Methods: 5055 legitimate ER records of primary respiratory conditions were abstracted for the yea... more Methods: 5055 legitimate ER records of primary respiratory conditions were abstracted for the year 2000. For each case the following information was recorded: name, date of birth, sex, address, admission date, temperature, weight, respiratory rate, and diagnosis. After ...
In the US, over 300,000 cases of Clostridium difficile associated-diarrhea (CDAD) occur annually ... more In the US, over 300,000 cases of Clostridium difficile associated-diarrhea (CDAD) occur annually in hospitals or long-term care facilities and incidence has risen over the past two decades. Though CDAD is considered to be a hospital acquired disease, there is some evidence of environmental and zoonotic associations with bacteria spores observed in calves and the disease itself presenting in various animals. We have demonstrated a clear seasonal pattern which also indicates a strong environmental influence. CDAD seasonality may be driven by seasonal patterns in livestock production or manure waste management. All 1,054,125 hospitalization records for the US elderly with C. difficile were abstracted from the Centers for Medicare and Medicaid Services (CMS) database for a 14-year period (1991-2004). Livestock production data for 2002 was extracted from the Census of Agriculture collected by the U.S. Department of Agriculture. Data was aggregated on a county basis and disease rates were...
In the US, over 300,000 cases of Clostridium difficile associated diarrhea occur annually in hosp... more In the US, over 300,000 cases of Clostridium difficile associated diarrhea occur annually in hospitals or long-term care facilities and incidence has risen over the past two decades. Though C. difficle is considered to be a hospital acquired disease, we have demonstrated a clear seasonal pattern which may indicate a strong environmental influence. C. difficle seasonality can also be driven by co-morbid conditions or infections with well defined seasonal patterns. All 1,054,125 hospitalization records for the US elderly with C. difficile were abstracted from the Centers for Medicare and Medicaid Services (CMS) database for a 14-year period (1991-2004). The most common co-morbid conditions, identified using the Elixhauser categorization scheme, were fluid and electrolyte disorders (429,152 cases, 40.7%) and hypertension (349,522 cases, 33.2%). Seasonality was assessed for the subset of cases with electrolyte disorders and hypertension, both of the co-morbid peaks were closely aligned ...
Epidemiologic analysis of waterborne diseases typically considers socio-economic, demographic, an... more Epidemiologic analysis of waterborne diseases typically considers socio-economic, demographic, and pathogen-specific characteristics. However, hydrological parameters may need to be considered as well. Increases in waterborne diseases have been associated with water quality parameters such as turbidity and river flow. Each watershed has unique characteristics, such as streamflow, which may affect the rates of waterborne diseases in populations residing within the watershed. We hypothesized that watershed attributes predict the rates of waterborne disease in these populations. This preliminary analysis explores seasonal patterns of waterborne diseases along the Mississippi River and Ohio River watersheds in the U.S. We considered diagnoses of various gastrointestinal infections using elderly hospitalization records from the Center for Medicare and Medicaid Services (CMS) from 1991 to 2004. Cases were aggregated according to diagnosis code, location, and date of admission. We assessed...
In the US, over 300,000 cases of Clostridium difficile associated diarrhea occur annually in hosp... more In the US, over 300,000 cases of Clostridium difficile associated diarrhea occur annually in hospitals or long-term care facilities and incidence has risen over the past two decades due to increased antibiotic use. It is plausible that C. difficile hospitalizations exhibit temporal patterns similar to seasonality of dominant pathogens for which antibiotics are prescribed. We hypothesize that the presence of pathogens and their pathogenicity are driven by environmental factors and therefore demonstrate seasonal patterns. All 448,914 hospitalization records for the US elderly for C. difficile were abstracted from the Centers for Medicare and Medicaid Services (CMS) MedPAR database for a 5-year period (1998-2002). Hospitalization rates due to C. difficile were increasing: 21.6, 22.8, 23.4, 26.6, and 32.3 per 10,000 elderly per year (p<0.05). Of all cases 10,256 (2.3%) exhibited co-morbid antibiotic resistance. The overall number of antibiotic co-morbid cases increased and the percen...
Individuals experience simultaneous exposure to pollutants and social factors, which cluster to a... more Individuals experience simultaneous exposure to pollutants and social factors, which cluster to affect human health outcomes. The optimal approach to combining these factors is unknown, therefore we developed a method to model simultaneous exposure using criteria air pollutants, hazardous air pollutants, and selected socio-demographic measures. Principle components analysis (PCA) was used to create an environmental quality index for all counties in the United States. The air domain was represented with data from the National Emissions Inventory and the National Air Toxics Assessment and the socio-demographic domain with Census 2000 data of percent population in poverty and time spent commuting. In PCA index construction, 35 variables were included for 2308 counties with complete data. Because exposures vary by urbanicity, counties were stratified by percentage of population living in urban areas (urban: greater than or equal to 50%); urban and rural indices were calculated. Overall,...
The Clean Water Act was established to restore and maintain the chemical, physical, and biologica... more The Clean Water Act was established to restore and maintain the chemical, physical, and biological integrity of the Nation's waters. Under this act, the U.S. Environmental Protection Agency (EPA) collects information from states on intended use and impairment of each stream. We hypothesized that counties with waters impaired for drinking and recreational uses have higher rates of gastrointestinal infections (GI). We obtained impairment data and merged it with stream hydrology information from the National Hydrography Dataset Plus and EPA's Reach Attribute Database to estimate the percent of impaired stream length intended for drinking and recreational water per county in the U.S. Limited data are available for drinking and recreational water impairment with only 13 and 27 states providing data, respectively. GI related hospitalization records (ICD-9CM 558.9, 787) were abstracted from the Center for Medicare and Medicaid Services (1991-2004), the only comprehensive national h...
Environmental exposures range across multiple domains to affect human health. In an effort to lea... more Environmental exposures range across multiple domains to affect human health. In an effort to learn how environmental factors combine to contribute to health outcomes we constructed a multiple environmental domain index (MEDI) for use in health research. We used principal components analysis to construct the MEDI with county-level data representing five environmental domains (air, water, land, built and sociodemographic). Using five years of North Carolina birth records data (2000-2005; n=628,010 records), fixed slope, random intercept multilevel logistic and linear models assessed the relationship between the county-level environment (n=100 counties) and preterm and very preterm birth (PTB, VPTB); low and very low birthweight (LBW, VLBW); small for gestational age (SGA); BW percent (%) for gestational age and pregnancy-induced hypertension (PIH). Outcomes were constructed using standard definitions. In models adjusted for maternal age, education, marital status and infant sex, resi...
Assessing exposure to environmental insults and human health outcomes is complex. Environmental e... more Assessing exposure to environmental insults and human health outcomes is complex. Environmental exposures tend to cluster spatially, with disamenities (e.g., landfills, industrial plants) often located in high-minority and largely poor neighborhoods, while wealthier neighborhoods contain amenities that promote and maintain good health (e.g., parks, health clubs, well-stocked stores). The spatial dependence of environmental conditions is inadequately estimated with single pollutant models. To address this limitation, an environmental quality index (EQI) is under development for all counties in the United States. Four main domains were identified that contribute to environmental quality: air, water, land, and built /social environment. An inventory of possible data sources for each of the four domains was created; data sources were identified using web-based search engines (e.g., google), site-specific search engines (e.g., Federal and State data sites), literature-reported data sourc...
The relationship between environmental conditions and human health varies by environmental media.... more The relationship between environmental conditions and human health varies by environmental media. In order to account for multiple ambient environmental conditions, we constructed an Environmental Quality Index (EQI) for health research. We used county-level data for the United States representing five environmental domains (air, water, land, built and sociodemographic) and principal components analysis to construct the EQI and domain specific indices for each county (n=3141). Infant mortality (IM) data was taken from U.S. linked births/infant deaths data for 2002 (4,027,479 birth records; 27,527 infant deaths). We used fixed slope, random intercept multilevel logistic models, adjusted for maternal age, education, marital status, and infant sex, to assess relationships between county-level environmental quality and domain specific indices with IM. Residence in a county with poor environmental quality (4th quartile) compared to the best quality (1st quartile) was not associated with ...
Combined sewer overflows (CSOs) occur in combined sewer systems when sewage and stormwater runoff... more Combined sewer overflows (CSOs) occur in combined sewer systems when sewage and stormwater runoff are released into water bodies potentially contaminating water sources. CSOs are often caused by heavy precipitation and are expected to increase with increasing extreme precipitation associated with climate change. To assess whether the association between heavy rainfall and rate of emergency room (ER) visits for gastrointestinal (GI) illness differed by the presence of CSOs. For the study period 2003 - 2007, time-series of daily rate of ER visits for GI illness and meteorological data were organized for three exposure regions: 1) CSOs impacting drinking water sources; 2) CSOs impacting recreational waters; 3) no CSOs. A distributed lag Poisson regression assessed cumulative effects for an 8-day lag period following heavy (≥90th and ≥95th percentile) and extreme (≥99th percentile) precipitation events, controlling for temperature and long term time trends. The association between extreme rainfall and rate of ER visits for GI illness differed among regions. Only the region with drinking waters exposed to CSOs demonstrated a significant increased cumulative risk for rate of ER visits for GI for all ages in the 8-day period following extreme rainfall, CRR: 1.13 (95% CI: 1.00, 1.28) compared to no rainfall. Rate of ER visits for GI illness was associated with extreme precipitation in the area with CSO discharges to a drinking water source. Our findings suggest an increased risk for gastrointestinal illness among consumers whose drinking water source may be impacted by CSOs after extreme precipitation.
BackgroundTrends in gastroenteritis-associated mortality are changing over time with development ... more BackgroundTrends in gastroenteritis-associated mortality are changing over time with development of antibiotic resistant strains of certain pathogens, improved diagnostic methods, and changing healthcare. In 1999, ICD-10 coding was introduced for mortality records which can also affect trends. We assess trends in gastroenteritis-associated mortality and changes associated with coding.MethodsTrends in gastroenteritis-associated mortality rates in the United States were examined using the National Center for Health Statistics Multiple Cause-of-Death Mortality databases for 1985¿2005. All deaths with the underlying cause or any contributing cause included gastroenteritis were included. Cases were selected based on ICD9 (pre-1999) and ICD10 (1999¿2005) codes and all analyses were stratified by ICD usage. Annual trends in age adjusted mortality rates were assessed using linear regression spline analysis. Relative risks and 95% confidence intervals (CIs) were calculated using Poisson regr...
ABSTRACT Combined sewer systems collect rainwater runoff, sewage, and industrial wastewater for t... more ABSTRACT Combined sewer systems collect rainwater runoff, sewage, and industrial wastewater for transit to treatment facilities. With heavy precipitation, volumes can exceed capacity of treatment facilities, and wastewater discharges directly to receiving waters. These combined sewer overflows (CSOs) are a source of episodic pollution for downstream water users. We evaluate associations between heavy precipitation and emergency room (ER) visits for gastrointestinal illness (GI) in areas with and without exposure to CSOs in Massachusetts (MA) using a distributed lag model. We considered three regions for analysis: two exposed regions (with recreational and drinking water exposure) and one unexposed region. ER visits, obtained from the MA Department of Healthcare Finance, during 2003–2007 for GI diagnoses (ICD9-CM 001-009, 558.9, 787.0, 787.01, 787.03, 787.4, 787.9, 787.91) were aggregated by region of residence and date of admission to create a time series for each region. Precipitation and temperature was abstracted from National Climatic Data Center for regions and heavy precipitation events defined (daily precipitation ≥ 99th percentile). We assessed associations between ER visits and heavy precipitation events using a distributed lag poisson regression model, with an 8 day lag, adjusting for temperature and a natural spline for time to control for unmeasured covariates. In the drinking water exposed region, heavy precipitation events were associated with an increased cumulative relative risk for ER visits over the 8 days following an event (RR: 1.15 (95% CI: 1.02, 1.30)). Associations in the recreational water exposed region and unexposed region were generally null. Analysis was also conducted by age group and associations varied by age. With the expected increase in variability of rainfall due to climate change and aging infrastructure in parts of the U.S. it is important to understand the impact of heavy precipitation on human health. This abstract does not necessarily reflect EPA policy.
ABSTRACT The relationship between environmental conditions and human health varies by urbanicity.... more ABSTRACT The relationship between environmental conditions and human health varies by urbanicity. To estimate ambient environmental conditions, an Environmental Quality Index (EQI) for 2000-2005 was constructed by the Environmental Protection Agency using county-level data representing five environmental domains (air, water, land, built and sociodemographic) for each U.S. county (n=3141). Annual county-level, age-adjusted, cancer incidence rate data for 2006-2010 from Surveillance, Epidemiology, and End Results Program (SEER) was modeled with EQI quintiles. A random intercept multi-level linear regression clustered by state estimated fixed effects of EQI quintiles on all-site cancer incidence by sex, adjusted for percentage of population ever smoked (both sexes), and percentage to have had a mammogram and a pap smear (females). Results are reported as incidence rate difference (IRD) (95% confidence interval) comparing highest quintile/worst environmental quality to lowest/best environmental quality. All cause cancer was strongly positively associated with EQI in both sexes (males: 32.60 (16.28, 48.91), females: 30.34 (20.47, 40.21)). Models were also stratified by four rural-urban continuum codes (RUCC) ranging from metropolitan urbanized (RUCC1) to rural (RUCC4). We observed positive associations between all cause cancer and EQI for most strata for males (RUCC1: 27.01 (11.29, 42.74); RUCC2: 11.29 (-18.10, 40.67), RUCC3: 25.66 (3.85, 47.47), RUCC4: -12.12 (-50.65, 26.42)) and across all strata for females (RUCC1: 21.76 (8.26, 35.26); RUCC2: 2.34 (1.62, 3.06), RUCC3: 1.77 (1.19, 2.35), RUCC4: 2.06 (0.93, 3.19)). The strength of association varied by urbanization with the strongest observed in the most urbanized areas for both sexes. In addition, we assessed associations with the top three causes of cancer for both sexes. Cancer incidence is associated with ambient environmental quality and the strength of association varies by level of urbanization, which has implications for public health programs intervention planning in more or less urban areas. This abstract does not necessarily reflect EPA policy.
Methods: 5055 legitimate ER records of primary respiratory conditions were abstracted for the yea... more Methods: 5055 legitimate ER records of primary respiratory conditions were abstracted for the year 2000. For each case the following information was recorded: name, date of birth, sex, address, admission date, temperature, weight, respiratory rate, and diagnosis. After ...
In the US, over 300,000 cases of Clostridium difficile associated-diarrhea (CDAD) occur annually ... more In the US, over 300,000 cases of Clostridium difficile associated-diarrhea (CDAD) occur annually in hospitals or long-term care facilities and incidence has risen over the past two decades. Though CDAD is considered to be a hospital acquired disease, there is some evidence of environmental and zoonotic associations with bacteria spores observed in calves and the disease itself presenting in various animals. We have demonstrated a clear seasonal pattern which also indicates a strong environmental influence. CDAD seasonality may be driven by seasonal patterns in livestock production or manure waste management. All 1,054,125 hospitalization records for the US elderly with C. difficile were abstracted from the Centers for Medicare and Medicaid Services (CMS) database for a 14-year period (1991-2004). Livestock production data for 2002 was extracted from the Census of Agriculture collected by the U.S. Department of Agriculture. Data was aggregated on a county basis and disease rates were...
In the US, over 300,000 cases of Clostridium difficile associated diarrhea occur annually in hosp... more In the US, over 300,000 cases of Clostridium difficile associated diarrhea occur annually in hospitals or long-term care facilities and incidence has risen over the past two decades. Though C. difficle is considered to be a hospital acquired disease, we have demonstrated a clear seasonal pattern which may indicate a strong environmental influence. C. difficle seasonality can also be driven by co-morbid conditions or infections with well defined seasonal patterns. All 1,054,125 hospitalization records for the US elderly with C. difficile were abstracted from the Centers for Medicare and Medicaid Services (CMS) database for a 14-year period (1991-2004). The most common co-morbid conditions, identified using the Elixhauser categorization scheme, were fluid and electrolyte disorders (429,152 cases, 40.7%) and hypertension (349,522 cases, 33.2%). Seasonality was assessed for the subset of cases with electrolyte disorders and hypertension, both of the co-morbid peaks were closely aligned ...
