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We hypothesized that improved air quality during the early implementation of Tier 3 (2017\u20132019) would result in reduced rates of hospitalizations and emergency department (ED) visits for respiratory infection associated with increased PM<jats:sub>2.5<\/jats:sub> compared to 2014\u20132016 (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\u00a0air 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 PM<jats:sub>2.5<\/jats:sub> concentrations in the previous 0\u20136 days and each week thereafter up to 1 month. Interquartile range (IQR) increases in PM<jats:sub>2.5<\/jats:sub> in the previous 6 days were associated with 4.6% (95% CI:\u2009\u2212\u20090.5, 10.1) and 11.9% (95% CI\u2009=\u20096.1, 18.0) increased rates of influenza hospitalizations in 2014\u20132016 and 2017\u20132019, respectively. This pattern of larger relative rates in 2017\u20132019 observed at all lag times was only present in males hospitalized for influenza but not other infections or in\u00a0females. The rates of respiratory infection visits associated with increased PM<jats:sub>2.5<\/jats:sub> were generally not reduced in this early Tier 3 implementation period compared to 2014\u20132016. 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.<\/jats:p>","DOI":"10.1007\/s11869-024-01505-6","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T07:02:31Z","timestamp":1706684551000},"page":"1267-1280","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Change in rate of healthcare encounters for respiratory infection from air pollution exposure after improved vehicle emissions standards in New York State"],"prefix":"10.1007","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1990-5542","authenticated-orcid":false,"given":"Daniel P.","family":"Croft","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Utell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip K.","family":"Hopke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally W.","family":"Thurston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunle","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Q.","family":"Rich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"1505_CR1","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1890\/13-1452.1","volume":"95","author":"K Aho","year":"2014","unstructured":"Aho K, Derryberry D, Peterson T (2014) Model selection for ecologists: the worldviews of AIC and BIC. 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The University at Albany Research Ethics Committee has confirmed that no ethical approval is required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Given the statewide database is managed by the New York State Department of Health, informed consent for participation or publication was not obtained by the study authors.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate and publish"}},{"value":"David Q Rich is an associate editor at <i>Air Quality, Atmosphere and Health<\/i>. No other competing interests for authors exist.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}