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. 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

Christine L Gray  1 , Danelle T Lobdell  2 , Kristen M Rappazzo  3 , Yun Jian  4 , Jyotsna S Jagai  5 , Lynne C Messer  6 , Achal P Patel  7 , Stephanie A DeFlorio-Barker  8 , Christopher Lyttle  9 , Julian Solway  10 , Andrey Rzhetsky  11
Affiliations

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

Christine L Gray et al. Environ Res. 2018 Oct.

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.

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Conflict of interest statement

Conflicts of Interest

The authors declare they have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Associations between Environmental Quality Index and having ≥ 2 asthma claims, all counties and stratified by Rural-Urban Continuum Codes
Figure 2.
Figure 2.
Associations between domain-specific between Environmental Quality Indices and having ≥ 2 asthma claims, all counties.
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References

    1. US Department of Health and Human Services. National Heart, Lung, and Blood Institute. What is asthma? https://www.nhlbi.nih.gov/health/health-topics/topics/asthma. Accessed September 20,2016.
    1. CDC U Vital signs: asthma prevalence, disease characteristics, and self-management education: United States, 2001--2009. MMWR Morbidity and mortality weekly report. 2011;60(17):547–552. - PubMed
    1. U.S. Centers for Disease Control and Prevention. Asthma’s Impact on the Nation. https://www.cdc.gov/asthma/impacts_nation/asthmafactsheet.pdf. Accessed September 20, 2016.
    1. Barnett SB, Nurmagambetov TA. Costs of asthma in the United States: 2002-2007. The Journal of allergy and clinical immunology. 2011;127(1):145–152. - PubMed
    1. U.S. Centers for Disease Control and Prevention. 2014. National Center for Health Statistics. Fast Stats. http://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2014_SHS_Table_A-... Accessed Sept 20, 2016.

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