Integration, Analysis, and Visualization of Health and Environmental Data in the National Tracking

Network

Heather StrosniderActing Science Development Team Lead

US CDC’s National Environmental Health Tracking Program

Frontiers in Spatial EpidemiologyLondon

11/6/2012

National Center for Environmental HealthAgency for Toxic Substances and Disease Registry

Pew Commission: Environmental Health Review, 2000

Chronic conditions account for 4 out of every 5 deaths in the United States

Little information is routinely collected on non-infectious disease

Environmental monitoring conducted regulatory purposes

Little human exposure dataAnswers needed about the role of the environment

on health outcomes

Recommended a “Nationwide Health Tracking Network for diseases and exposures”

Tracking Program Goals

Goal 1 Build a Sustainable National Environmental Public Health Tracking Network

Goal 2 Advance Environmental Public Health Science and Research

Goal 3 Disseminate Information to Guide Policy, Practice, and Other Actions to Improve the Nation’s Health

Goal 4 Enhance Environmental Public Health Tracking Workforce and Infrastructure

Goal 5 Foster Collaboration Among Health and Environmental Programs

Detect and monitor trends Generate hypotheses Guide action Inform policymaking Provide information Track progress

Tracking Network:Integrated Data for Environmental Health

Tracking Program

National Network Public Portals Secure Portals Standardized Data

Data Utilization Engage Partners Build Capacity

DATA

INFORMATION

KNOWLEDGE

ACTION

National Public Portal 15 datasets 2.2 GB of data 18.7 million rows of

data 257 measures

National Public Portal 15 datasets 2.2 GB of data 18.7 million rows of

data 257 measures

24 state and city public portals

Total Coverage 165 million (55%)

Asian 9.6 million (70%)

Black 18.5 million (48%)

Hispanic 28 million (61%)

Native American 1.4 million (48%)

Other 2.8 million (57%)

White 132 million (55%)

Total Coverage of US

Population by Tracking Program

60% (156) measures cover more than Tracking states and city

Content and Data Asthma Birth Defects Cancer CO Poisoning Childhood Lead Developmental

Disabilities Heart Attacks Reproductive Birth

Outcomes

Biomonitoring Climate Change Community Design Homes Outdoor Air Population

Characteristics Water

Criteria for Prioritization

Burden - Magnitude and severity Information system factors Resonates with partners Scientific plausibility Ability to take action Direction from Congress

CMS T4 Tables

Middleware

SQL SQL

JAVASpring

HibernateBlaze DS

FlexAnychart

ESRI Flex Map

Portal

T3 Tables

SQL

Percent of children tested with confirmed elevated blood lead levels, by birth cohort

MEASURES 4

COUNTIES 2736 (87%)

YEARS 8

VARIABLE BLL category

Average annual number of Cleft Lip with or without Cleft Palate among live births

MEASURES 26

DEFECTS 12

VARIABLE Age, Race, Ethnicity, Infant Sex

Number of states providing birth defect data

Estimated prevalence of ASDs per 1000 children 8 years old

Percent of children, 3-17, receiving early intervention, special education, or related services for developmental disability

Autism Spectrum DisordersDevelopmental Delay

Emotional DisturbanceHearing ImpairmentsIntellectual Disability

Specific Learning DisabilitiesSpeech or Language Impairments

Total Arsenic concentration in urine (µg/g of creatinine)

ANALYTES 11

VARIABLE Age, Race, Ethnicity, Sex

HIA

Estimated percent change in death rate from baseline associated with 20% reduction in air pollution

Integrated messaging with data

Added new base layers to maps

Improved export by adding supporting info

New Data Over the Next Year

SUMMER 2012 FALL 2012

Children’s Environmental Health - launched

Access to ParksBRFSS Smoking PrevalenceExtreme Heat Events

Drinking Water - Atrazine, DEHP, PCE, TCE, Radium, UraniumAir toxicsAsthma ED visits Heat ED visits, hospital, mortalityAnnual blood lead levels in children

Pesticide exposures reported to poison control centersChemical Incidents from ATSDR’s National Toxic Substance Incidents Program USGS Well Water

WINTER 2013 SPRING 2013

Extreme Heat Days and Events

Number of extreme heat events

Climate Change

Definition

(Required)