Epidemiologic analysis of waterborne diseases typically considers socio-economic, demographic, an... more Epidemiologic analysis of waterborne diseases typically considers socio-economic, demographic, and pathogen-specific characteristics. However, hydrological parameters may need to be considered as well. Increases in waterborne diseases have been associated with water quality parameters such as turbidity and river flow. Each watershed has unique characteristics, such as streamflow, which may affect the rates of waterborne diseases in populations residing within the watershed. We hypothesized that watershed attributes predict the rates of waterborne disease in these populations. This preliminary analysis explores seasonal patterns of waterborne diseases along the Mississippi River and Ohio River watersheds in the U.S. We considered diagnoses of various gastrointestinal infections using elderly hospitalization records from the Center for Medicare and Medicaid Services (CMS) from 1991 to 2004. Cases were aggregated according to diagnosis code, location, and date of admission. We assessed...
In the US, over 300,000 cases of Clostridium difficile associated diarrhea occur annually in hosp... more In the US, over 300,000 cases of Clostridium difficile associated diarrhea occur annually in hospitals or long-term care facilities and incidence has risen over the past two decades due to increased antibiotic use. It is plausible that C. difficile hospitalizations exhibit temporal patterns similar to seasonality of dominant pathogens for which antibiotics are prescribed. We hypothesize that the presence of pathogens and their pathogenicity are driven by environmental factors and therefore demonstrate seasonal patterns. All 448,914 hospitalization records for the US elderly for C. difficile were abstracted from the Centers for Medicare and Medicaid Services (CMS) MedPAR database for a 5-year period (1998-2002). Hospitalization rates due to C. difficile were increasing: 21.6, 22.8, 23.4, 26.6, and 32.3 per 10,000 elderly per year (p<0.05). Of all cases 10,256 (2.3%) exhibited co-morbid antibiotic resistance. The overall number of antibiotic co-morbid cases increased and the percen...
Individuals experience simultaneous exposure to pollutants and social factors, which cluster to a... more Individuals experience simultaneous exposure to pollutants and social factors, which cluster to affect human health outcomes. The optimal approach to combining these factors is unknown, therefore we developed a method to model simultaneous exposure using criteria air pollutants, hazardous air pollutants, and selected socio-demographic measures. Principle components analysis (PCA) was used to create an environmental quality index for all counties in the United States. The air domain was represented with data from the National Emissions Inventory and the National Air Toxics Assessment and the socio-demographic domain with Census 2000 data of percent population in poverty and time spent commuting. In PCA index construction, 35 variables were included for 2308 counties with complete data. Because exposures vary by urbanicity, counties were stratified by percentage of population living in urban areas (urban: greater than or equal to 50%); urban and rural indices were calculated. Overall,...
The Clean Water Act was established to restore and maintain the chemical, physical, and biologica... more The Clean Water Act was established to restore and maintain the chemical, physical, and biological integrity of the Nation's waters. Under this act, the U.S. Environmental Protection Agency (EPA) collects information from states on intended use and impairment of each stream. We hypothesized that counties with waters impaired for drinking and recreational uses have higher rates of gastrointestinal infections (GI). We obtained impairment data and merged it with stream hydrology information from the National Hydrography Dataset Plus and EPA's Reach Attribute Database to estimate the percent of impaired stream length intended for drinking and recreational water per county in the U.S. Limited data are available for drinking and recreational water impairment with only 13 and 27 states providing data, respectively. GI related hospitalization records (ICD-9CM 558.9, 787) were abstracted from the Center for Medicare and Medicaid Services (1991-2004), the only comprehensive national h...
Environmental exposures range across multiple domains to affect human health. In an effort to lea... more Environmental exposures range across multiple domains to affect human health. In an effort to learn how environmental factors combine to contribute to health outcomes we constructed a multiple environmental domain index (MEDI) for use in health research. We used principal components analysis to construct the MEDI with county-level data representing five environmental domains (air, water, land, built and sociodemographic). Using five years of North Carolina birth records data (2000-2005; n=628,010 records), fixed slope, random intercept multilevel logistic and linear models assessed the relationship between the county-level environment (n=100 counties) and preterm and very preterm birth (PTB, VPTB); low and very low birthweight (LBW, VLBW); small for gestational age (SGA); BW percent (%) for gestational age and pregnancy-induced hypertension (PIH). Outcomes were constructed using standard definitions. In models adjusted for maternal age, education, marital status and infant sex, resi...
