/UC visits per 100,000 total ED/UC visits for each county and the region from 2016 to 2024 warm seasons.”
Allergy Hospitalizations
Key Takeaway: “Since 2018, after two years of decline, allergy-related hospitalization rates have been increasing across the counties.”
Alt Text: “Line graph showing the rates of allergy-related hospitalizations per 100,000 total hospitalizations for each county and the region from 2016 to 2024.”
Asthma
Asthma Annual Counts
Asthma Emergency Department and Urgent Care Visits
Key Takeaway: “The number of asthma-related ED/UC visits increased in 2024 in all counties.”
Alt Text: “Bar graph showing the number of ED/UC visits for asthma-related exposure for each county and the region from 2020 to 2024 warm seasons.”
Asthma Hospitalizations
Key Takeaway: “The number of asthma-related hospitalizations has steadily increased in all counties since 2020.”
Alt Text: “Bar graph showing the number of hospitalizations for asthma-related exposure for each county and the region from 2020 to 2024 warm seasons.”
Asthma Deaths
Key Takeaway: “The number of asthma-related deaths increased in all counties in 2024.”
Alt Text: “Bar graph showing the number of deaths for asthma-related exposure for each county and the region from 2020 to 2024 warm seasons.”
Asthma Rates
Asthma Emergency Department and Urgent Care Visits
Key Takeaway: “Since 2021, allergy-related hospitalizations have been increasing across the counties.”
Alt Text: “Line graph showing the rates of asthma-related ED/UC visits per 100,000 total visits for each county and the region from 2016 to 2024.”
Asthma Hospitalizations
Key Takeaway: “Asthma-related hospitalization rates have been increasing across all counties since 2018.”
Alt Text: “Line graph showing the rates of asthma-related hospitalizations per 100,000 total hospitalizations for each county and the region from 2016 to 2024.”
Asthma Deaths
Key Takeaway: “Asthma-related death rates have been increasing in all counties since 2021.”
Alt Text: “Line graph showing the rates of asthma-related deaths per 100,000 total deaths for each county and the region from 2016 to 2024.”
Demographics
This section looks at demographic information for the region through Emergency Department and Urgent Care (ED/UC) visits, hospitalizations, and deaths. Percentage of visits from 2016 – 2024 are presented by age, sex, and race.
Non-Infectious Respiratory Disease
Non-Infectious Respiratory Disease Demographics
Non-Infectious Respiratory Disease Emergency Department and Urgent Care Visits
Key Takeaway: “Patients admitted to the ED/UC for non-infectious respiratory illness were more likely to be seniors ages 65+ and of white race than other ED/UC patients.”
Alt Text: “Table showing ED/UC visits for non-infectious respiratory illness and all visits by age, race and ethnicity, and sex from 2021 to 2024 in the tri-counties.”
Key Takeaway: “Patients hospitalized for non-infectious respiratory illness are more likely older (65+) and of white race compared to other patients.”
Alt Text: “Table showing hospitalizations for non-infectious respiratory illness and all hospitalizations from 2021 to 2024 in the tri-counties.”
Category
Sub-Category
Non-Infectious Respiratory Hospitalizations
All Hospitalizations
Sex
Female*
0.54
0.53
Sex
Male*
0.46
0.47
Age
Older Senior (75+)*
0.32
0.22
Age
Older Adult (45-64)*
0.27
0.21
Age
Senior (65-74)*
0.24
0.16
Age
Younger Adult (18-44)*
0.14
0.21
Age
Preschool (0-4)*
0.01
0.18
Age
Childhood (5-9)
0.01
0.01
Age
Adolescence (10-17)*
0.01
0.02
Race Alone
White alone*
0.74
0.65
Race Alone
Refused/Unknown/NA*
0.07
0.11
Race Alone
Black or African American alone*
0.06
0.05
Race Alone
Hispanic or Latino*
0.05
0.09
Race Alone
Asian alone*
0.03
0.05
Race Alone
Other Race alone*
0.02
0.04
Race Alone
American Indian or Alaska Native alone*
0.01
0.01
Race Alone
Native Hawaiian or Pacific Islander alone*
0.01
0.01
Non-Infectious Respiratory Disease Deaths
Key Takeaway: “Those who died from non-infectious respiratory illness were more likely to be older (65+) than those who died from any cause.”
