1. An Analysis of Childhood Asthma and Environmental Exposures in Utah Michelle Gillette, M.P.H. Office of Epidemiology Utah Department of Health

2. Asthma in the United States Increasing prevalence in all age, sex, and racial groups (NHLBI Data Fact Sheet, 1999)

3. Trends in Asthma Prevalence by Age National Heart, Lung and Blood Institute, 1999 Age

4. Asthma in Utah Hospitalization due to asthma –12.3 asthma cases per 10,000 children ages 0-14 for 1992- 1995 (LeFevre, 1997) Childhood asthma hospitalization rates at the zip code level –Analysis conducted in four Urban counties Previous Study Data:

5. Significantly Lower Not Significantly Different Significantly Higher Freeways Asthma Incidence Rates by Zip Code (1992-1995) Ages 0-14 Salt Lake County The Great Salt Lake N E S W

6. Asthma in Utah Increased Rate Of Childhood Asthma Many Industrial Emission Sites Relationship? In Western Salt Lake County:

7. Study Objectives Analyze the spatial and temporal variation of childhood asthma within four urban Utah counties Determine if there is a relationship between childhood asthma development and proximity to industrial emission sources

8. Study Population Study Location –Four urban Utah counties –Approx. 77% Utah’s population Asthma Cases –ICD-9 code 493 –1990-1999 –Ages 0-14 Salt Lake City

9. Salt Lake County Utah County Davis County Weber County Salt Lake City Great Salt Lake Utah Lake Counties Major Roads Major Lakes Childhood Asthma Study Area

10. Data Collection: Asthma Cases Hospital Discharge Data: 11,522 Cases Name Birth Date Sex Date of Admit/Discharge Address at time of hospitalization

11. Data Collection: Asthma Cases Birth Certificate Data: 8,932 Unique individuals Race Tobacco Use (Mother) Alcohol Use (Mother) Congenital Anomalies Birth Address

12. Data Collection: Emission Sites NPL CERCLIS RCRA TRI Point Source Emissions Sources of Hazardous Emissions:

13. Utah Lake Great Salt Lake Industrial Emission Sites (1990-1999) NPL TRI CERCLIS PSE RCRA X

14. Data Collection: Confounders Socioeconomic Data –1990 and 2000 Census Data Access to Healthcare –Proximity to hospital Climatological Data –Wind speed & direction, temp, humidity

15. Data Analysis: Statistical Tests Cluster Identification through Spatial and Temporal Analysis –Are cases close together in space and time? Statistical Tests Used –Knox Test –Moran’s I –Gedis-Ord G –Geary’s C

16. Data Analysis: Statistical Tests cont. Relationship between emission sources and asthma cases –Lawson test Point-specific analysis –Rule out potential confounding factors (i.e. socioeconomic & climatological data)

17. Status of Study At this point: –11,522 cases mapped based on address at time of hospitalization –8,032 cases mapped based on birth address –6,094 industrial emission sites identified and mapped

18. Conclusions Previous study indicates increased incidence of asthma in certain areas Ongoing analysis to identify clusters and evaluate relationship to emission sources Final Results available Fall 2002

19. Questions? Contact Information: Michelle Gillette, M.P.H. Office of Epidemiology Utah Department of Health (801) 538-6191 mgillett@doh.state.ut.us Funding for this study provided by: The Agency for Toxic Substances and Disease Registry Cooperative Agreement #U50/ATU887580-03 Additional assistance provided by Dr. R. Wayne Ball, Greg Williams, Amy Coombs, Samuel LeFevre, and the University of Utah Digit Lab

20. References National Heart, Lung, and Blood Institute, National Institutes of Health, Centers for Disease Control and Prevention. (1999). NHLBI Data Fact Sheet: Asthma Statistics, January 1999. http://www.nhlbi.nih.gov/health/prof/lung/asthma/asthstat. htm http://www.nhlbi.nih.gov/health/prof/lung/asthma/asthstat. htm LeFevre, S., and Ball, R.W. (1997). Health Assessment: Asthma Hospitalization Rates Among Children in Utah.