Assessing exposure to environmental insults and human health outcomes is complex. Environmental e... more Assessing exposure to environmental insults and human health outcomes is complex. Environmental exposures tend to cluster spatially, with disamenities (e.g., landfills, industrial plants) often located in high-minority and largely poor neighborhoods, while wealthier neighborhoods contain amenities that promote and maintain good health (e.g., parks, health clubs, well-stocked stores). The spatial dependence of environmental conditions is inadequately estimated with single pollutant models. To address this limitation, an environmental quality index (EQI) is under development for all counties in the United States. Four main domains were identified that contribute to environmental quality: air, water, land, and built /social environment. An inventory of possible data sources for each of the four domains was created; data sources were identified using web-based search engines (e.g., google), site-specific search engines (e.g., Federal and State data sites), literature-reported data sourc...
The relationship between environmental conditions and human health varies by environmental media.... more The relationship between environmental conditions and human health varies by environmental media. In order to account for multiple ambient environmental conditions, we constructed an Environmental Quality Index (EQI) for health research. We used county-level data for the United States representing five environmental domains (air, water, land, built and sociodemographic) and principal components analysis to construct the EQI and domain specific indices for each county (n=3141). Infant mortality (IM) data was taken from U.S. linked births/infant deaths data for 2002 (4,027,479 birth records; 27,527 infant deaths). We used fixed slope, random intercept multilevel logistic models, adjusted for maternal age, education, marital status, and infant sex, to assess relationships between county-level environmental quality and domain specific indices with IM. Residence in a county with poor environmental quality (4th quartile) compared to the best quality (1st quartile) was not associated with ...
Combined sewer overflows (CSOs) occur in combined sewer systems when sewage and stormwater runoff... more Combined sewer overflows (CSOs) occur in combined sewer systems when sewage and stormwater runoff are released into water bodies potentially contaminating water sources. CSOs are often caused by heavy precipitation and are expected to increase with increasing extreme precipitation associated with climate change. To assess whether the association between heavy rainfall and rate of emergency room (ER) visits for gastrointestinal (GI) illness differed by the presence of CSOs. For the study period 2003 - 2007, time-series of daily rate of ER visits for GI illness and meteorological data were organized for three exposure regions: 1) CSOs impacting drinking water sources; 2) CSOs impacting recreational waters; 3) no CSOs. A distributed lag Poisson regression assessed cumulative effects for an 8-day lag period following heavy (≥90th and ≥95th percentile) and extreme (≥99th percentile) precipitation events, controlling for temperature and long term time trends. The association between extreme rainfall and rate of ER visits for GI illness differed among regions. Only the region with drinking waters exposed to CSOs demonstrated a significant increased cumulative risk for rate of ER visits for GI for all ages in the 8-day period following extreme rainfall, CRR: 1.13 (95% CI: 1.00, 1.28) compared to no rainfall. Rate of ER visits for GI illness was associated with extreme precipitation in the area with CSO discharges to a drinking water source. Our findings suggest an increased risk for gastrointestinal illness among consumers whose drinking water source may be impacted by CSOs after extreme precipitation.
BackgroundTrends in gastroenteritis-associated mortality are changing over time with development ... more BackgroundTrends in gastroenteritis-associated mortality are changing over time with development of antibiotic resistant strains of certain pathogens, improved diagnostic methods, and changing healthcare. In 1999, ICD-10 coding was introduced for mortality records which can also affect trends. We assess trends in gastroenteritis-associated mortality and changes associated with coding.MethodsTrends in gastroenteritis-associated mortality rates in the United States were examined using the National Center for Health Statistics Multiple Cause-of-Death Mortality databases for 1985¿2005. All deaths with the underlying cause or any contributing cause included gastroenteritis were included. Cases were selected based on ICD9 (pre-1999) and ICD10 (1999¿2005) codes and all analyses were stratified by ICD usage. Annual trends in age adjusted mortality rates were assessed using linear regression spline analysis. Relative risks and 95% confidence intervals (CIs) were calculated using Poisson regr...