Alt Text: “Table showing the deaths from non-infectious respiratory illness and all deaths by age, race and ethnicity, and sex from 2021 to 2024 in the tri-counties.”
Category
Sub-Category
Non-Infectious Respiratory Deaths
All Deaths
Sex
Male
0.53
0.54
Sex
Female
0.47
0.46
Age
Older Senior (75+)
0.52
0.51
Age
Senior (65-74)*
0.26
0.21
Age
Older Adult (45-64)
0.18
0.19
Age
Younger Adult (18-44)*
0.03
0.08
Age
Adolescence (10-17)*
0.00
0.00
Age
Childhood (5-9)
0.00
0.00
Age
Preschool (0-4)*
0.00
0.01
Race Alone
White alone*
0.88
0.85
Race Alone
Hispanic or Latino*
0.04
0.05
Race Alone
Asian alone*
0.03
0.04
Race Alone
Black or African American alone*
0.03
0.04
Race Alone
American Indian and Alaska Native alone
0.01
0.01
Race Alone
Native Hawaiian or Pacific Islander alone
0.01
0.00
Race Alone
Other Race alone
0.00
0.01
Non-Infectious Respiratory Disease Rates by Demographic
Non-Infectious Respiratory Disease Emergency Department and Urgent Care Visits
Key Takeaway: “Rates of ED/UC visits for non-infectious respiratory illness decreased for all age groups except preschool (0 – 4 years). Visit rates increased slightly for Native Hawaiian/Pacific Islander and Asian groups but declined for other racial groups. Rates are lower than in previous years for all sex categories.”
Alt Text: “Barbell chart showing the rates of ED/UC visits for non-infectious respiratory illness per 100,000 total visits during the warm seasons of 2019 to 2022 compared with 2023 to 2024 by patient age, race/ethnicity and sex.”
Key Takeaway: “Rates of non-infectious respiratory illness hospitalizations increased for all age groups between 2019 – 2022 and 2023 – 2024, except among older adults ages 45 – 64. Rates increased for all race groups except among American Indians and Alaska Natives and Native Hawaiians and Pacific Islanders. Rates are highest among American Indians and Alaska Natives, White, and Black/African American groups.”
Alt Text: “Barbell chart showing the rate of non-infectious respiratory illness hospitalizations per 100,000 total hospitalizations during the 2019 to 2022 and 2023 to 2024 warm seasons by patient age in the region.”
Non-Infectious Respiratory Disease Deaths
Key Takeaway: “Rates of non-infectious respiratory illness deaths were highest among seniors (ages 65 – 74), older seniors (ages 75+), and older adults (ages 45 – 64). Rates of deaths were highest among White and American Indian and Alaskan Native groups.”
Alt Text: “Barbell chart showing the rates of non-infectious respiratory illness deaths per 100,000 total deaths during the 2019 to 2022 and 2023 to 2024 warm seasons, by patient age, race/ethnicity, and sex in the region.”
Allergy
Allergy Demographics
Allergy Emergency Department and Urgent Care Visits
Key Takeaway: “Allergy-related ED/UC visits are more likely to be school-aged (ages 5 – 17), younger adults (ages 18 – 44), and of Hispanic ethnicity than other ED/UC patients.”
Alt Text: “Table showing allergy-related ED/UC visits and all visits by age, race and ethnicity, and sex from 2021 to 2024 in the tri-counties.”
Category
Sub-Category
Allergy ED/UC Visits
All ED/UC Visits
Sex
Female
0.55
0.55
Sex
Male
0.45
0.45
Age
Younger Adult (18-44)*
0.49
0.40
Age
Older Adult (45-64)*
0.22
0.24
Age
Adolescence (10-17)*
0.08
0.06
Age
Childhood (5-9)*
0.08
0.04
Age
Preschool (0-4)
0.05
0.05
Age
Senior (65-74)*
0.05
0.11
Age
Older Senior (75+)*
0.03
0.11
Race Alone
White alone*
0.43
0.64
Race Alone
Hispanic or Latino*
0.24
0.12
Race Alone
Other Race
0.12
0.11
Race Alone
Asian alone*
0.11
0.05
Race Alone
Black or African American alone
0.07
0.06
Race Alone
Native Hawaiian or Pacific Islander alone*
0.02
0.01
Race Alone
American Indian or Alaska Native alone
0.01
0.01
Allergy Hospitalizations
Key Takeaway: “Patients hospitalized for allergies were more likely to be seniors (ages 65 – 74), female, and of white race, compared to other patients.”
