Asthma Simulation Tool for Housing, Medication and Social Adversity (ASTHMA)

针对住房、药物和社会逆境的哮喘模拟工具 (ASTHMA)

• 批准号: 10203966
• 负责人: Maria Patricia Fabian
• 金额: $ 32万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10203966
• 关键词: Address; Affect; Air; Asthma; Behavior; Behavioral; Boston; Characteristics; Chemical Exposure; Child; Child health care; Childhood; Childhood Asthma; Chronic Disease; Clinical; Code; Communities; Complex; Crime; Data; Databases; Department of Energy; Dimensions; Disease; Drug Prescriptions; Electronic Health Record; Ensure; Environment; Environmental Exposure; Environmental Pollution; Evaluation; Event; Exposure to; Feedback; Health; Healthcare; Home; Hospitalization; Housing; Humidity; Income; Individual; Indoor Air Quality; Intervention; Link; Location; Low income; Measures; Medical; Medical center; Methodology; Methods; Modeling; Neighborhood Health Center; Neighborhoods; Nitrogen Dioxide; Outcome; Pathway interactions; Patients; Pattern; Pharmaceutical Preparations; Physical environment; Policies; Population; Populations at Risk; Psychosocial Stress; Public Health; Public Housing; Published Database; Publishing; Risk Factors; Science; Services; Social support; Statistical Models; Stress; Structure; System; Techniques; Temperature; Time; asthma exacerbation; asthmatic; base; behavioral response; community intervention; contextual factors; data resource; demographics; design; electronic data; environmental health disparity; ethnic minority population; fine particles; health care availability; health care disparity; health care service utilization; high risk; indoor pollutant; insight; intervention effect; medication compliance; minority children; model building; models and simulation; pollutant; programs; prototype; pulmonary function; racial and ethnic; repository; simulation; simulation software; social; social stressor; sociodemographics; socioeconomics; stressor; therapy design; tool; urban area; urban setting; ventilation; violence exposure

PROJECT SUMMARY / ABSTRACT Pediatric asthma has a substantial public health burden with numerous contributing risk factors in the physical, social, and health care environments. This burden is elevated among low-income minority children living in urban areas, related in part to multi-factorial residential exposures. There are numerous complex feedback loops among risk factors, with interventions potentially inducing behavioral responses that modify levels of other risk factors. Given these characteristics, pediatric asthma is an ideal candidate for systems science tools to prioritize among risk factors and design intervention strategies. However, there have been few applications of systems science techniques to asthma, and no applications to date that take account of multiple risk factors with housing, social and behavioral components. Discrete event simulation (DES), a systems science approach that involves modeling a complex system in which individuals can be tracked over time, multiple attributes can be incorporated simultaneously, and interactions and non-linear effects can be incorporated, is ideally suited for this application. This project (the Asthma Simulation Tool for Housing, Medication, and Social Adversity - ASTHMA) builds upon the only DES model of pediatric asthma or the physical environment, leveraging data from a longstanding electronic health record (EHR) database, and extensive neighborhood contextual data available from a BU center of environmental health disparities. Building on prior expertise and the strength of an established interdisciplinary team we propose the following specific aims: Aim 1: To build the Boston Children’s Healthcare Disparities Repository (BCHDR), a large database of predominantly low-income and racial/ethnic minority asthmatic children extracted from the BMC EHR, and use it to develop associations among key predictors of lung function, medication prescription and adherence, social adversity, asthma outcomes, and healthcare utilization. Aim 2: To predict exposure to indoor pollutants and environmental conditions across a range of housing types, resident behaviors, and sociodemographic characteristics, in a manner useful for DES modeling. Aim 3: To expand the existing DES model to capture the variability in housing, sociodemographic, and neighborhood environments for asthmatic children in the BCHDR, and evaluate the influence of implemented or proposed policies addressing housing conditions, medication adherence, and aspects of social adversity on asthma outcomes. These data and methods collectively allow us to develop unique insights about the individual and cumulative impacts of multiple stressors on asthma outcomes, as well as about how candidate interventions would influence asthma outcomes given the multiple pathways and complex behavioral responses. While we focus on data specific to Boston to ensure internal consistency, our methods and insights will generalize to other urban settings, our housing modeling approach can be expanded to any are in the US, and our discrete event simulation code and methodology for extracting and analyzing clinical and social risk factor data from an EHR could be adapted to other circumstances.

