Change in rate of healthcare encounters for respiratory infection from air pollution exposure after improved vehicle emissions standards in New York State.

The introduction of Tier 3 light-duty vehicles with reduced emissions began in New York State (NYS) in 2017, with required compliance by 2025. We hypothesized that improved air quality during the early implementation of Tier 3 (2017-2019) would result in reduced rates of hospitalizations and emergency department (ED) visits for respiratory infection associated with increased PM2.5 compared to 2014-2016 (pre-Tier 3). Using data on adult patients hospitalized or having an ED visit for influenza, upper respiratory infection, culture-negative pneumonia, or respiratory bacterial infection, living within 15 miles of six air quality monitoring sites in NY, and a case-crossover design and conditional logistic regression, we estimated the rates of respiratory infection hospitalizations and ED visits associated with increased ambient PM2.5 concentrations in the previous 0-6 days and each week thereafter up to 1 month. Interquartile range (IQR) increases in PM2.5 in the previous 6 days were associated with 4.6% (95% CI: -0.5, 10.1) and 11.9% (95% CI = 6.1, 18.0) increased rates of influenza hospitalizations in 2014-2016 and 2017-2019, respectively. This pattern of larger relative rates in 2017-2019 observed at all lag times was only present in males hospitalized for influenza but not other infections or in females. The rates of respiratory infection visits associated with increased PM2.5 were generally not reduced in this early Tier 3 implementation period compared to 2014-2016. Limited fleet penetration of Tier 3 vehicles and differences in particle deposition, infection type, and sex by period may all have contributed to this lack of improvement.