|
California Tracking |
No. 10 summer 2005 |
|
|
The Newsletter of the California Environmental Health Tracking Program |
||
|
In This Issue
Setting the Stage for a Statewide System :: the Alameda County Pilot Project The goals of the Alameda County Pilot Project (ACPP) are to: 1) identify communities with elevated risk for asthma, preterm birth, or term low birthweight and assess their exposure to traffic pollution in Alameda County; 2) improve our ability to examine possible connections between asthma, preterm birth, and term low birthweight with exposure to pollution caused by automobile and truck traffic; 3) explore various methods of measuring and visualizing asthma occurrence in populations; and 4) assess the benefits, limitations, and costs of this type of tracking system and explore how these approaches may be applied to other health conditions and environmental hazards in California. The ACPP has begun to demonstrate how utilization of existing data can contribute to public knowledge while maintaining data confidentiality. Key processes that have contributed to early successes include:
Applying New Methods to Existing Data :: Better Understanding Birth Outcomes Distribution In some cases, the data available for environmental health
tracking are very complete but there have been limitations in the analysis,
visualization, and
communication of the data. In the ACPP,
we are applying various new methods to improve the analysis and utility of birth
outcomes data.
Improving our Understanding of Asthma in a Population :: Analysis and Application of Multiple Asthma Indicators Indicators are used to identify, describe, and communicate
the condition of a population. There are various asthma indicators that can
be used to describe the asthma status of populations. Because a population's
asthma status will look different depending on the indicator, using a single
indicator for asthma can results in incomplete and/or misleading descriptions. A common method of characterizing asthma in California is through hospital discharge data. While useful, these data can only provide zip code-level rates and are limited to asthma-related hospitalizations. In order to better understand and describe asthma, especially at a small-scale level, we need to examine other asthma-related events (e.g. emergency room visits, outpatient visits, and medication purchases). To that end, ACPP collaborated with public and private partners (Medi-Cal and Kaiser Permanente of Northern California) to obtain street address-level patient data needed to develop various asthma indicators, including rates of:
Using similar statistical and GIS (Geographic Information Systems) techniques used to produce the birth outcomes results (article above), we created smoothed-surface maps for each of the asthma indicators. Figures 3 and 4 represent maps for rates of emergency room visits and maintenance medication purchases. As evidenced by those figures, the asthma status in Alameda County looks very different depending on which indicator is being used. We can now see that the different asthma events are not equally distributed. Table 1 clearly illustrates an inverse relationship between emergency room visits and purchase of maintenance medications. The findings speak to the fact that people experience asthma in different ways and that the different events represent a range of asthma severity. By comparing maps based on various asthma indicators, we can identify communities that are likely experiencing more severe asthma (e.g. higher rates of emergency room visits) and communities with relatively high but well maintained asthma (e.g. higher rates of medication purchases).
The findings also help to generate questions around factors that contribute to the disparate ways that communities experience asthma (e.g. air quality, housing conditions, quality of/access to health care, and other community factors). In summary, asthma indicators developed using high-quality
data, amenable to high-resolution geographical analysis, can more accurately
describe and communicate a population's asthma status while preserving privacy
and confidentiality.
Information
to Support Public Policy and Interventions :: Disparate Economic Burden of
Asthma Due to rising asthma spending and the need to define health status in economic terms, we have developed an indicator that puts asthma information in the context of economic costs to society. In order to develop such an indicator we obtained average costs* for each of the asthma-related health events (Table 2). Immediately apparent is the enormous difference in costs along a range of asthma events. In order to describe the distribution of asthma costs
in Alameda County, we applied methods which combine the cost data with our previous
analyses of asthma data (article above). For any given
location in Alameda County, we can calculate
a rate for hospitalizations, emergency room visits, outpatient visits, and medication
purchases. We multiply each of these rates by the respective costs; add the
results; and divide that sum by the This map demonstrates another approach to understanding and describing the conditions in a population. This type of information can support decisions based on both health and economic data. It can also be useful in targeting resources/ services such as primary and secondary prevention. For example, Figure 5 identifies areas with potential to avoid high costs by addressing health care inequities. In developing and disseminating this type of information, we hope to increase the utility of environmental health tracking information for a broad range of stakeholders.
Keys to Success :: Collaborating with Stakeholders to Develop Meaningful and Relevant Information The ACPP findings speak to the benefits of a participatory process in which stakeholders define issues and influence solutions that are useful and relevant to their needs and concerns. Thanks to the guidance of the ACPP Advisory Group (community and governmental stakeholders), we have been able to produce results that could have tremendous implications for policy-makers, public health officials, and community-based organizations. Various stakeholders have confirmed that the findings can be used to:
The ACPP Advisory Group is working to ensure that the
findings get to appropriate stakeholders in appropriate formats and methods
by guiding the outreach and dissemination strategy that will be based on overall
project findings.
Tracking Children's Environmental Health :: the Central Valley/South Coast Pilot Project
Although this pilot project differs in geographic scope
and several health and environmental topics, the processes are similar to those
of the ACPP. For more information about this pilot project, please visit
www.catracking.com/sub/p2.htm
or contact the project's Principal Investigator, Eric Roberts, MD, PHD at
erobert1@dhs.ca.gov. |
||
|
Disclaimer: Links to non-CEHTP resources are provided solely as a service. These links do not constitute an endorsement of these resources and none should be inferred. CEHTP is not responsible for the content of the individual organization Web pages or documents found at these links. |
||
Working with a knowledgeable, diverse advisory group (comprised
of community and governmental experts) that guides the development and dissemination
of ACPP materials.
)
)
)
We are also able to more accurately analyze disparities
by geography and socioeconomic status. For example, we have found that communities
with higher poverty rates have significantly higher rates of emergency room
visits while having disproportionately lower rates of maintenance medications
purchases.
)
This, our other
pilot project, focuses on counties in the Sacramento Valley, San Joaquin Valley,
and South Coast air basins. We are exploring geographic variations in health
outcomes and their possible relationships with environmental hazards, using
data on: preterm birth and term low birthweight events; SIDS (Sudden Infant
Death Syndrome); Autism Spectrum Disorders; mental retardation; airborne hazards
(pesticide use and toxic air pollutants); and maternal and child blood lead
levels. The goals of the Central Valley/South Coast Pilot Project are to: