Analysis of Asthma Prevalence Using Clinical Electronic Health Records and Air Pollution Data
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Analysis of Asthma Prevalence Using Clinical Electronic Health Records and Air Pollution Data. Carrie Tomasallo, PhD, MPH Wisconsin Department of Health Services Division of Public Health Bureau of Environmental and Occupational Health [email protected]

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Analysis of Asthma Prevalence Using Clinical Electronic Health Records and Air Pollution Data

Carrie Tomasallo, PhD, MPH

Wisconsin Department of Health Services

Division of Public Health

Bureau of Environmental and Occupational Health

[email protected]



Rationale
Rationale environment & community?

  • A multilevel approach that includes an ecological viewpoint may help to explain heterogeneities in chronic disease expression across socioeconomic, behavioral, and geographic boundaries that remain largely unexplained

  • Improved knowledge for interventions


Background
Background environment & community?

  • Asthma affects 500,000 children and adults in Wisconsin

  • Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) data provide annual statewide asthma prevalence estimates

  • Alternative Surveillance Data: Health information exchange between UW Health and WI Division of Public Health (details on next slide)


Electronic Health Record environment & community?(EHR) data from UW Department of Family Medicine, Pediatrics, and Internal Medicine Clinics to identify a patient population with asthma at a census block level

HIPAA limited data set

462,000 patients (45,000 asthmatics)

  • UW eHealth– PHINEXUniversity of Wisconsin Electronic Health Record – Public Health Information Exchange


Uw ehealth phinex clinic ehr data 2007 2011
UW environment & community?ehealth– PHINEX (Clinic EHR Data, 2007-2011)



Specific aims
Specific Aims environment & community?

Examine asthma prevalence and risk factors in clinical EHR and air pollution data

  • Frequency tables of asthma prevalence

  • Multivariate regression modeling


Specific aims cont
Specific Aims environment & community?cont.

Determine areas and populations of asthma disparity

  • GIS and spatial analyses of population trends


Current asthma definition
Current Asthma Definition environment & community?

Asthma diagnosis (ICD-9 code 493) in either encounter diagnosis or problem diagnosis field of clinical EHR


Air pollution data
Air Pollution Data environment & community?

EPA Criteria air pollutant data (CO, NO2 PM2.5, PM10, SO2) modeled from stack emissions and aggregated to the census block group (CBG)


Air pollution data cont
Air Pollution Data environment & community?cont.

EPA Airmod program used to construct a distance decay model from each point source

Pollutant values aggregated to the CBG

A five-mile radius applied for each stack

Values of zero apply in areas where no data points were located


Results environment & community?

Asthma Prevalence


Results environment & community?

Asthma Prevalence cont.


Results environment & community?

Asthma Prevalence cont.


Results environment & community?

Predictive Model

Prevalent Asthma =

Sex + Age + Race + BMI +

Smoking Status + Household Income +

Insurance Status +

Air Pollutants (CO, NO2, PM2.5, PM10, SO2)


Results environment & community?

Multivariate Regression for Asthma

*Asthma Yes = 32,133; Asthma No = 222,964


Results environment & community?

Multivariate Regression for Asthma cont.


Results environment & community?

Multivariate Regression for Asthma cont.


Results environment & community?

Multivariate Regression for Asthma cont.

*Other criteria air pollutants (CO, NO2, SO2 and PM10) were not significant at the p=0.05 level



Average Concentration of PM County, WI2.5 by Census Block Group, Dane County, WI


Conclusions
Conclusions County, WI

Between 2007-2011, EHR clinic data identified 45,000 asthmatics

Prevalence ranged from 6.4% (adults 65+ years) to 13.5% (children 5-11 years)

Asthma prevalence highest among Black non-Hispanics (17.9%)


Conclusions cont
Conclusions County, WIcont.

Factors associated with asthma prevalence:

Younger age, female gender

Black non-Hispanic race/ethnicity

Former smoking status

Elevated BMI

Reporting government insurance

Average PM2.5value

Identified asthma patients at the neighborhood level in Madison, WI


Future directions
Future Directions County, WI

Refining air pollution model; alternate sources of data?

Change definitions of asthma and asthma control

Follow clinical outcomes for an intervention group


Phinex asthma group collaborative effort thank you
PHINEX Asthma Group Collaborative County, WIEffort - Thank You!


Uw ehealth phinex theory and methods wisconsin medical journal june 2012
UW eHealth PHINEX Theory and Methods County, WIWisconsin Medical Journal, June 2012

http://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/111/3/124.pdf


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