Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-30 (of 37 Records) |
Query Trace: Vaidyanathan A [original query] |
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Evaluating data quality for blended data using a data quality framework
Parker JD , Mirel LB , Lee P , Mintz R , Tungate A , Vaidyanathan A . Stat J IAOS 2024 40 (1) 125-136 In 2020 the U.S. Federal Committee on Statistical Methodology (FCSM) released 'A Framework for Data Quality', organized by 11 dimensions of data quality grouped among three domains of quality (utility, objectivity, integrity). This paper addresses the use of the FCSM Framework for data quality assessments of blended data. The FCSM Framework applies to all types of data, however best practices for implementation have not been documented. We applied the FCSM Framework for three health-research related case studies. For each case study, assessments of data quality dimensions were performed to identify threats to quality, possible mitigations of those threats, and trade-offs among them. From these assessments the authors concluded: 1) data quality assessments are more complex in practice than anticipated and expert guidance and documentation are important; 2) each dimension may not be equally important for different data uses; 3) data quality assessments can be subjective and having a quantitative tool could help explain the results, however, quantitative assessments may be closely tied to the intended use of the dataset; 4) there are common trade-offs and mitigations for some threats to quality among dimensions. This paper is one of the first to apply the FCSM Framework to specific use-cases and illustrates a process for similar data uses. © 2024 - IOS Press. All rights reserved. |
Ambient air quality and fatal asthma exacerbations among children in North Carolina
Mirabelli MC , Flanders WD , Vaidyanathan A , Beavers DP , Gower WA . Epidemiology 2023 34 (6) 888-891 BACKGROUND: Little is known about the role of air quality in fatal asthma exacerbations among children. METHODS: We collected information about 80 deaths that occurred in North Carolina from 2001 through 2016, among children aged 5-17 years, with asthma identified as the primary cause of death. We linked information about each death with county-level estimates of particulate matter ≤2.5 µm (PM2.5) and ozone (O3). Using the linked data, we conducted a case-crossover analysis of associations between PM2.5 and O3 lagged by 3-5 days with the odds of fatal asthma exacerbations. RESULTS: In the highest tertile of PM2.5 lag(3-5), the odds of a fatal exacerbation of asthma were more than twice the odds in the lowest tertile (odds ratio = 2.2; 95% confidence interval = 1.1, 4.6). CONCLUSION: These findings from North Carolina provide evidence to support the hypothesis that ambient air pollution increases the risk of fatal exacerbations of asthma among children. |
At the intersection: Protecting public health from smoke while addressing the U.S. Wildfire Crisis
Sacks JD , Holder AL , Rappold AG , Vaidyanathan A . Am J Respir Crit Care Med 2023 208 (7) 755-757 Climate change, historical practices of fire suppression, and an increase in the growth of the wildland-urban interface are driving forces behind the increased occurrence of large, catastrophic fires in the U.S. (1, 2). While fire itself can lead to extensive damage and detrimental ecological effects, the smoke emitted has substantial adverse impacts on public health. Wildfire smoke consists of a complex mixture, including fine particles (PM2.5; particles with aerodynamic diameter generally ≤ 2.5 μm), which has been shown to impact large geographic domains and contribute to thousands of estimated deaths and illnesses annually (2, 3). As a result, public health agencies at the local, state, and national levels have developed strategies to reduce exposure to smoke and to address wide-ranging health concerns associated with such exposures. These strategies help prepare and educate individuals and communities before, during, and after smoke episodes; and are instituted by well-documented programs (e.g., smoke-ready programs, the Interagency Wildland Fire Air Quality Response Program (IWFAQRP) (https://www.wildlandfiresmoke.net/) with the overarching goal of raising awareness on a suite of public health approaches and preventative measures (4). |
Trends in heat related illness: Nationwide observational cohort at the US Department of Veteran Affairs
Osborne TF , Veigulis ZP , Vaidyanathan A , Arreola DM , Schramm PJ . J Clim Cha Health 2023 12 Introduction: Environmental heat can have a negative impact on health, leading to increased healthcare utilization, disability, and death. Specific clinical conditions, in combination with a global rise in temperature, may amplify the risk of heat related illnesses. Materials and Methods: We conducted a retrospective analysis of VA's national electronic health record database from January 1, 2002, through December 31, 2019. Heat related illness diagnoses were assessed for associations with patient demographics, comorbidities, and geographic residence at the time of a heat related illness diagnosis. Descriptive statistics, linear regression, and additive seasonal decomposition methods were utilized to assess risk factors and trends. Results: There were 33,114 documented cases of heat related illness, which impacted 28,039 unique patients, during our 18 year assessment period. Veterans were diagnosed with heat related illnesses in all 50 US states and there was an increase in the rate over time. The likelihood of heat related illnesses was greater for those with increased comorbidity burden. Rates increased for homeless Veterans in the first half of the assessment period, and then declined for the second half. Black, as well as American Indian/Alaska Native Veterans accounted for a greater proportion of heat related illnesses. Conclusion: There has been a statistically significant and clinically important increase in the incidence of heat related illnesses over time. There has also been an increased number of heat related diagnoses associated with existing health and demographic factors, and the increase over time did not strictly follow the expected geographic North-South climate trends. © 2023 |
An analysis of prescribed fire activities and emissions in the Southeastern United States from 2013 to 2020
