Risk effects of near-roadway pollutants and asthma status on bronchitic symptoms in children

Tang

et al. 2020

Preprint

Background Asthma exacerbations in children often require medications, urgent care, and hospitalization. Multiple environmental triggers have been associated with asthma exacerbations, including particulate matter 2.5 (PM2.5) and carbon monoxide (CO), which are primarily generated by motor vehicle exhaust. There is mixed evidence as to whether proximity to highways increases risk of asthma exacerbations. Methods To test this hypothesis, we assessed the association between asthma exacerbations and the distance to two types of roadways in Durham County, accounting for other patient-level factors. We abstracted data from the Duke University Health System electronic health record (EHR), identifying 6,208 children with asthma between 2014 – 2019. We geocoded each child’s distance to roadways (both 35 MPH+ and 55 MPH+). We classified asthma exacerbation severity into four tiers and fitted a recurrent event survival model to account for multiple exacerbations. Results There was a consistent weak effect of residential distance from 55+ MPH highway and any asthma exacerbation (Hazard Ratio: 0.98 (95% confidence interval: 0.94, 1.01)), but there was no effect from distance to 35+ MPH roadway (Hazard Ratio: 0.98 (95% confidence interval: 0.83, 1.15)). Conclusions While the results were negative, characteristics of a study sample – namely farther distance to roadways and generally good ambient environmental pollution may contribute to this. Compared to previous work which often relied on self-report measures, we are able to obtain a more objective assessment of outcomes. Overall, this work highlights the opportunity to use EHR data to study environmental impacts of disease.

Section: Study Populationmentioning

confidence: 99%

Section: Primary Exposurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of associations between asthma exacerbations and distance to roadways using geocoded electronic health records data

Tang

et al. 2020

Preprint

“…The primary exposure in our study was the residential distances to two types of roadways: roads with U.S. Census feature Class Code A1 (55 + MPH with limited access only accessible via ramps) and A2 (35 + MPH-primary road without limited access), [32][33][34] with these speeds corresponding to highways and major roadways, respectively. 15,16,18,25 We abstracted the address information of each individual in our cohort from our EHR system and geocoded them using ArcGIS (version 10.5; ESRI Inc., Redlands, CA).…”

Section: Primary Exposurementioning

confidence: 99%

Evaluation of associations between asthma exacerbations and distance to roadways using geocoded electronic health records data

Tang

et al. 2020

Preprint

Background: Asthma exacerbations in children often require medications, urgent care, and hospitalization. Multiple environmental triggers have been associated with asthma exacerbations, including particulate matter 2.5 (PM2.5) and carbon monoxide (CO), which are primarily generated by motor vehicle exhaust. There is mixed evidence as to whether proximity to highways increases risk of asthma exacerbations. Methods: To test this hypothesis, we assessed the association between asthma exacerbations and the distance to two types of roadways in Durham County, accounting for other patient-level factors. We abstracted data from the Duke University Health System electronic health record (EHR), identifying 6,208 children with asthma between 2014 – 2019. We geocoded each child’s distance to roadways (both 35 MPH+ and 55 MPH+). We classified asthma exacerbation severity into four tiers and fitted a recurrent event survival model to account for multiple exacerbations. Results: There was a consistent weak effect of residential distance from 55+ MPH highway and any asthma exacerbation (Hazard Ratio: 0.98 (95% confidence interval: 0.94, 1.01)), but there was no effect from distance to 35+ MPH roadway (Hazard Ratio: 0.98 (95% confidence interval: 0.83, 1.15)). Conclusions: While the results were negative, characteristics of a study sample – namely farther distance to roadways and generally good ambient environmental pollution may contribute to this. Compared to previous work which often relied on self-report measures, we are able to obtain a more objective assessment of outcomes. Overall, this work highlights the opportunity to use EHR data to study environmental impacts of disease.

“…Specifically, particulate matter 2.5 (PM2.5) and ozone (O 3 ), which form from motor vehicle exhaust, are well studied environmental triggers of asthma symptoms [ 10 – 12 ]. Areas close to major roadways can have high PM2.5 and CO levels [ 13 , 14 ], and there is a growing body of evidence suggesting that proximity to car traffic sources can negatively affect asthma severity [ 15 – 25 ]. Importantly, the results of these studies are somewhat mixed, with a few studies either finding no association or weak associations between asthma exacerbations and distance to roadways [ 6 , 26 – 28 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of associations between asthma exacerbations and distance to roadways using geocoded electronic health records data

et al. 2020

BMC Public Health

Background Asthma exacerbations in children often require medications, urgent care, and hospitalization. Multiple environmental triggers have been associated with asthma exacerbations, including particulate matter 2.5 (PM2.5) and ozone, which are primarily generated by motor vehicle exhaust. There is mixed evidence as to whether proximity to highways increases risk of asthma exacerbations. Methods To evaluate the impact of highway proximity, we assessed the association between asthma exacerbations and the distance of child’s primary residence to two types of roadways in Durham County, North Carolina, accounting for other patient-level factors. We abstracted data from the Duke University Health System electronic health record (EHR), identifying 6208 children with asthma between 2014 and 2019. We geocoded each child’s distance to roadways (both 35 MPH+ and 55 MPH+). We classified asthma exacerbation severity into four tiers and fitted a recurrent event survival model to account for multiple exacerbations. Results There was a no observed effect of residential distance from 55+ MPH highway (Hazard Ratio: 0.98 (95% confidence interval: 0.94, 1.01)) and distance to 35+ MPH roadway (Hazard Ratio: 0.98 (95% confidence interval: 0.83, 1.15)) and any asthma exacerbation. Even those children living closest to highways (less 0.25 miles) had no increased risk of exacerbation. These results were consistent across different demographic strata. Conclusions While the results were non-significant, the characteristics of the study sample – namely farther distance to roadways and generally good ambient environmental pollution may contribute to the lack of effect. Compared to previous studies, which often relied on self-reported measures, we were able to obtain a more objective assessment of outcomes. Overall, this work highlights the opportunity to use EHR data to study environmental impacts on disease.