Data Integration Methods for Environmental Exposures with Applications to Air Pollution and Asthma Morbidity

环境暴露数据集成方法及其在空气污染和哮喘发病率中的应用

• 批准号: 10288264
• 负责人: Howard H Chang
• 金额: $ 15.13万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-28 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10288264
• 关键词: Accident and Emergency department; Acute; Adult; Age; Air; Air Pollutants; Air Pollution; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Arizona; Asthma; Biometry; California; Cardiovascular Diseases; Cardiovascular system; Caregivers; Caring; Cause of Death; Cessation of life; Chronic Disease; Chronic Kidney Failure; Cities; Code; Communities; Data; Data Set; Databases; Dementia; Diabetes Mellitus; Diagnosis; Disease Outcome; Economic Burden; Economics; Elderly; Emergency department visit; Environmental Epidemiology; Environmental Exposure; Environmental Impact; Environmental Risk Factor; Epidemiology; Event; Exposure to; Future; Geographic Locations; Geographic state; Goals; Health; Healthcare Systems; Heat Waves; High Prevalence; Hospitalization; Imagery; Impairment; Individual; Kidney; Maryland; Measurement; Measures; Medicare; Medicare/Medicaid; Meteorology; Methods; Modification; Monitor; Morbidity - disease rate; National Institute of Environmental Health Sciences; Nevada; New Jersey; New York; Nitrogen Dioxide; North Carolina; Outcome; Ozone; Patients; Pilot Projects; Pollution; Polypharmacy; Population; Presenile Alzheimer Dementia; Prevalence; Prevention strategy; Public Health; Records; Reporting; Research; Resource Allocation; Risk; Risk Assessment; Risk Factors; Services; Symptoms; System; Temperature; Time Series Analysis; Uncertainty; Utah; Variant; Weather; Wildfire; Work; acute care; age group; ambient air pollution; behavioral impairment; behavioral response; built environment; comorbidity; coping; data integration; data streams; economic evaluation; epidemiology study; extreme heat; extreme weather; fine particles; health care service utilization; health warning; high risk; improved; models and simulation; modifiable risk; multiple chronic conditions; parent project; patient population; payment; resource guides; respiratory; response; secondary analysis; social

ABSTRACT Dementia is a major public health issue with substantial societal and economic burdens. Alzheimer's disease (AD) contributes to about two-thirds of dementia cases and is the sixth leading cause of death in the US. A small but growing number of studies have reported increased risks of hospitalizations among AD and Alzheimer's- related dementias (ADRD) patients following days with high ambient air pollution and high ambient temperature. AD/ADRD patients may be more vulnerable to acute environmental insults because of multimorbidity and polypharmacy, poorer management of chronic diseases, and impaired behavioral responses to reduce exposure. Given the projected increase in AD/ADRD prevalence, there is a pressing need to support patients and their caregivers by identifying modifiable risk factors, such as environmental exposures, that may reduce morbidity and improve care. The overarching aim of this 1-year pilot project is to examine associations between short- term environmental exposures and emergency department (ED) visits for AD/ADRD. We will leverage a unique patient-level database compiled under the parent project (R01ES027892), originally for examining air pollution exposure and asthma morbidity. The dataset includes over 330 million ED visit records from 10 US states, covering 33% of the US population. We will expand the parent's project's analyses by conducting multi- city time-series analyses to estimate associations between daily AD/ADRD ED visits and short-term (up to 7 days) environmental exposures, including fine particulate matter pollution, nitrogen dioxide, ozone, and temperature (daily minimum and maximum). We will first identify AD/ADRD ED visits using diagnosis codes, and then using patient residential ZIP code, we will assign exposure estimates with state-of-the-art air quality and meteorology products derived from the integration of monitoring measurements, satellite imagery, and numerical model simulations. Stratified analyses will be conducted by age group, by whether the AD/ADRD ED visit led to hospitalization, and by geographical region. In secondary analyses, we will also conduct analyses with ED visits of broad disease outcome groups (cardiovascular, respiratory, kidney-related, diabetes) to examine whether environmental exposure-related risks are higher among patients with an AD/ADRD diagnosis. Because our ED visit database includes all ages, we will also capture patients with early-onset AD or mild dementia without prior diagnosis by clinicians. To our knowledge, the proposed multi-city ED visit analyses will be the largest study to examine short-term associations between air pollution, temperature, and AD/ADRD ED visits in the US. Past findings on hospitalizations, which represent severe cases, do not fully quantify impacts of AD/ADRD morbidity burden on healthcare systems. Finally, results from our 1-year project can provide support for future studies to consider additional environmental exposures (e.g. other air pollutants, the built environment, and extreme weather events). Additional epidemiology studies may also examine effect modification by individual-level and community-level factors that may confer enhanced vulnerability among AD/ADRD patients.