Li Z , Maji KJ , Hu Y , Vaidyanathan A , O’Neill SM , Odman MT , Russell AG . Remote Sens 2023 15 (11) Prescribed burning is a major source of a fine particular matter, especially in the southeastern United States, and quantifying emissions from burning operations accurately is an integral part of ascertaining air quality impacts. For instance, a critical factor in calculating fire emissions is identifying fire activity information (e.g., location, date/time, fire type, and area burned) and prior estimations of prescribed fire activity used for calculating emissions have either used burn permit records or satellite-based remote sensing products. While burn permit records kept by state agencies are a reliable source, they are not always available or readily accessible. Satellite-based remote sensing products are currently used to fill the data gaps, especially in regional studies; however, they cannot differentiate prescribed burns from the other types of fires. In this study, we developed novel algorithms to distinguish prescribed burns from wildfires and agricultural burns in a satellite-derived product, Fire INventory from NCAR (FINN). We matched and compared the burned areas from permit records and FINN at various spatial scales: individual fire level, 4 km grid level, and state level. The methods developed in this study are readily usable for differentiating burn type, matching and comparing the burned area between two datasets at various resolutions, and estimating prescribed burn emissions. The results showed that burned areas from permits and FINN have a weak correlation at the individual fire level, while the correlation is much higher for the 4 km grid and state levels. Since matching at the 4 km grid level showed a relatively higher correlation and chemical transport models typically use grid-based emissions, we used the linear regression relationship between FINN and permit burned areas at the grid level to adjust FINN burned areas. This adjustment resulted in a reduction in FINN-burned areas by 34%. The adjusted burned area was then used as input to the BlueSky Smoke Modeling Framework to provide long-term, three-dimensional prescribed burning emissions for the southeastern United States. In this study, we also compared emissions from different methods (FINN or BlueSky) and different data sources (adjusted FINN or permits) to evaluate uncertainties of our emission estimation. The comparison results showed the impacts of the burned area, method, and data source on prescribed burning emission estimations. © 2023 by the authors. |
Large-scale agricultural burning and cardiorespiratory emergency department visits in the U.S. state of Kansas
Pennington AF , Vaidyanathan A , Ahmed FS , Manangan A , Mirabelli MC , Sircar KD , Yip F , Flanders WD . J Expo Sci Environ Epidemiol 2023 33 (4) 663-669 BACKGROUND: Prescribed agricultural burning is a common land management practice, but little is known about the health effects from the resulting smoke exposure. OBJECTIVE: To examine the association between smoke from prescribed burning and cardiorespiratory outcomes in the U.S. state of Kansas. METHODS: We analyzed a zip code-level, daily time series of primary cardiorespiratory emergency department (ED) visits for February-May (months when prescribed burning is common in Kansas) in the years 2009-2011 (n = 109,220). Given limited monitoring data, we formulated a measure of smoke exposure using non-traditional datasets, including fire radiative power and locational attributes from remote sensing data sources. We then assigned a population-weighted potential smoke impact factor (PSIF) to each zip code, based on fire intensity, smoke transport, and fire proximity. We used Poisson generalized linear models to estimate the association between PSIF on the same day and in the past 3 days and asthma, respiratory including asthma, and cardiovascular ED visits. RESULTS: During the study period, prescribed burning took place on approximately 8 million acres in Kansas. Same-day PSIF was associated with a 7% increase in the rate of asthma ED visits when adjusting for month, year, zip code, meteorology, day of week, holidays, and correlation within zip codes (rate ratio [RR]: 1.07; 95% confidence interval [CI]: 1.01, 1.13). Same-day PSIF was not associated with a combined outcome of respiratory ED visits (RR [95% CI]: 0.99 [0.97, 1.02]), or cardiovascular ED visits (RR [95% CI]: 1.01 [0.98, 1.04]). There was no consistent association between PSIF during the past 3 days and any of the outcomes. SIGNIFICANCE: These results suggest an association between smoke exposure and asthma ED visits on the same day. Elucidating these associations will help guide public health programs that address population-level exposure to smoke from prescribed burning. |
Public health applications of historical smoke forecasts: An evaluation of archived BlueSky data for the coterminous United States, 20152018
Michael R , Mirabelli MC , Vaidyanathan A . Comput Geosci 2023 171 Background: Wildfires are increasing in magnitude, frequency, and severity. Populations in the wildland-urban interface and in downwind communities are at increased risk of exposure to elevated concentrations of fine particulate matter (PM2.5) and other harmful components of wildfire smoke. We conducted this analysis to evaluate the use of modeled predictions of wildfire smoke to create county-level measures of smoke exposure for public health research and surveillance. Methods: We evaluated four years (20152018) of grid-based North American Mesoscale (NAM)-derived PM2.5 forecasts from the U.S. Forest Service BlueSky modeling framework with monitoring data from the Environmental Protection Agency Air Quality System (AQS), the Interagency Monitoring of Protected Visual Environments (IMPROVE), the Western Regional Climate Center (WRCC), and the Interagency Real Time Smoke Monitoring (AIRSIS) programs. To assess relationships between model-derived estimates and monitor-based observations, we assessed Spearman's correlations by spatial (i.e., county, level of urbanization, states in the western United States impacted by major wildfires, and climate regions) and temporal (i.e., month and wildfire activity periods) characteristics. We then generated county-level smoke estimates and examined spatial and temporal patterns in total and person-days of smoke exposure. Results: Across all counties in the coterminous United States and for all days, the correlation between county-level model- and monitor-derived PM2.5 estimates was 0.14 (p < 0.001). Correlations were stronger using data from temporary monitors and for areas and days impacted by high wildfire smoke, especially in the western United States. Correlations between county-level model- and monitor-derived estimates in non-metropolitan counties, and at higher concentrations ranged from 0.25 to 0.54 (p < 0.001). Conclusions: In general, public health practitioners and health researchers need to consider the pros and cons associated with modeled data products for conducting health analyses. Our results support the use of model-derived smoke estimates to identify communities impacted by heavy smoke events, especially during emergency response and for communities located near wildfire episodes. 2022 |
