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Environ Res. 2018 Oct;166:529-536. doi: 10.1016/j.envres.2018.06.020. Epub 2018 Jun 27.

Associations between environmental quality and adult asthma prevalence in medical claims data.

Author information

1
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB# 7435, Chapel Hill, NC, 27599, United States; Oak Ridge Institute for Science and Education at the US Environmental Protection Agency, USEPA Human Studies Facility, 104 Mason Farm Rd, Chapel Hill, NC, 27514, United States. Electronic address: clgray@email.unc.edu.
2
National Health and Environmental Effects Research Laboratory, US Environmental Protection Agency, MD 58A, Research Triangle Park, NC 27711, United States. Electronic address: lobdell.danelle@epa.gov.
3
National Health and Environmental Effects Research Laboratory, US Environmental Protection Agency, MD 58A, Research Triangle Park, NC 27711, United States. Electronic address: rappazzo.kristen@epa.gov.
4
Informatics Institute, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, United States. Electronic address: yunjian0925@gmail.com.
5
Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 2121 W. Taylor Street, Chicago, IL, 60612, United States. Electronic address: jjagai2@uic.edu.
6
School of Public Health, Oregon Health & Sciences University-Portland State University, 840 Gaines St., Portland, OR, United States. Electronic address: lymesser@pdx.edu.
7
Oak Ridge Associated Universities at the US Environmental Protection Agency, USEPA Human Studies Facility, 104 Mason Farm Rd, Chapel Hill, NC, 27514, United States. Electronic address: patel.achal@epa.gov.
8
National Health and Environmental Effects Research Laboratory, US Environmental Protection Agency, MD 58A, Research Triangle Park, NC 27711, United States. Electronic address: deflorio-barker.stephanie@epa.gov.
9
The Center for Health and the Social Sciences, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, United States. Electronic address: clyttle@bsd.uchicago.edu.
10
Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, United States; Department of Pediatrics, Committee on Molecular Medicine, University of Chicago, 5721S, Maryland Avenue, Chicago, IL 60637, United States. Electronic address: jsolway@medicine.bsd.uchicago.edu.
11
Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, United States; Department of Human Genetics, University of Chicago, 920 E 58th Street, Chicago, IL 60637, United States; Department of Medicine, Institute of Genomics and Systems Biology, and Computation Institute, University of Chicago, 5801 S. Ellis Avenue, Chicago, IL 60637, United States. Electronic address: arzhetsk@medicine.bsd.uchicago.edu.

Abstract

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 defined 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 (CIs). We estimated associations using the cumulative EQI and domain-specific EQIs; 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% CI: 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.

KEYWORDS:

Asthma; Bayesian; Claims; Environment; MarketScan

PMID:
29957506
PMCID:
PMC6110955
[Available on 2019-10-01]
DOI:
10.1016/j.envres.2018.06.020
[Indexed for MEDLINE]

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