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An Analysis of Childhood Asthma and Environmental Exposures in Utah
Michelle Gillette, M.P.H.Office of Epidemiology
Utah Department of Health
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Asthma in the United States
• Increasing prevalence in all age, sex, and racial groups (NHLBI Data Fact Sheet, 1999)
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Trends in Asthma Prevalence by Age
0
10
20
30
40
50
60
70
80
1980 1981-83 1984-86 1987-89 1990-92 1993-94
Year
Rat
e pe
r 1,
000
pers
ons
0-45-1415-3435-6465+
National Heart, Lung and Blood Institute, 1999
Age
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Asthma in Utah
• Hospitalization due to asthma– 12.3 asthma cases per 10,000
children ages 0-14 for 1992-1995 (LeFevre, 1997)
• Childhood asthma hospitalization rates at the zip code level – Analysis conducted in four
Urban counties
Previous Study Data:
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84 0 4 4 84 1 0 4
84 1 1 6 84 1 0 3
84 1 1 984 1 2 0
84 1 1 8
84 0 8 4
84 0 8 8
84 0 0 684 0 9 5
84 0 6 584 0 2 0
84 0 9 2
84 1 1 784 1 0 6 84 1 0 9
84 1 2 4
84 1 2 184 0 4 7
84
07
0
84
09
4
84
12
3
84
10
78
41
15
84
101
841
11
84 0 9 3
84 1 0 5 84 1 0 8
11 211 310 2
84 1 1 7
84 0 5 4 84 0 1 0
84 0 8 7
84 0 1 4
84 0 2 5
84 0 3 7
84 0 4 0
84 0 4 1
84 0 7 5
84 0 4 384 0 0 3
D A V IS C O U N T Y
M O R G A NC O U N T Y
T h eG r e a tS a lt L a k e
S A L TL A K EC O U N T Y
L a k e s
A s t h m a H o s p i t a l R a t e s ( 1 9 9 2 - 1 9 9 5 )
S ig n i f ic a n t ly L o w e rN o t S ig n i f ic a n t l y D i f f e r e n tS ig n i f ic a n t ly H ig h e r
N o C a s e s R e p o rt e d
F r e e w a y s
C o u n t y B o u n d a r ie sSignificantly Lower
Not Significantly DifferentSignificantly HigherFreeways
Asthma Incidence Rates by Zip Code (1992-1995) Ages 0-14
Salt Lake County
The GreatSaltLake
N
E
S
W
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Asthma in Utah
Increased Rate Of Childhood
Asthma
Many Industrial
Emission Sites
Relationship?
In Western Salt Lake County:
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Study Objectives
• Analyze the spatial and temporal variation of childhood asthma within four urban Utah counties
• Determine if there is a relationship between childhood asthma development and proximity to industrial emission sources
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Study Population
• Study Location– Four urban
Utah counties – Approx. 77%
Utah’s population
• Asthma Cases–ICD-9 code 493–1990-1999–Ages 0-14
Salt Lake City
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Salt Lake County
Utah County
Davis County
Weber County
Salt Lake City
GreatSalt Lake
UtahLake
Counties Major Roads Major Lakes
Childhood Asthma Study Area
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Data Collection: Asthma Cases
Hospital Discharge Data:•11,522 Cases•Name•Birth Date•Sex•Date of Admit/Discharge•Address at time of hospitalization
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Data Collection: Asthma Cases
Birth Certificate Data:•8,932 Unique individuals•Race•Tobacco Use (Mother)•Alcohol Use (Mother)•Congenital Anomalies•Birth Address
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Data Collection: Emission Sites
• NPL• CERCLIS• RCRA• TRI• Point Source Emissions
Sources of Hazardous Emissions:
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UtahLake
Great Salt
Lake
Industrial Emission Sites (1990-1999)
NPLTRI
CERCLISPSE
RCRA
X
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Data Collection: Confounders
• Socioeconomic Data– 1990 and 2000 Census Data
• Access to Healthcare– Proximity to hospital
• Climatological Data– Wind speed & direction, temp,
humidity
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Data Analysis: Statistical Tests
• Cluster Identification through Spatial and Temporal Analysis– Are cases close together in space and time?
• Statistical Tests Used – Knox Test– Moran’s I– Gedis-Ord G– Geary’s C
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Data Analysis: Statistical Tests cont.
• Relationship between emission sources and asthma cases– Lawson test
• Point-specific analysis– Rule out potential confounding
factors (i.e. socioeconomic & climatological data)
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Status of Study
• At this point:– 11,522 cases mapped based on
address at time of hospitalization
– 8,032 cases mapped based on birth address
– 6,094 industrial emission sites identified and mapped
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Conclusions
• Previous study indicates increased incidence of asthma in certain areas
• Ongoing analysis to identify clusters and evaluate relationship to emission sources
• Final Results available Fall 2002
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Questions?
• Contact Information:Michelle Gillette, M.P.H.Office of EpidemiologyUtah Department of Health(801) [email protected]
Funding for this study provided by:
The Agency for Toxic Substances and Disease Registry Cooperative Agreement #U50/ATU887580-03
Additional assistance provided by Dr. R. Wayne Ball, Greg Williams, Amy Coombs, Samuel LeFevre, and the University of Utah Digit Lab
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References
National Heart, Lung, and Blood Institute, National Institutes of Health, Centers for Disease Control and Prevention. (1999). NHLBI Data Fact Sheet: Asthma Statistics, January 1999. http://www.nhlbi.nih.gov/health/prof/lung/asthma/asthstat.htm
LeFevre, S., and Ball, R.W. (1997). Health Assessment: Asthma Hospitalization Rates Among Children in Utah.