Alt Text: “Table showing the allergy-related hospitalizations and d all hospitalizations by age, race and ethnicity, and sex from 2021 to 2024 in the tri-counties.”
Category
Sub-Category
Allergy Hospitalizations
All Hospitalizations
Sex
Female*
0.59
0.53
Sex
Male*
0.41
0.47
Age
Older Senior (75+)
0.25
0.22
Age
Older Adult (45-64)
0.24
0.21
Age
Senior (65-74)*
0.23
0.16
Age
Younger Adult (18-44)
0.22
0.21
Age
Adolescence (10-17)*
0.04
0.02
Age
Childhood (5-9)*
0.02
0.01
Age
Preschool (0-4)*
0.01
0.18
Race Alone
White alone*
0.76
0.65
Race Alone
Hispanic or Latino
0.06
0.09
Race Alone
Refused/Unknown/NA*
0.06
0.11
Race Alone
Asian alone
0.04
0.05
Race Alone
Black or African American alone
0.04
0.05
Race Alone
American Indian or Alaska Native alone
0.01
0.01
Race Alone
Other Race alone*
0.01
0.04
Race Alone
Native Hawaiian or Pacific Islander alone
0.00
0.01
Allergy Rates by Demographic
Allergy Emergency Department and Urgent Care Visits
Key Takeaway: “From 2019 – 2022 to 2023 – 2024, allergy-related ED/UC visit rates increased for all age groups. Visit rates increased for men and women. Visits for all race and ethnicity groups increased except for American Indians or Alaska Natives.”
Alt Text: “Barbell chart showing rates of allergy-related ED/UC visits per 100,000 total visits during the 2019 to 2022 and 2023 to 2024 warm seasons by patient age, race/ethnicity and sex in the tri-counties.”
Allergy Hospitalizations
Key Takeaway: “Rates of allergy-related hospitalizations increased the most for children (ages 5 – 9) and decreased for adolescents (ages 10 – 17), older adults (ages 45 – 64), and younger adults (ages 18 – 44). American Indian and Alaska Native, white, and Hispanic/Latino people saw increases in rates of allergy-related hospitalizations, while Black and Asian people saw decreases in rates. Rates increased for all sex groups.”
Alt Text: “Barbell chart showing the rates of allergy-related hospitalizations per 100,000 total hospitalizations during the 2019 to 2022 and 2023 to 2024 warm seasons by patient age, race/ethnicity and sex in the tri-counties.”
Asthma
Asthma Demographics
Asthma Emergency Department and Urgent Care Visits
Key Takeaway: “Asthma-related ED/UC visits are more likely to be female, younger adults (ages 18 – 44), and white than other ED/UC patients.”
Alt Text: “Table showing asthma-related ED/UC visits and all visits by patient age, race/ethnicity and sex from 2021 to 2024 in the tri-counties.”
Category
Sub-Category
Asthma ED Visits
All ED Visits
Sex
Female*
0.61
0.55
Sex
Male*
0.39
0.45
Age
Younger Adult (18-44)*
0.39
0.40
Age
Older Adult (45-64)*
0.25
0.24
Age
Senior (65-74)
0.11
0.11
Age
Older Senior (75+)*
0.09
0.11
Age
Childhood (5-9)*
0.06
0.04
Age
Adolescence (10-17)*
0.05
0.06
Age
Preschool (0-4)*
0.05
0.05
Race Alone
White alone*
0.61
0.64
Race Alone
Hispanic or Latino*
0.11
0.12
Race Alone
Other Race
0.11
0.11
Race Alone
Black or African American alone*
0.09
0.06
Race Alone
Asian alone
0.05
0.05
Race Alone
American Indian or Alaska Native alone
0.01
0.01
Race Alone
Native Hawaiian or Pacific Islander alone*
0.01
0.01
Asthma Hospitalizations
Key Takeaway: “Asthma-related hospitalizations are more likely to be female, younger adults (ages 18 – 44), and white than other hospitalized patients.”
