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Associations between environmental quality and adult asthma prevalence in medical claims data.

Publication ,  Journal Article
Gray, CL; Lobdell, DT; Rappazzo, KM; Jian, Y; Jagai, JS; Messer, LC; Patel, AP; DeFlorio-Barker, SA; Lyttle, C; Solway, J; Rzhetsky, A
Published in: Environmental research
October 2018

As of 2014, approximately 7.4% of U.S. adults had current asthma. The etiology of asthma is complex, involving genetics, behavior, and environmental factors. To explore the association between cumulative environmental quality and asthma prevalence in U.S. adults, we linked the U.S. Environmental Protection Agency's Environmental Quality Index (EQI) to the MarketScan® Commercial Claims and Encounters Database. The EQI is a summary measure of five environmental domains (air, water, land, built, sociodemographic). We defined asthma as having at least 2 claims during the study period, 2003-2013. We used a Bayesian approach with non-informative priors, implementing mixed-effects regression modeling with a Poisson link function. Fixed effects variables were EQI, sex, race, and age. Random effects were counties. We modeled quintiles of the EQI comparing higher quintiles (worse quality) to lowest quintile (best quality) to estimate prevalence ratios (PR) and credible intervals (CIs). We estimated associations using the cumulative EQI and domain-specific EQIs; we assessed U.S. overall (non-stratified) as well as stratified by rural-urban continuum codes (RUCC) to assess rural/urban heterogeneity. Among the 71,577,118 U.S. adults with medical claims who could be geocoded to county of residence, 1,147,564 (1.6%) met the asthma definition. Worse environmental quality was associated with increased asthma prevalence using the non-RUCC-stratified cumulative EQI, comparing the worst to best EQI quintile (PR:1.27; 95% CI: 1.21, 1.34). Patterns varied among different EQI domains, as well as by rural/urban status. Poor environmental quality may increase asthma prevalence, but domain-specific drivers may operate differently depending on rural/urban status.

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Published In

Environmental research

DOI

EISSN

1096-0953

ISSN

0013-9351

Publication Date

October 2018

Volume

166

Start / End Page

529 / 536

Related Subject Headings

  • Young Adult
  • United States
  • Toxicology
  • Rural Population
  • Prevalence
  • Middle Aged
  • Male
  • Humans
  • Female
  • Bayes Theorem
 

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Gray, C. L., Lobdell, D. T., Rappazzo, K. M., Jian, Y., Jagai, J. S., Messer, L. C., … Rzhetsky, A. (2018). Associations between environmental quality and adult asthma prevalence in medical claims data. Environmental Research, 166, 529–536. https://doi.org/10.1016/j.envres.2018.06.020
Gray, Christine L., Danelle T. Lobdell, Kristen M. Rappazzo, Yun Jian, Jyotsna S. Jagai, Lynne C. Messer, Achal P. Patel, et al. “Associations between environmental quality and adult asthma prevalence in medical claims data.Environmental Research 166 (October 2018): 529–36. https://doi.org/10.1016/j.envres.2018.06.020.
Gray CL, Lobdell DT, Rappazzo KM, Jian Y, Jagai JS, Messer LC, et al. Associations between environmental quality and adult asthma prevalence in medical claims data. Environmental research. 2018 Oct;166:529–36.
Gray, Christine L., et al. “Associations between environmental quality and adult asthma prevalence in medical claims data.Environmental Research, vol. 166, Oct. 2018, pp. 529–36. Epmc, doi:10.1016/j.envres.2018.06.020.
Gray CL, Lobdell DT, Rappazzo KM, Jian Y, Jagai JS, Messer LC, Patel AP, DeFlorio-Barker SA, Lyttle C, Solway J, Rzhetsky A. Associations between environmental quality and adult asthma prevalence in medical claims data. Environmental research. 2018 Oct;166:529–536.
Journal cover image

Published In

Environmental research

DOI

EISSN

1096-0953

ISSN

0013-9351

Publication Date

October 2018

Volume

166

Start / End Page

529 / 536

Related Subject Headings

  • Young Adult
  • United States
  • Toxicology
  • Rural Population
  • Prevalence
  • Middle Aged
  • Male
  • Humans
  • Female
  • Bayes Theorem