ABSTRACT Combined sewer systems collect rainwater runoff, sewage, and industrial wastewater for t... more ABSTRACT Combined sewer systems collect rainwater runoff, sewage, and industrial wastewater for transit to treatment facilities. With heavy precipitation, volumes can exceed capacity of treatment facilities, and wastewater discharges directly to receiving waters. These combined sewer overflows (CSOs) are a source of episodic pollution for downstream water users. We evaluate associations between heavy precipitation and emergency room (ER) visits for gastrointestinal illness (GI) in areas with and without exposure to CSOs in Massachusetts (MA) using a distributed lag model. We considered three regions for analysis: two exposed regions (with recreational and drinking water exposure) and one unexposed region. ER visits, obtained from the MA Department of Healthcare Finance, during 2003–2007 for GI diagnoses (ICD9-CM 001-009, 558.9, 787.0, 787.01, 787.03, 787.4, 787.9, 787.91) were aggregated by region of residence and date of admission to create a time series for each region. Precipitation and temperature was abstracted from National Climatic Data Center for regions and heavy precipitation events defined (daily precipitation ≥ 99th percentile). We assessed associations between ER visits and heavy precipitation events using a distributed lag poisson regression model, with an 8 day lag, adjusting for temperature and a natural spline for time to control for unmeasured covariates. In the drinking water exposed region, heavy precipitation events were associated with an increased cumulative relative risk for ER visits over the 8 days following an event (RR: 1.15 (95% CI: 1.02, 1.30)). Associations in the recreational water exposed region and unexposed region were generally null. Analysis was also conducted by age group and associations varied by age. With the expected increase in variability of rainfall due to climate change and aging infrastructure in parts of the U.S. it is important to understand the impact of heavy precipitation on human health. This abstract does not necessarily reflect EPA policy.
ABSTRACT The relationship between environmental conditions and human health varies by urbanicity.... more ABSTRACT The relationship between environmental conditions and human health varies by urbanicity. To estimate ambient environmental conditions, an Environmental Quality Index (EQI) for 2000-2005 was constructed by the Environmental Protection Agency using county-level data representing five environmental domains (air, water, land, built and sociodemographic) for each U.S. county (n=3141). Annual county-level, age-adjusted, cancer incidence rate data for 2006-2010 from Surveillance, Epidemiology, and End Results Program (SEER) was modeled with EQI quintiles. A random intercept multi-level linear regression clustered by state estimated fixed effects of EQI quintiles on all-site cancer incidence by sex, adjusted for percentage of population ever smoked (both sexes), and percentage to have had a mammogram and a pap smear (females). Results are reported as incidence rate difference (IRD) (95% confidence interval) comparing highest quintile/worst environmental quality to lowest/best environmental quality. All cause cancer was strongly positively associated with EQI in both sexes (males: 32.60 (16.28, 48.91), females: 30.34 (20.47, 40.21)). Models were also stratified by four rural-urban continuum codes (RUCC) ranging from metropolitan urbanized (RUCC1) to rural (RUCC4). We observed positive associations between all cause cancer and EQI for most strata for males (RUCC1: 27.01 (11.29, 42.74); RUCC2: 11.29 (-18.10, 40.67), RUCC3: 25.66 (3.85, 47.47), RUCC4: -12.12 (-50.65, 26.42)) and across all strata for females (RUCC1: 21.76 (8.26, 35.26); RUCC2: 2.34 (1.62, 3.06), RUCC3: 1.77 (1.19, 2.35), RUCC4: 2.06 (0.93, 3.19)). The strength of association varied by urbanization with the strongest observed in the most urbanized areas for both sexes. In addition, we assessed associations with the top three causes of cancer for both sexes. Cancer incidence is associated with ambient environmental quality and the strength of association varies by level of urbanization, which has implications for public health programs intervention planning in more or less urban areas. This abstract does not necessarily reflect EPA policy.
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