Understanding Air Quality Changes after Implementation of Mitigation Measures during a Pandemic: A Scoping Review of Literature in the United States
McElroy S , Vaidyanathan A . Aerosol Air Qual Res 2022 22 (11) Traffic-related emissions continue to be a significant source of air pollution in the United States (US) and around the globe. Evidence has shown that previous policies implemented to restrict-traffic flows have affected air pollution levels. Thus, mitigation strategies associated with the COVID-19 pandemic that modified population-level mobility patterns provide a unique opportunity to study air pollution change across the US. For instance, to slow the spread of the pandemic, state and local governments started implementing various mitigation actions, including stay-at-home directives, social distancing measures, school closures, and travel restrictions. This scoping review aimed to summarize the existing evidence about how air quality changed through mitigation practices throughout the pandemic in the US. We found 66 articles that fit our inclusion criteria. Generally, the consolidated results revealed that nitrogen dioxide (NO2) and carbon monoxide (CO) decreased across the country. Studies observed mixed directions and magnitudes of change for fine and coarse particulate matter (PM2.5, PM10), ozone (O3), and sulfur dioxide (SO2). Few articles tried to explain this notable heterogeneity in air quality changes by associating contextual factors, such as mobility, traffic flow, and demographic factors. However, all studies agreed that the change in air pollution was nonuniform across the US and even varied within a city. © The Author(s). |
Wildfire smoke and symptoms affecting mental health among adults in the U.S. state of Oregon
Mirabelli MC , Vaidyanathan A , Pennington AF , Ye D , Trenga CA . Prev Med 2022 164 107333 The physical and mental health impacts of wildfires are wide-ranging. We assessed associations between exposure to wildfire smoke and self-reported symptoms affecting mental health among adults living in Oregon. We linked by interview date and county of residence survey responses from 5807 adults who responded to the 2018 Behavioral Risk Factor Surveillance System's depression and anxiety module with smoke plume density, a proxy for wildfires and wildfire smoke exposure. Associations between weeks in the past year with medium and heavy smoke plume densities and symptoms affecting mental health during the two weeks before the interview date were estimated using predicted marginal probabilities from logistic regression models. In the year before completing the interview, 100% of respondents experienced ≥2 weeks of medium or heavy smoke, with an average exposure duration of 32 days. Nearly 10% reported being unable to stop or control their worrying more than half the time over the past two weeks. Medium or heavy smoke for 6 or more weeks in the past year, compared to ≤4 weeks in the past year, was associated with a 30% higher prevalence of being unable to stop or control worrying more than half the time during the past two weeks (prevalence ratio: 1.30, 95% confidence interval: 1.03, 1.65). Among adults in Oregon, selected symptoms affecting mental health were associated with extended durations of medium and heavy smoke. These findings highlight the burden of such symptoms among adults living in communities affected by wildfires and wildfire smoke. |
Extreme heat exposure: Access and barriers to cooling centers - Maricopa and Yuma Counties, Arizona, 2010-2020
Mallen E , Roach M , Fox L , Gillespie E , Watkins L , Hondula DM , Vaidyanathan A , Manangan A , Perkins AN , Schramm PJ . MMWR Morb Mortal Wkly Rep 2022 71 (24) 781-785 Extreme heat exposure increases the risk for heat-related illnesses (HRIs) and deaths, and comprehensive strategies to prevent HRIs are increasingly important in a warming climate (1). An estimated 702 HRI-associated deaths and 67,512 HRI-associated emergency department visits occur in the United States each year (2,3). In 2020, Phoenix and Yuma, Arizona, experienced a record 145 and 148 days, respectively, of temperatures >100°F (37.8°C), and a record 522 heat-related deaths occurred in the state. HRIs are preventable through individual and community-based strategies*(,)(†); cooling centers,(§) typically air-conditioned or cooled buildings designated as sites to provide respite and safety during extreme heat, have been established in Maricopa and Yuma counties to reduce HRIs among at-risk populations, such as older adults. This analysis examined trends in HRIs by age during 2010-2020 for Maricopa and Yuma counties and data from a survey of older adults related to cooling center availability and use in Yuma County during 2018-2019. Data from CDC's Social Vulnerability Index (SVI) were also used to overlay cooling center locations with SVI scores. During 2010-2020, heat days, defined as days with an excessive heat warning issued by the National Weather Service Phoenix Office,(¶) for any part of Maricopa and Yuma counties (4), increased in both Maricopa County (1.18 days per year) and Yuma County (1.71 days per year) on average. Adults aged ≥65 years had higher rates of HRI hospitalization compared with those aged <65 years. In a survey of 39 adults aged ≥65 years in Yuma County, 44% reported recent HRI symptoms, and 18% reported electricity cost always or sometimes constrained their use of air conditioning. Barriers to cooling center access among older adults include awareness of location and transportation. Collaboration among diverse community sectors and health profession education programs is important to better prepare for rising heat exposure and HRIs. States and communities can implement adaptation and evaluation strategies to mitigate and assess heat risk, such as the use of cooling centers to protect communities disproportionately affected by HRI during periods of high temperatures. |
Short term physician visits and medication prescriptions for allergic disease associated with seasonal tree, grass, and weed pollen exposure across the United States
