ADVANCEMENT OF THE SCIENCE
The CRB reported 90,861 cases of coc- cidioidomycosis with an average annual incidence of 43.47 cases per 100,000 resi- dents. Pinal County, Arizona, reported the highest average incidence of 162.5 cases per 100,000 residents. Valley fever cases peaked in the CRB in 2021 with 12,901 cases and an incidence of 59.9 cases per 100,000 residents. Additionally, Valley fever case incidences ranged annually from 0 cases to 258.3 cases per 100,000 residents, with an average minimum incidence of 26.8 cases per 100,000 residents and an average maxi- mum incidence of 68.2 cases per 100,000 residents. Figures 7 and 8 show the average incidence of Valley fever in the CRB during the study period. From 2013–2021, PRB groundwater nitrate concentration averaged 24.2 mg/L. Nitrate concentrations ranged from 0.92 mg/L to 435.9 mg/L with an average minimum value of 14.9 mg/L and an average maximum value of 55.8 mg/L. PRB nitrate concentrations peaked in 2020, with an average concentra- tion of 53.5 mg/L. Figure 9 shows the average nitrate concentrations in the PRB during the study period. In the seven CRB states, groundwater nitrate concentrations averaged 88.2 mg/L. Nitrate concentrations ranged from 0.2 mg/L to 1,845.5 mg/L with an average minimum concentration of 85.6 mg/L and an average maximum concentration of 91.3 mg/L. CRB nitrate concentrations peaked in 2018, with an average concentration of 311.5 mg/L. Fig- ure 10 shows the average nitrate concentra- tions in the CRB during the study period. From 2013–2022, the PRB reported 1,182 cases of WNV for an average cumulative incidence of 8.3 cases per 100,000 residents, with Rovigo Province in Italy having the highest cumulative incidence of 40.5 cases per 100,000 residents. WNV cases peaked in 2018 and 2022 as the PRB reported 403 and 389 cases, respectively, corresponding to an average incidence of 3.1 cases per 100,000 residents in 2018 and 2022. The CRB reported 4,155 cases of WNV between 2013 and 2022 for an average cumu- lative incidence of 33.4 cases per 100,000 residents. Delta County, Colorado, had the highest cumulative incidence with 368 cases per 100,000 residents over the study period. WNV cases peaked in 2021 as CRB counties reported 1,934 cases.
Annual Average A) PM 2.5 and B) PM 10 Concentrations in the Po River Basin From 2013–2021 FIGURE 4 A
B
The PRB experienced an average relative poverty incidence of 5.6% (of households) from 2014–2022. The poverty incidence ranged from 3.2% to 11.7% with an average minimum incidence of 4.3% and an average maximum incidence of 7.6%. Poverty inci- dence peaked in 2016 with an average inci- dence of 6.4%. The CRB experienced an average poverty rate of 14.42% (of individuals) from 2013– 2022. The poverty rate ranged from 3.6% to 38.7% with an average minimum rate of 10.7% and an average maximum rate of 19.4%. Poverty rates peaked in 2014 with an average rate of 15.9%. Discussion Prioritizing the salient health-related conse- quences of drought is a critical step for pub- lic health practitioners and policymakers, because identifying the most salient conse-
quences allows for a targeted, actionable, and feasible mitigation strategy (Bardach, 2000). We identified the most salient consequence based on the following criteria: number of people at risk, number of people affected, severity of the hazard, trend (increasing or decreasing) during the study period, and availability of mitigation systems or policies. Based on the above considerations, the most salient health-related consequence of drought in the PRB is poor air quality. Despite existing regulations, the PRB’s aver- age annual particulate matter concentrations remain well above those recommended by the World Health Organization (WHO, 2025). Although particulate matter concentrations declined slightly over the study period, these reductions are insufficient to protect the health of PRB residents. Furthermore, air quality exposes all PRB residents to a variety of severe health hazards. Because poor air
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Volume 87 • Number 10
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