There was an increase in mortality related to cardiovascular and lower-respiratory-tract illness in counties infested with the emerald ash borer. The magnitude of this effect was greater as infestation progressed and in counties with above-average median household income. Across the 15 states in the study area, the borer was associated with an additional 6113 deaths related to illness of the lower respiratory system, and 15,080 cardiovascular-related deaths. The effect of EAB is 6.8 addditional respiratory deaths per year per 100,000 adults. 16.7 additional cardiovasular related deaths per year per 1000,000 adults.