摘要 痴呆症是一个重大的公共卫生问题，具有巨大的社会和经济负担。阿尔茨海默病 (AD)导致大约三分之二的痴呆症病例，是美国第六大死亡原因。一个小 但越来越多的研究报告称，AD和阿尔茨海默病患者住院的风险增加， 在高环境空气污染和高环境温度的日子后，与ADRD相关的痴呆（ADRD）患者。 AD/ADRD患者可能更容易受到急性环境损伤，因为多morphine， 多种药物，慢性病管理不善，以及减少暴露的行为反应受损。 考虑到AD/ADRD患病率的预计增加，迫切需要支持患者及其治疗。 通过确定可改变的风险因素，如环境暴露，可以降低发病率， 改善护理。这个为期一年的试点项目的总体目标是检查短期之间的关联， 长期环境暴露和AD/ADRD急诊（艾德）访视。我们将利用 在父项目（R 01 ES 027892）下编制的唯一患者级数据库，最初用于检查空气 污染暴露和哮喘发病率。该数据集包括来自10个美国的超过3.3亿艾德就诊记录 覆盖美国人口的33%。我们将通过进行多方面的分析来扩展母公司项目的分析， 城市时间序列分析，以估计每日AD/ADRD艾德访视与短期（最多7 天）的环境暴露，包括细颗粒物污染、二氧化氮、臭氧，以及 温度（每日最低和最高）。我们将首先使用诊断代码识别AD/ADRD艾德访视， 然后使用患者住宅的邮政编码，我们将根据最先进的空气质量分配暴露估计值 和气象产品从监测测量，卫星图像， 数值模拟将按年龄组、AD/ADRD艾德是否 按地理区域分列的住院率。在二次分析中，我们还将进行分析 广泛疾病结局组（心血管、呼吸、肾脏相关、糖尿病）的艾德访视， 检查诊断为AD/ADRD的患者与环境暴露相关的风险是否更高。 由于我们的艾德访视数据库包括所有年龄段，我们还将收集早发性AD或轻度AD患者， 没有临床医生事先诊断的痴呆症。据我们所知，拟议的多城市艾德访问分析将 是研究空气污染、温度和AD/ADRD艾德之间短期关联的最大研究 访问美国。过去关于住院的调查结果（代表严重病例）没有完全量化 AD/ADRD对医疗保健系统的发病率负担。最后，我们为期一年的项目结果可以提供支持 未来的研究考虑额外的环境暴露（例如其他空气污染物，建筑环境， 极端天气事件）。其他流行病学研究也可能会检查以下因素对效果的影响 个体水平和社区水平的因素，可能赋予增强的脆弱性AD/ADRD患者。

项目成果

A Multivariate Dynamic Spatial Factor Model for Speciated Pollutants and Adverse Birth Outcomes.

特定污染物和不良出生结果的多元动态空间因素模型。

• DOI: 10.3390/ijerph14091046
• 发表时间: 2017
• 期刊: International journal of environmental research and public health
• 作者: Kaufeld,KimberlyA;Fuentes,Montse;Reich,BrianJ;Herring,AmyH;Shaw,GaryM;Terres,MariaA
• 通讯作者: Terres,MariaA

A Bayesian framework for incorporating exposure uncertainty into health analyses with application to air pollution and stillbirth.

将暴露不确定性纳入健康分析并应用于空气污染和死产的贝叶斯框架。

• DOI: 10.1093/biostatistics/kxac034
• 发表时间: 2023
• 期刊: Biostatistics (Oxford, England)
• 作者: Comess,Saskia;Chang,HowardH;Warren,JoshuaL
• 通讯作者: Warren,JoshuaL

Spatial PM2.5 mobile source impacts using a calibrated indicator method.

使用校准指标方法进行空间 PM2.5 移动源影响。

• DOI: 10.1080/10962247.2018.1532468
• 发表时间: 2019
• 期刊: Journal of the Air & Waste Management Association (1995)
• 作者: Zhai,Xinxin;Mulholland,JamesA;Friberg,MarielD;Holmes,HeatherA;Russell,ArmisteadG;Hu,Yongtao
• 通讯作者: Hu,Yongtao

CRITICAL WINDOW VARIABLE SELECTION FOR MIXTURES: ESTIMATING THE IMPACT OF MULTIPLE AIR POLLUTANTS ON STILLBIRTH.

• DOI: 10.1214/21-aoas1560
• 发表时间: 2022-09
• 期刊: The annals of applied statistics

Impacts of gestational age uncertainty in estimating associations between preterm birth and ambient air pollution.

• DOI: 10.1097/ee9.0000000000000031
• 发表时间: 2018-12
• 期刊: Environmental epidemiology (Philadelphia, Pa.)
• 作者: Nealy BE;Warren JL;Strickland MJ;Darrow LA;Chang HH
• 通讯作者: Chang HH