Saha S , Vaidyanathan A , Lo F , Brown C , Hess JJ . Environ Health 2021 20 (1) 85 BACKGROUND: While year-round exposure to pollen is linked to a large burden of allergic diseases, location-specific risk information on pollen types and allergy outcomes are limited. We characterize the relationship between acute exposure to tree, grass and weed pollen taxa and two allergy outcomes (allergic rhinitis physician visit and prescription allergy medication fill) across 28 metropolitan statistical areas (MSA) in the United States. METHODS: We obtained daily pollen data from National Allergy Bureau (NAB) monitors at these 28 MSAs for 2008-2015. We revised the NAB guidelines to classify taxa-specific pollen severity each day. Daily information on allergic rhinitis and prescribed allergy medications for individuals with employer-based health insurance from the IBM MarketScan Research database for these MSAs. We combined the daily pollen and health data for each MSA into a longitudinal dataset. We conducted a MSA-specific conditional quasi-Poisson regression analysis to assess how different levels of pollen concentration impact the health outcomes, controlling for local air pollution, meteorology and Influenza-like illness (ILI). We used a random effects meta-analysis to produce an overall risk estimate for each pollen type and health outcome. RESULTS: The seasonal distribution of pollen taxa and associated health impacts varied across the MSAs. Relative risk of allergic rhinitis visits increased as concentrations increased for all pollen types; relative risk of medication fills increased for tree and weed pollen only. We observed an increase in health risk even on days with moderate levels of pollen concentration. 7-day average concentration of pollen had stronger association with the health outcomes compared to the same-day measure. Controlling for air pollution and ILI had little impact on effect estimates. CONCLUSION: This analysis expands the catalogue of associations between different pollen taxa and allergy-related outcomes across multiple MSAs. The effect estimates we present can be used to project the burden of allergic disease in specific locations in the future as well inform patients with allergies on impending pollen exposure. |
Heat-Related Emergency Department Visits During the Northwestern Heat Wave - United States, June 2021
Schramm PJ , Vaidyanathan A , Radhakrishnan L , Gates A , Hartnett K , Breysse P . MMWR Morb Mortal Wkly Rep 2021 70 (29) 1020-1021 Record high temperatures are occurring more frequently in the United States, and climate change is causing heat waves to become more intense (1), directly impacting human health, including heat-related illnesses and deaths. On average, approximately 700 heat-related deaths occur in the United States each year (2). In the northwestern United States, increasing temperatures are projected to cause significant adverse health effects in the coming years (3). During June 25-30, 2021, most of Oregon and Washington were under a National Weather Service excessive heat warning.* Hot conditions persisted in parts of Oregon, Washington, or Idaho through at least July 14, 2021. The record-breaking heat had the largest impact in Oregon and Washington, especially the Portland metropolitan area, with temperatures reaching 116°F (46.7°C), which is 42°F (5.6°C) hotter than the average daily maximum June temperature. |
Notes from the field: Understanding smoke exposure in communities and fire camps affected by wildfires- California and Oregon, 2020
Navarro K , Vaidyanathan A . MMWR Morb Mortal Wkly Rep 2020 69 (49) 1873-1875 During 2020, the United States has experienced unseasonably higher fire activity than in past years, resulting in >7.8 million burned acres; as of December, wildfires were still active in the western United States (1). A major public health concern associated with wildfires is exposure to air pollutants, such as fine inhalable particles in smoke, with aerodynamic diameters ≤2.5 μm (particulate matter [PM]2.5). Exposure to wildfire smoke can irritate the lungs, alter immune function, and increase susceptibility to respiratory infections. In addition, exacerbations of asthma, chronic obstructive pulmonary disease, cardiovascular disease, and possibly increased mortality are associated with smoke exposure* (2). Characterizing smoke exposure levels for communities located near the fires and personnel involved in response efforts is a critical public health function during wildfire episodes. |
Association between work-related hyperthermia emergency department visits and ambient heat in five southeastern states, 2010-2012 - a case-crossover study
Shire J , Vaidyanathan A , Lackovic M , Bunn T . Geohealth 2020 4 (8) e2019GH000241 The objective of this study is to assess ambient temperatures' and extreme heat events' contribution to work-related emergency department (ED) visits for hyperthermia in the southeastern United States to inform prevention. Through a collaborative network and established data framework, work-related ED hyperthermia visits in five participating southeastern U.S. states were analyzed using a time stratified case-crossover design. For exposure metrics, day- and location-specific measures of ambient temperatures and county-specific identification of extreme heat events were used. From 2010 to 2012, 5,017 work-related hyperthermia ED visits were seen; 2,298 (~46%) of these visits occurred on days when the daily maximum heat index was at temperatures the Occupational Safety and Health Administration designates as having "lower" or "moderate" heat risk. A 14% increase in risk of ED visit was seen for a 1°F increase in average daily mean temperature, modeled as linear predictor across all temperatures. A 54% increase in risk was seen for work-related hyperthermia ED visits during extreme heat events (two or more consecutive days of unusually high temperatures) when controlling for average daily mean temperature. Despite ambient heat being a well-known risk to workers' health, this study's findings indicate ambient heat contributed to work-related ED hyperthermia visits in these five states. Used alone, existing OSHA heat-risk levels for ambient temperatures did not appear to successfully communicate workers' risk for hyperthermia in this study. Findings should inform future heat-alert communications and policies, heat prevention efforts, and heat-illness prevention research for workers in the southeastern United States. |
Heat-related deaths - United States, 2004-2018