项目概要/摘要 小儿哮喘给公众健康带来了沉重的负担，身体、身体等方面有许多危险因素。 社会和医疗保健环境。居住在城市的低收入少数民族儿童的这一负担更为严重 地区，部分与多因素住宅暴露有关。有许多复杂的反馈循环 在风险因素中，干预措施可能会引发改变其他风险水平的行为反应 因素。鉴于这些特征，小儿哮喘是系统科学工具优先考虑的理想候选者 风险因素之间的关系并设计干预策略。但该系统的应用还很少 哮喘的科学技术，迄今为止还没有考虑到住房等多种危险因素的应用程序， 社会和行为成分。离散事件模拟 (DES)，一种系统科学方法，涉及 建模一个复杂的系统，其中可以随着时间的推移跟踪个人，可以使用多个属性 同时合并，并且可以合并相互作用和非线性效应，非常适合这种情况 应用。该项目（住房、药物和社会逆境的哮喘模拟工具 - ASTHMA） 建立在儿科哮喘或物理环境的唯一 DES 模型之上，利用来自 长期的电子健康记录 (EHR) 数据库和大量可用的社区背景数据 来自 BU 环境健康差异中心。以先前的专业知识和实力为基础 建立跨学科团队后，我们提出以下具体目标： 目标 1：建立波士顿儿童医院 医疗保健差异存储库 (BCHDR)，一个主要包含低收入和种族/民族的大型数据库 从 BMC EHR 中提取少数哮喘儿童，并用它来建立关键儿童之间的关联 肺功能、药物处方和依从性、社会逆境、哮喘结果的预测因素， 医疗保健利用。目标 2：预测整个范围内的室内污染物暴露和环境条件 以对 DES 有用的方式了解一系列住房类型、居民行为和社会人口特征 造型。目标 3：扩展现有的 DES 模型，以捕捉住房、社会人口统计和 BCHDR 中哮喘儿童的邻里环境，并评估实施或实施的影响 拟议的政策涉及住房条件、药物依从性和社会逆境的各个方面 哮喘结果。这些数据和方法共同使我们能够对个人形成独特的见解 多种压力源对哮喘结果的累积影响，以及候选干预措施的方式 鉴于多种途径和复杂的行为反应，会影响哮喘的结果。当我们 专注于波士顿特定的数据以确保内部一致性，我们的方法和见解将推广到其他地区 城市环境中，我们的住房建模方法可以扩展到美国的任何地区，并且我们的离散事件 用于从 EHR 中提取和分析临床和社会风险因素数据的模拟代码和方法 可以适应其他情况。

项目成果

Spatial resolution of Normalized Difference Vegetation Index and greenness exposure misclassification in an urban cohort

• DOI: 10.1038/s41370-022-00409-w
• 发表时间: 2022-01-29
• 期刊: JOURNAL OF EXPOSURE SCIENCE AND ENVIRONMENTAL EPIDEMIOLOGY
• 影响因子: 4.5
• 作者: Jimenez, Raquel B.;Lane, Kevin J.;Fabian, M. Patricia
• 通讯作者: Fabian, M. Patricia

Sensitivity of modeled residential fine particulate matter exposure to select building and source characteristics: A case study using public data in Boston, MA.

• DOI: 10.1016/j.scitotenv.2022.156625
• 发表时间: 2022-09-20
• 期刊: SCIENCE OF THE TOTAL ENVIRONMENT
• 影响因子: 9.8
• 作者: Milando, Chad W.;Carnes, Fei;Vermeer, Kimberly;Levy, Jonathan I.;Fabian, M. Patricia
• 通讯作者: Fabian, M. Patricia

The impact of energy retrofits on pediatric asthma exacerbation in a Boston multi-family housing complex: a systems science approach.

• DOI: 10.1186/s12940-021-00699-x
• 发表时间: 2021-02-14
• 期刊: Environmental health : a global access science source
• 作者: Tieskens KF;Milando CW;Underhill LJ;Vermeer K;Levy JI;Fabian MP
• 通讯作者: Fabian MP