Alt Text: “Table showing asthma-related hospitalizations and all hospitalizations by patient age, race/ethnicity, and sex from 2021 to 2024 in the tri-counties.”
Category
Sub-Category
Asthma Hospitalizations
All Hospitalizations
Sex
Female*
0.68
0.53
Sex
Male*
0.32
0.47
Age
Younger Adult (18-44)*
0.31
0.21
Age
Older Adult (45-64)*
0.26
0.21
Age
Older Senior (75+)*
0.19
0.22
Age
Senior (65-74)
0.16
0.16
Age
Preschool (0-4)*
0.03
0.18
Age
Childhood (5-9)*
0.02
0.01
Age
Adolescence (10-17)*
0.02
0.02
Race Alone
White alone*
0.69
0.65
Race Alone
Black or African American alone*
0.08
0.05
Race Alone
Hispanic or Latino*
0.08
0.09
Race Alone
Refused/Unknown/NA*
0.07
0.11
Race Alone
Asian alone*
0.03
0.05
Race Alone
Other Race alone*
0.03
0.04
Race Alone
American Indian or Alaska Native alone*
0.01
0.01
Race Alone
Native Hawaiian or Pacific Islander alone
0.01
0.01
Asthma Deaths
Key Takeaway: “Asthma-related deaths are more likely to be female, older seniors (ages 75+), and white than other ED patients.”
Alt Text: “Table showing percentage of asthma-related deaths and all deaths by patient age, race/ethnicity, and sex from 2021 to 2024 warm seasons in the tri-counties.”
Category
Sub-Category
Asthma Deaths
All Deaths
Sex
Female*
0.62
0.46
Sex
Male*
0.38
0.54
Age
Older Senior (75+)*
0.39
0.51
Age
Older Adult (45-64)*
0.29
0.19
Age
Senior (65-74)
0.18
0.21
Age
Younger Adult (18-44)*
0.14
0.08
Age
Childhood (5-9)
0.01
0.00
Race Alone
White alone
0.86
0.85
Race Alone
Asian alone
0.06
0.04
Race Alone
Black or African American alone
0.03
0.04
Race Alone
Hispanic or Latino
0.03
0.05
Race Alone
American Indian and Alaska Native alone
0.01
0.01
Asthma Rates by Demographic
Asthma Emergency Department and Urgent Care Visits
Key Takeaway: “Rates of asthma-related ED/UC visits decreased in all age groups except preschool age (ages 0-4). Rates of visits decreased for all race groups except Native Hawaiian and Pacific Islanders and Asian people. Rates decreased for both sexes from 2019 – 2022 to 2023 – 2024.”
Alt Text: “Barbell chart showing the rates of asthma-related ED/UC visits per 100,000 total visits during the 2019 to 2022 and 2023 to 2024 warm seasons by patient age, race and ethnicity, and sex in the tri-counties.”
Asthma Hospitalizations
Key Takeaway: “Rates of asthma-related hospitalizations increased in all age groups, both sexes, and for all race groups from 2019 – 2022 to 2023 – 2024.”
Alt Text: “Barbell chart showing the rates of asthma-related hospitalizations per 100,000 total hospitalizations during the 2019 to 2022 and 2023 to 2024 warm seasons by patient age, race/ethnicity, and sex in the tri-counties.”
Asthma Deaths
Key Takeaway: “Rates of asthma-related deaths increased in all age groups except seniors (ages 65 – 74). Rates of deaths decreased in Asian and white groups but increased for Black or African American and Hispanic or Latino groups. Rates of deaths increased for both sexes from 2019 – 2022 to 2023 – 2024.”
Alt Text: “Barbell chart showing the rates of asthma-related deaths per 100,000 total deaths during the 2019 to 2022 and 2023 to 2024 warm seasons by patient age, race and ethnicity, and sex in the tri-counties.”
Notes
Data details
Daily data on Air Quality Index (AQI) comes from the Environmental Protection Agency (EPA), and the number of Emergency Department and Urgent Care visits (ED/UC) for asthma, non-infectious respiratory illness, and allergies came from the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) in Oregon. The number of hospitalizations was obtained by request from the Office of Health Analytics at Oregon Health Authority Health Policy and Analytics Division. Data on deaths came from death certificates from Oregon Vital Statistics. This data was for the months of May-September from 2019-2024.