Percentile

Fahrenheit

Heat Metric

Percentile

Max Daily TemperatureMax Daily Heat Index

Threshold: Absolute or Relative

2 or more days

Minimum Duration

3 or more days

Under Evaluation for the Public Portal

Air toxics Ischemic heart disease mortality benefits associated w/

reducing PM2.5 Mortality associated with extreme heat events Addt’l cardio and resp hospitalizations, ED visits, & mortality Temporal & spatial patterns in pollen Radon in homes Private well water Occupational health ALS (from ATSDR registry) Vulnerability measures Pesticide residue in food New modeled air Intellectual disabilities from ADDM BLL 5 to <10 USGS soil Precipitation PM speciation and source

Future Functionality

Improved metadata Enhanced charting

options View benchmarks Exploring

Animated time map Ability to compare related

measures Ability to compare populations

Percent living in povertyPercent living in poverty

20022002

Percent uninsuredPercent uninsured

20022002

Percent smokePercent smoke

20022002

Percent low birthweightPercent low birthweight

2002-20062002-2006

Addressing Gaps in Data, Methods & Information

Evaluating national, state, and local data systems Inventory of available data and quality Recommendations for reaching national consistency

Evaluating and developing methods Environmental epidemiology Exposure assessment Linking health and environmental data

Tracking environmental health Picture of America report Surveillance summaries Impact of exposure Evaluation of policies and programs

Addressing Gaps in Data, Methods & Information

Evaluating methods for defining extreme heat events

Linking PM2.5 with cleft birth defects and reproductive birth outcomes

Estimating IHD benefits associated with reductions in PM2.5

Evaluating and developing models for estimating air pollution

Tracking in Action

200+ skilled EPH practitioners in 23 states and NYC

18 ASTHO fellowships since 2008

133 publications and health reports since 2002

132 public health actions since 2005

http://www.cdc.gov/nceh/tracking/successstories.htm

Reducing Effects of Extreme Heat in California

Cooling centers costly, but can be life-saving San Jose city leaders needed proof of health impacts of

heat before approving cooling centers Tracking identified increase of heat-related ER visits

during heat events City leaders approved cooling centers to open

Reducing Asthma Hospital Stays in New York City

Increase in childhood asthma hospital stays and ED visitsData used to urge update of asthma management plans for

school startDecreasing rates of asthma hospital staysAdvisories now standard practice

Reducing Arsenic Exposure in Oregon

Known elevated levels of arsenic in private wells Oregon does not require water to be tested for arsenic Using data on arsenic levels in drinking water

• Educated community by explaining results and encouraged water testing

• Prompted state legislation to add arsenic to list of substances to test in private wells

Improving Water Quality Datain Wisconsin

Tracking Program enhanced community drinking water data by identifying water sources and connecting population to their water system

Data used to identify and prioritize water sourcesthat are likely to be contaminatedand areas of greatest risk

Addressing Childhood Lead Poisoning Risk in Missouri

Many children living in St. Louis have elevated blood lead levels

Tracking Program looked at relationship between building demolitions and BLLs of children living nearby

Children exposed to multiple demolitions showed a rise in BLLs

Demolition site work practices revised and inspections increased

Value “The [Pew] Commission estimates that the annual cost for a Nationwide Health Tracking Network is $275 million.”

For ~ 10% of this investment –National NetworkEnvironmental health infrastructure in 23 states and NYCMentoring and resources for unfunded statesIncreased responsiveness to community concernsResource to other PH programsOpportunities to be proactive vs reactiveInforming policy changesImproving our understanding of impact on health

External Program Review

Grantees report that Tracking is one of the most significant and far-reaching national environmental health programs.

Programmatic and policy improvements directly attributed to Tracking: Data availability, quality, and specificity Intra- and inter- agency collaboration between health

and environmental programs Data-driven prioritization of and interventions to

address environmental public health problems.

Thank youHStrosnider@cdc.govephtracking.cdc.gov

For more information please contact Agency for Toxic Substances and Disease Registry or the Centers for Disease Control and Prevention

ATSDR:

4770 Buford Highway NE, Chamblee, GA 30341

Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: cdcinfo@cdc.gov

Web: http://www.atsdr.cdc.gov

CDC:

1600 Clifton Road NE, Atlanta, GA 30333

Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: cdcinfo@cdc.gov

Web: http://www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers

for Disease Control and Prevention or the Agency for Toxic Substances and Disease Registry

National Center for Environmental HealthAgency for Toxic Substances and Disease Registry