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Associations between environmental quality and adult asthma prevalence in medical claims data
Citation:
Gray, C., D. Lobdell, K. Rappazzo, Y. Jian, J. Jagai, L. Messer, A. Patel, S. Deflorio-Barker, C. Lyttle, J. Solway, AND A. Rzhetsky. Associations between environmental quality and adult asthma prevalence in medical claims data. ENVIRONMENTAL RESEARCH. Elsevier B.V., Amsterdam, Netherlands, 166:529-536, (2018). https://doi.org/10.1016/j.envres.2018.06.020
Impact/Purpose:
This study addresses research questions under Sustainable and Healthy Communities (Project 2.64 Indicators, Indices & Report on the Environment and Project 2.62 Community Public Health & Well-Being). National Health Environmental Effects Research Laboratory in the Environmental Public Health Division, Epidemiology Branch is currently engaged in research aimed at developing a measure that estimates overall environmental quality at the county level across the U.S. spanning the years 2000 – 2005 called the Environmental Quality Index (EQI). This work is being conducted for the purpose of learning more about how various environmental factors contribute in concert to health disparities in low-income, underrepresented minority and vulnerable populations, and to better estimate the total environmental and social context to which humans are exposed. The EQI was used to assess associations between cumulative environmental exposures and asthma prevalence.
Description:
As of 2014, approximately 7.4% of U.S. adults had current asthma. The etiology of asthma is complex, involving genetics, behavior, and environmental factors. To explore the association between cumulative environmental quality and asthma prevalence in U.S. adults, we linked the U.S. Environmental Protection Agency's Environmental Quality Index (EQI) to the MarketScan® Commercial Claims and Encounters Database. The EQI is a summary measure of five environmental domains (air, water, land, built, sociodemographic). We define asthma as having at least 2 claims during the study period, 2003-2013. We used a Bayesian approach with non-informative priors, implementing mixed effects regression modeling with a Poisson link function. Fixed effects variables were EQI, sex, race, and age. Random effects were counties. We modeled quintiles of the EQI comparing higher quintiles (worse quality) to lowest quintile (best quality) to estimate prevalence ratios (PR) and credible intervals (Cls). We estimated associations using the cumulative and EQl domain-specific EQls; we assessed U.S. overall (non-stratified) as well as stratified by rural-urban continuum codes (RUCC) to assess rural/urban heterogeneity. Among the 71,577,118 U.S. adults with medical claims who could be geocoded to county of residence, 1,147,564 (1.6%) met the asthma definition. Worse environmental quality was associated with increased asthma prevalence using the non-RUCC-stratified cumulative EQI, comparing the worst to best EQI quintile (PR:1.27; 95% Cl: 1.21,1.34). Patterns varied among different EQI domains, as well as by rural/urban status. Poor environmental quality may increase asthma prevalence, but domain-specific drivers may operate differently depending on rural/urban status.
URLs/Downloads:
DOI: Associations between environmental quality and adult asthma prevalence in medical claims data