Vaidyanathan A , Malilay J , Schramm P , Saha S . MMWR Morb Mortal Wkly Rep 2020 69 (24) 729-734 Deaths attributable to natural heat exposure, although generally considered preventable (1), represent a continuing public health concern in the United States. During 2004-2018, an average of 702 heat-related deaths occurred in the United States annually. To study patterns in heat-related deaths by age group, sex, race/ethnicity, and level of urbanization, and to explore comorbid conditions associated with deaths resulting from heat exposure, CDC analyzed nationally comprehensive mortality data from the National Vital Statistics System (NVSS).* The rate of heat-related mortality tended to be higher among males, persons aged >/=65 years, non-Hispanic American Indian/Alaska Natives, and persons living in noncore nonmetropolitan and large central metropolitan counties. Natural heat exposure was a contributing cause of deaths attributed to certain chronic medical conditions and other external causes. Preparedness and response initiatives directed toward extreme heat events, currently underway at local, state, and national levels, can contribute to reducing morbidity and mortality associated with natural heat exposure. Successful public health interventions(dagger) to mitigate heat-related deaths include conducting outreach to vulnerable communities to increase awareness of heat-related symptoms and provide guidance for staying cool and hydrated, particularly for susceptible groups at risk such as young athletes and persons who are older or socially isolated (2). Improved coordination across various health care sectors could inform local activities to protect health during periods of high heat. For instance, jurisdictions can monitor weather conditions and syndromic surveillance data to guide timing of risk communication and other measures (e.g., developing and implementing heat response plans, facilitating communication and education activities) to prevent heat-related mortality in the United States. CDC also recommends that federal, state, local, and tribal jurisdictions open cooling centers or provide access to public locations with air conditioning for persons in need of a safe, cool, environment during hot weather conditions. In light of the coronavirus disease 2019 (COVID-19) pandemic, CDC updated its guidance on the use of cooling centers to provide best practices (e.g., potential changes to staffing procedures, separate areas for persons with symptoms of COVID-19, and physical distancing) to reduce the risk for introducing and transmitting SARS COV-2, the virus that causes COVID-19, into cooling centers.( section sign). |
The association between wildfire smoke exposure and asthma-specific medical care utilization in Oregon during the 2013 wildfire season
Gan RW , Liu J , Ford B , O'Dell K , Vaidyanathan A , Wilson A , Volckens J , Pfister G , Fischer EV , Pierce JR , Magzamen S . J Expo Sci Environ Epidemiol 2020 30 (4) 618-628 Wildfire smoke (WFS) increases the risk of respiratory hospitalizations. We evaluated the association between WFS and asthma healthcare utilization (AHCU) during the 2013 wildfire season in Oregon. WFS particulate matter </= 2.5 mum in diameter (PM2.5) was estimated using a blended model of in situ monitoring, chemical transport models, and satellite-based data. Asthma claims and place of service were identified from Oregon All Payer All Claims data from 1 May 2013 to 30 September 2013. The association with WFS PM2.5 was evaluated using time-stratified case-crossover designs. The maximum WFS PM2.5 concentration during the study period was 172 microg/m(3). A 10 microg/m(3) increase in WFS increased risk in asthma diagnosis at emergency departments (odds ratio [OR]: 1.089, 95% confidence interval [CI]: 1.043-1.136), office visit (OR: 1.050, 95% CI: 1.038-1.063), and outpatient visits (OR: 1.065, 95% CI: 1.029-1.103); an association was observed with asthma rescue inhaler medication fills (OR: 1.077, 95% CI: 1.065-1.088). WFS increased the risk for asthma morbidity during the 2013 wildfire season in Oregon. Communities impacted by WFS could see increases in AHCU for tertiary, secondary, and primary care. |
Methods, availability, and applications of PM2.5 exposure estimates derived from ground measurements, satellite, and atmospheric models
Diao M , Holloway T , Choi S , O'Neill SM , Al-Hamdan MZ , van Donkelaar A , Martin RV , Jin X , Fiore AM , Henze DK , Lacey F , Kinney PL , Freedman F , Larkin NK , Zou Y , Kelly JT , Vaidyanathan A . J Air Waste Manag Assoc 2019 69 (12) 1391-1414 Fine particulate matter (PM2.5) is a well-established risk factor for public health. To support both health risk assessment and epidemiological studies, data are needed on spatial and temporal patterns of PM2.5 exposures. This review article surveys publicly available exposure datasets for surface PM2.5 mass concentrations over the contiguous U.S., summarizes their applications and limitations, and provides suggestions on future research needs. The complex landscape of satellite instruments, model capabilities, monitor networks, and data synthesis methods offers opportunities for research development, but would benefit from guidance for new users. Guidance is provided to access publicly available PM2.5 datasets, to explain and compare different approaches for dataset generation, and to identify sources of uncertainties associated with various types of datasets. Three main sources used to create PM2.5 exposure data are: ground-based measurements (especially regulatory monitoring), satellite retrievals (especially aerosol optical depth, AOD), and atmospheric chemistry models. We find inconsistencies among several publicly available PM2.5 estimates, highlighting uncertainties in the exposure datasets that are often overlooked in health effects analyses. Major differences among PM2.5 estimates emerge from the choice of data (ground-based, satellite, and/or model), the spatiotemporal resolutions, and the algorithms used to fuse data sources. |
Differences in heat-related mortality by citizenship status: United States, 2005-2014
Taylor EV , Vaidyanathan A , Flanders WD , Murphy M , Spencer M , Noe RS . Am J Public Health 2018 108 S131-s136 OBJECTIVES: To determine whether non-US citizens have a higher mortality risk of heat-related deaths than do US citizens. METHODS: We used place of residence reported in mortality data from the National Vital Statistics System from 2005 to 2014 as a proxy for citizenship to examine differences in heat-related deaths between non-US and US citizens. Estimates from the US Census Bureau American Community Survey of self-reported citizenship status and place of birth provided the numbers for the study population. We calculated the standardized mortality ratio and relative risk for heat-related deaths between non-US and US citizens nationally. RESULTS: Heat-related deaths accounted for 2.23% (n = 999) of deaths among non-US citizens and 0.02% (n = 4196) of deaths among US citizens. The age-adjusted standardized mortality ratio for non-US citizens compared with US citizens was 3.4 (95% confidence ratio [CI] = 3.2, 3.6). This risk was higher for Hispanic non-US citizens (risk ratio [RR] = 3.6; 95% CI = 3.2, 3.9) and non-US citizens aged 18 to 24 years (RR = 20.6; 95% CI = 16.5, 25.7). CONCLUSIONS: We found an increased mortality risk among non-US citizens compared with US citizens for heat-related deaths, especially those younger and of Hispanic ethnicity. |
Community drinking water data on the National Environmental Public Health Tracking Network: a surveillance summary of data from 2000 to 2010