Measures AQI 24-hour averages were taken from all air monitor stations and results from the air monitor with the highest daily index were included in this dashboard.
Methods
We pulled non-infectious respiratory illness,allergy, and asthma emergency and urgent care visits/hospitalizations/deaths that occured during the warm season and presented annual number of visits/hospitalizations/deaths for the region and each county in bar graphs. We calculated percentages of non-infectious respiratory illness-related/asthma/allergy ED/UC visits/hospitalizations/deaths among all ED/UC visits/hospitalizations/deaths per season and presented a line graph to identify trends over time. We did not calculate visit/hospitalizations/deaths percentages or rates by census population data because multiple visits may be by the same person, and facilities choosing to report to ESSENCE can change over time. Therefore, the percentage of non-infectious respiratory illness/allergy/asthma among all ED/UC visits/hospitalizations/deaths provides a consistent way to track changes in the burden of climate-related care over time and identify differences between who typically seek care.
Air Quality Health Indicators
Health Outcome
Data Source
Query Details
Asthma (ED/UC visit) This query refers to a variety of lung conditions that cause wheezing, breathlessness, chest tightness and coughing.
Oregon ESSENCE (Electronic Surveillance System for the Early Notification of Community-Based Epidemics)
Common terms that people or clinicians might use:
• "asthma" (including misspellings like "asma," "asthmae," "asthmia")
• "bronchospasm" (tightening of the muscles around the airways)
• "reactive airway disease"
• "airway disease"
ICD and SNOMED codes:
• Asthma (J45) and many SNOMED concept codes for various types of asthma
• Other diagnoses and clinical terms related to asthma or airway reactivity
Terms That Are Excluded
Any record that explicitly says: "not asthma". This ensures the system doesn't count people whose symptoms were ruled out as asthma.
Non-Infectious Respiratory Illness (ED/UC visit) This query looks for words and codes for non-infectious respiratory illnesses, including asthma and chronic obstructive pulmonary disease, and words like "wheezing" and "shortness of breath." While these illnesses can be exacerbated by worsening air quality, this query does not specifically include search terms for air quality.
Breathing problems and symptoms such as:
• "difficulty breathing"
• "breathing problem"
• "shortness of breath"
• "dyspnea"
• "chest tightness"
• "chronic cough"
• "wheezing" (but only if not clearly linked to a cold, cough, or congestion)
Excluded Conditions: To focus only on non-infectious causes, this search filters out:
• Fever-related conditions, such as:
- "fever," "febrile," "high temp"
- ICD codes R50.9, 780.60 (general fever codes)
• Wheezing cases clearly related to infection, if they also mention:
- "cough"
- "cold"
- "congestion"
Seasonal Allergies (ED/UC visit) This query looks for chief complaints containing the text string "ALLERG" without any indication of severe allergic reaction or mention of other allergy-inducing agents.
Oregon ESSENCE Source: Stein, Z. Syndromic surveillance for monitoring health impacts of pollen exposure. APHA 2021
Included
It looks for:
• Any mention of "allergy" or "allergies"
This helps identify patients who might be reacting to pollen, dust, or seasonal environmental allergens (e.g., grasses, trees, weeds).
Excluded
To focus only on seasonal/environmental allergies, it excludes complaints related to:
• Severe allergic reactions: "anaphylaxis," "allergic reaction," "allergy RX"
• Insect or animal-related allergies: "sting," "insect," "bee," "wasp," "bug," "bite"
• Poison plants: "poison ivy"
• Food allergies: "shrimp," "fish," "nut," "peanut"
• Skin or contact allergies: "soap," "lotion," "detergent," "rash"
• Swelling in sensitive areas (suggesting a more serious allergic reaction):
- Any swelling or "swol" of the lip, face, eye, or tongue
Asthma-related hospitalization among Tricounty residents and Deaths that occurred in the Tricounty
Office of Health Analytics: Hospital Reporting Program Oregon Vital Statistics
ICD 10 Codes:J45, J46, R06.2
Respiratory-related hospitalizations among Tricounty residents Deaths that occurred in the Tricounty
Office of Health Analytics: Hospital Reporting Program Oregon Vital Statistics
