This work was supported by the Office of Research and Development at the U.S. Environmental Protection Agency (contracts EP12D000264, EP09D000003 and EP17D000079 to LCM, contract EP17D000063 to JSJ, and appointment of CLG to the Research Participation Program, administered through the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and the U.S. Environmental Protection Agency); NIH grants 1P50MH094267 and R01HL122712, in addition to DARPA contract W911NF1410333, and a gift from Liz and Kent Dauten; and University of Chicago Clinical and Translational Science Award UL1 TR 002389.
Asthma -- Environmental aspects, Health insurance claims -- Analysis, Bayesian statistical decision theory, Environmentally induced diseases, Diseases -- Causes and theories of causation
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.
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Gray, C. L., Lobdell, D. T., Rappazzo, K. M., Jian, Y., Jagai, J. S., Messer, L. C., … Rzhetsky, A. (2018). Associations between environmental quality and adult asthma prevalence in medical claims data. Environmental Research, 166, 529–536.