Monti MM , David F , Shin M , Vaidyanathan A . Environ Monit Assess 2019 191 (9) 557 This report describes the available drinking water quality monitoring data on the Centers for Disease Control and Prevention (CDC) National Environmental Public Health Tracking Network (Tracking Network). This surveillance summary serves to identify the degree to which ten drinking water contaminants are present in finished water delivered to populations served by community water systems (CWS) in 24 states from 2000 to 2010. For each state, data were collected from every CWS. CWS are sampled on a monitoring schedule established by the Environmental Protection Agency (EPA) for each contaminant monitored. Annual mean and maximum concentrations by CWS for ten water contaminants were summarized from 2000 to 2010 for 24 states. For each contaminant, we calculated the number and percent of CWS with mean and maximum concentrations above the maximum contaminant level (MCL) and the number and percent of population served by CWS with mean and maximum concentrations above the MCL by year and then calculated the median number of those exceedances for the 11-year period. We also summarized these measures by CWS size and by state and identified the source water used by those CWS with exceedances of the MCL. The contaminants that occur more frequently in CWS with annual mean and annual maximum concentrations greater than the MCL include the disinfection byproducts, total trihalomethanes (TTHM), and haloacetic acids (HAA5); arsenic; nitrate; radium and uranium. A very high proportion of exceedances based on MCLs occurred mostly in very small and small CWS, which serve a year-round population of 3,300 or less. Arsenic in New Mexico and disinfection byproducts HAA5 and TTHM, represent the greatest health risk in terms of exposure to regulated drinking water contaminants. Very small and small CWS are the systems' greatest difficulty in achieving compliance. |
Development of a WebGIS-based analysis tool for human health protection from the impacts of prescribed fire smoke in southeastern USA
Hu Y , Ai HH , Odman MT , Vaidyanathan A , Russell AG . Int J Environ Res Public Health 2019 16 (11) We have developed the Southern Integrated Prescribed Fire Information System (SIPFIS) to disseminate prescribed fire information, including daily forecasts of potential air quality impacts for southeastern USA. SIPFIS is a Web-based Geographic Information Systems (WebGIS) assisted online analysis tool that provides easy access to air quality and fire-related data products, and it facilitates visual analysis of exposure to smoke from prescribed fires. We have demonstrated that the information that SIPFIS provides can help users to accomplish several fire management activities, especially those related to assessing environmental and health impacts associated with prescribed burning. SIPFIS can easily and conveniently assist tasks such as checking residential community-level smoke exposures for personal use, pre-screening for fire-related exceptional events that could lead to air quality exceedances, supporting analysis for air quality forecasts, and the evaluation of prescribed burning operations, among others. The SIPFIS database is currently expanding to include social vulnerability and human health information, and this will evolve to bring more enhanced interactive functions in the future. |
Assessment of extreme heat and hospitalizations to inform early warning systems
Vaidyanathan A , Saha S , Vicedo-Cabrera AM , Gasparrini A , Abdurehman N , Jordan R , Hawkins M , Hess J , Elixhauser A . Proc Natl Acad Sci U S A 2019 116 (12) 5420-5427 Heat early warning systems and action plans use temperature thresholds to trigger warnings and risk communication. In this study, we conduct multistate analyses, exploring associations between heat and all-cause and cause-specific hospitalizations, to inform the design and development of heat-health early warning systems. We used a two-stage analysis to estimate heat-health risk relationships between heat index and hospitalizations in 1,617 counties in the United States for 2003-2012. The first stage involved a county-level time series quasi-Poisson regression, using a distributed lag nonlinear model, to estimate heat-health associations. The second stage involved a multivariate random-effects meta-analysis to pool county-specific exposure-response associations across larger geographic scales, such as by state or climate region. Using results from this two-stage analysis, we identified heat index ranges that correspond with significant heat-attributable burden. We then compared those with the National Oceanic and Atmospheric Administration National Weather Service (NWS) heat alert criteria used during the same time period. Associations between heat index and cause-specific hospitalizations vary widely by geography and health outcome. Heat-attributable burden starts to occur at moderately hot heat index values, which in some regions are below the alert ranges used by the NWS during the study time period. Locally specific health evidence can beneficially inform and calibrate heat alert criteria. A synchronization of health findings with traditional weather forecasting efforts could be critical in the development of effective heat-health early warning systems. |
Emergency Department Visits and Ambient Temperature: Evaluating the Connection and Projecting Future Outcomes
Lay CR , Mills D , Belova A , Sarofim MC , Kinney PL , Vaidyanathan A , Jones R , Hall R , Saha S . Geohealth 2018 2 (6) 182-194 The U.S. Global Climate Change Research Program has identified climate change as a growing public health threat. We investigated the potential effects of changes in ambient daily maximum temperature on hyperthermia and cardiovascular emergency department (ED) visits using records for patients age 64 and younger from a private insurance database for the May-September period for 2005-2012. We found a strong positive relationship between daily maximum temperatures and ED visits for hyperthermia but not for cardiovascular conditions. Using the fitted relationship from 136 metropolitan areas, we calculated the number and rate of hyperthermia ED visits for climates representative of year 1995 (baseline period), as well as years 2050 and 2090 (future periods), for two climate change scenarios based on outcomes from five global climate models. Without considering potential adaptation or population growth and movement, we calculate that climate change alone will result in an additional 21,000-28,000 hyperthermia ED visits for May to September, with associated treatment costs between $6 million and $52 million (2015 U.S. dollars) by 2050; this increases to approximately 28,000-65,000 additional hyperthermia ED visits with treatment costs between $9 million and $118 million (2015 U.S. dollars) by 2090. The range in projected additional hyperthermia visits reflects the difference between alternative climate scenarios, and the additional range in valuation reflects different assumptions about per-case valuation. |
Age-specific associations of ozone and PM2.5 with respiratory emergency department visits in the US
Strosnider HM , Chang HH , Darrow LA , Liu Y , Vaidyanathan A , Strickland MJ . Am J Respir Crit Care Med 2018 199 (7) 882-890 RATIONALE: While associations between air pollution and respiratory morbidity for adults 65 and older are well-documented in the United States, the evidence for people under 65 is less extensive. To address this gap, the Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program collected respiratory emergency department (ED) data from 17 states. OBJECTIVES: Estimate age-specific acute effects of ozone and fine particulate matter (PM2.5) on respiratory ED visits. METHODS: We conducted time-series analyses in 894 counties by linking daily respiratory ED visits with estimated ozone and PM2.5 concentrations during the week before the date of the visit. Overall effect estimates were obtained using a Bayesian hierarchical model to combine county estimates for each pollutant by age group (children 0-18, adults 19-64, adults >/=65, and all ages) and by outcome group (acute respiratory infection, asthma, chronic obstructive pulmonary disease, pneumonia, and all respiratory ED visits). MEASUREMENTS AND MAIN RESULTS: Rate ratios (95% credible interval) per 10 microg/m3 increase in PM2.5 and all respiratory ED visits were 1.024 (1.018, 1.029) among children, 1.008 (1.004, 1.012) among adults <65, and 1.002 (0.996, 1.007) among adults 65 and older. Per 20 ppb increase in ozone, rate ratios were 1.017 (1.011, 1.023) among children, 1.051 (1.046, 1.056) among adults <65, and 1.033 (1.026, 1.040) among adults 65 and older. Associations varied in magnitude by age group for each outcome group. CONCLUSIONS: These results address a gap in the evidence used to ensure adequate public health protection under national air pollution policies. |
Assessing heat-related mortality risks among rural populations: A systematic review and meta-analysis of epidemiological evidence
Odame EA , Li Y , Zheng S , Vaidyanathan A , Silver K . Int J Environ Res Public Health 2018 15 (8) Most epidemiological studies of high temperature effects on mortality have focused on urban settings, while heat-related health risks in rural areas remain underexplored. To date there has been no meta-analysis of epidemiologic literature concerning heat-related mortality in rural settings. This study aims to systematically review the current literature for assessing heat-related mortality risk among rural populations. We conducted a comprehensive literature search using PubMed, Web of Science, and Google Scholar to identify articles published up to April 2018. Key selection criteria included study location, health endpoints, and study design. Fourteen studies conducted in rural areas in seven countries on four continents met the selection criteria, and eleven were included in the meta-analysis. Using the random effects model, the pooled estimates of relative risks (RRs) for all-cause and cardiovascular mortality were 1.030 (95% CI: 1.013, 1.048) and 1.111 (95% CI: 1.045, 1.181) per 1 degrees C increase in daily mean temperature, respectively. We found excess risks in rural settings not to be smaller than risks in urban settings. Our results suggest that rural populations, like urban populations, are also vulnerable to heat-related mortality. Further evaluation of heat-related mortality among rural populations is warranted to develop public health interventions in rural communities. |
Electronic health record case studies to advance environmental public health tracking
Namulanda G , Qualters J , Vaidyanathan A , Roberts E , Richardson M , Fraser A , McVeigh KH , Patterson S . J Biomed Inform 2018 79 98-104 Data from traditional public health surveillance systems can have some limitations, e.g., timeliness, geographic level, and amount of data accessible. Electronic health records (EHRs) could present an opportunity to supplement current sources of routinely collected surveillance data. The National Environmental Public Health Tracking Program (Tracking Program) sought to explore the use of EHRs for advancing environmental public health surveillance practices. The Tracking Program funded four state/local health departments to obtain and pilot the use of EHR data to address several issues including the challenges and technical requirements for accessing EHR data, and the core data elements required to integrate EHR data within their departments' Tracking programs. The results of these pilot projects highlighted the potential of EHR data for public health surveillance of rare diseases that may lack comprehensive registries, and surveillance of prevalent health conditions or risk factors for health outcomes at a finer geographic level. EHRs therefore, may have potential to supplement traditional sources of public health surveillance data. |
Particulate matter air pollution exposure and heart disease mortality risks by race and ethnicity in the United States: 1997-2009 NHIS with mortality followup through 2011
Parker JD , Kravets N , Vaidyanathan A . Circulation 2017 137 (16) 1688-1697 Background -Most U.S. studies of mortality and air pollution have been conducted on largely non-Hispanic white study populations. However, many health and mortality outcomes differ by race and ethnicity, and non-Hispanic white persons experience lower air pollution exposures than those who are non-Hispanic black or Hispanic. This study examines whether associations between air pollution and heart disease mortality differ by race/ethnicity. Methods -We used data from the 1997-2009 National Health Interview Survey linked to mortality records through December 2011 and annual estimates of fine particulate matter (PM2.5) by Census tract. Proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) between PM2.5 (per 10 mug/m(3)) and heart disease mortality using the full sample and the sample adults, which have information on additional health variables. Interaction terms were used to examine differences in the PM2.5-mortality association by race/ethnicity. Results -Overall, 65,936 of the full sample died during follow-up and 22,152 died from heart disease. After adjustment for several factors, we found a significant positive association between PM2.5 and heart disease mortality (HR 1.16 95% CI 1.08-1.25). This association was similar in sample adults with adjustment for smoking and body mass index (HR 1.18 95% CI 1.06-1.31). Interaction terms for non-Hispanic black and Hispanic groups compared to the non-Hispanic white group were not statistically significant. Conclusions -Using a nationally representative sample, the association between PM2.5 and heart disease mortality was elevated and similar to previous estimates. Associations for non-Hispanic black and Hispanic adults were not statistically significantly different from that for non-Hispanic white adults. |
Developing an online tool for identifying at-risk populations to wildfire smoke hazards
Vaidyanathan A , Yip F , Garbe P . Sci Total Environ 2017 619-620 376-383 Wildfire episodes pose a significant public health threat in the United States. Adverse health impacts associated with wildfires occur near the burn area as well as in places far downwind due to wildfire smoke exposures. Health effects associated with exposure to particulate matter arising from wildfires can range from mild eye and respiratory tract irritation to more serious outcomes such as asthma exacerbation, bronchitis, and decreased lung function. Real-time operational forecasts of wildfire smoke concentrations are available but they are not readily integrated with information on vulnerable populations necessary to identify at-risk communities during wildfire smoke episodes. Efforts are currently underway at the Centers for Disease Control and Prevention (CDC) to develop an online tool that utilizes short-term predictions and forecasts of smoke concentrations and integrates them with measures of population-level vulnerability for identifying at-risk populations to wildfire smoke hazards. The tool will be operationalized on a national scale, seeking input and assistance from several academic, federal, state, local, Tribal, and Territorial partners. The final product will then be incorporated into CDC's National Environmental Public Health Tracking Network (http://ephtracking.cdc.gov), providing users with access to a suite of mapping and display functionalities. A real-time vulnerability assessment tool incorporating standardized health and exposure datasets, and prevention guidelines related to wildfire smoke hazards is currently unavailable for public health practitioners and emergency responders. This tool could strengthen existing situational awareness competencies, and expedite future response and recovery efforts during wildfire episodes. |
Comparison of wildfire smoke estimation methods and associations with cardiopulmonary-related hospital admissions
Gan RW , Ford B , Lassman W , Pfister G , Vaidyanathan A , Fischer E , Volckens J , Pierce JR , Magzamen S . Geohealth 2017 1 (3) 122-136 Climate forecasts predict an increase in frequency and intensity of wildfires. Associations between health outcomes and population exposure to smoke from Washington 2012 wildfires were compared using surface monitors, chemical-weather models, and a novel method blending three exposure information sources. The association between smoke particulate matter ≤2.5 mum in diameter (PM2.5) and cardiopulmonary hospital admissions occurring in Washington from 1 July to 31 October 2012 was evaluated using a time-stratified case-crossover design. Hospital admissions aggregated by ZIP code were linked with population-weighted daily average concentrations of smoke PM2.5 estimated using three distinct methods: a simulation with the Weather Research and Forecasting with Chemistry (WRF-Chem) model, a kriged interpolation of PM2.5 measurements from surface monitors, and a geographically weighted ridge regression (GWR) that blended inputs from WRF-Chem, satellite observations of aerosol optical depth, and kriged PM2.5. A 10 mug/m3 increase in GWR smoke PM2.5 was associated with an 8% increased risk in asthma-related hospital admissions (odds ratio (OR): 1.076, 95% confidence interval (CI): 1.019-1.136); other smoke estimation methods yielded similar results. However, point estimates for chronic obstructive pulmonary disease (COPD) differed by smoke PM2.5 exposure method: a 10 mug/m3 increase using GWR was significantly associated with increased risk of COPD (OR: 1.084, 95%CI: 1.026-1.145) and not significant using WRF-Chem (OR: 0.986, 95%CI: 0.931-1.045). The magnitude (OR) and uncertainty (95%CI) of associations between smoke PM2.5 and hospital admissions were dependent on estimation method used and outcome evaluated. Choice of smoke exposure estimation method used can impact the overall conclusion of the study. |
A statistical framework to evaluate extreme weather definitions from a health perspective: A demonstration based on extreme heat events
Vaidyanathan A , Kegler SR , Saha SS , Mulholland JA . Bull Am Meteorol Soc 2016 97 (10) 1817-1830 A statistical framework for evaluating definitions of extreme weather phenomena can help weather agencies and health departments identify the definition(s) most applicable for alerts and other preparedness operations related to extreme weather episodes. |
Outdoor PM2.5, ambient air temperature, and asthma symptoms in the past 14 days among adults with active asthma
Mirabelli MC , Vaidyanathan A , Flanders WD , Qin X , Garbe P . Environ Health Perspect 2016 124 (12) 1882-1890 BACKGROUND: Relationships between air quality and health are well-described, but little information is available about the joint associations between particulate air pollution, ambient temperature, and respiratory morbidity. OBJECTIVES: To evaluate associations between concentrations of particulate matter ≤2.5 microns in diameter (PM2.5) and exacerbation of existing asthma and modification of the associations by ambient air temperature. METHODS: Data from 50,356 adult 2006-2010 Asthma Call-back Survey respondents were linked by interview date and county of residence to estimates of daily averages of PM2.5 and maximum air temperature. Associations between 14-day average PM2.5 and the presence of any asthma symptoms during the 14 days leading up to and including the interview date were evaluated using binomial regression. We explored variation by air temperature using similar models, stratified into quintiles of the 14-day average maximum temperature. RESULTS: Among adults with active asthma, 57.1% reported asthma symptoms within the past 14 days and 14-day average PM2.5 ≥7.07 microg.m-3 was associated with an estimated 4 to 5% higher asthma symptom prevalence. In the range of 4.00 to 7.06 microg.m-3 of PM2.5, each microg.m-3 increase was associated with a 3.4% (95% confidence interval: 1.1, 5.7) increase in symptom prevalence; across categories of temperature from 1.1 to 80.5 degrees F, each microg.m-3 increase was associated with increased symptom prevalence (1.1-44.4 degrees F: 7.9%; 44.5-58.6 degrees F: 6.9%; 58.7-70.1 degrees F: 2.9%; 70.2-80.5 degrees F: 7.3%). CONCLUSIONS: These results suggest that each unit increase in PM2.5 may be associated with an increase in the prevalence of asthma symptoms, even at levels as low as 4.00 to 7.06 microg.m-3. |
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