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Demonstration Projects from the California Environmental Health Tracking Program

Demonstration Projects from the California Environmental Health Tracking Program. Eric M. Roberts, MD PhD, Pilot Project Manager Paul English, PhD MPH, Principal Investigator Michelle Wong, MPH, Health Educator Craig Wolff, MS Eng, IT/GIS Manager, CEHTP

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Demonstration Projects from the California Environmental Health Tracking Program

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  1. Demonstration Projects from the California Environmental Health Tracking Program Eric M. Roberts, MD PhD, Pilot Project Manager Paul English, PhD MPH, Principal Investigator Michelle Wong, MPH, Health Educator Craig Wolff, MS Eng, IT/GIS Manager, CEHTP Samuel Valdez, IT/GIS Technician, CEHTP Environmental Health Investigations BranchDivision of Environmental and Occupational Disease ControlCalifornia Department of Health Services

  2. EPHT Process • coordinate between agencies • develop IT infrastructure • format and process data Disparate sources of data • tabulation • statistical analysis • map making Useable datasets Results • stakeholder input • develop and field test materials • create mechanisms for access and dissemination Information for action

  3. CEHTP Demonstration Projects Central Valley and South Coast Air Basins Funded 2003 Adverse birth outcomes SIDS Idiopathic mental retardation Autism spectrum disorders Commercial pesticide applications Air toxics Lead biomonitoring Alameda County Funded 2002 Adverse birth outcomes Asthma Motor vehicle traffic

  4. Alameda County Project Health Outcomes • Birth outcomes • Preterm birth and term-low birthweight • Source: Vital records (birth certificates) • Issues: Largely complete data with maternal addresses—can we analyze and visualize these data in useful ways? • Asthma • Health “events” such as hospitalizations and ER visits • Source: Dataset assembled from Medi-Cal and Kaiser Permanente administrative records • Issues: How workable is a dataset like this? What is the “best” way to represent asthma?

  5. Alameda County birth outcomes Preterm singleton birth rates by maternal race/ethnicity for Alameda County, 2001 Pacific Islander Latina African-American European-American Asian-American

  6. Preterm singleton births: Alameda County, 2001

  7. Preterm singleton births: Alameda County, 2001

  8. Elevated preterm singleton birth rates: Alameda County, 2001

  9. Asthma hospitalizations among children 0-14, 1998-2000 Source: OSHPD

  10. Limitations • Hospitalizations only “tip of the iceberg” • Hospitalizations represent only most severe and/or poorly treated asthma

  11. Asthma indicators Decreasing quality of care Increasing quality of care Mortality Outpatient visits Symptom medication purchasing Hospitalizations Maintenance medication purchasing ER visits

  12. Asthma ER visits by children Kaiser Permanente & Medi-Cal Alameda County, 2001

  13. Asthma ER visits by children Kaiser Permanente & Medi-Cal Alameda County, 2001

  14. Asthma outpatient visits by children Kaiser Permanente & Medi-Cal Alameda County, 2001

  15. Asthma symptom med fills by children Kaiser Permanente & Medi-Cal Alameda County, 2001

  16. Asthma maintenance med fills by children Kaiser Permanente & Medi-Cal Alameda County, 2001

  17. Asthma maintenance med fills by children Kaiser Permanente & Medi-Cal Alameda County, 2001

  18. Summary of Asthma Results • Mapping methods produced higher geographic resolution while maintaining confidentiality • Picture of where asthma is depends on which indicator you look at • Detected previously unidentified areas where asthma may be a serious problem • Identified health disparities and disparities in quality of care

  19. Caltrans traffic count data Average Daily Traffic, 2001 Alameda County Vehicles per weekday

  20. Central Valley/South Coast Children’s Environmental Health Tracking Project Central Valley and South Coast Air Basins Funded 2003 Adverse birth outcomes SIDS Idiopathic mental retardation Autism spectrum disorders Commercial pesticide applications Air toxics Lead biomonitoring

  21. Autism spectrum disorders Mental retardation Health outcomes SIDS Exposures to hazards Term LBW Preterm birth CVSC:Time course of health outcomes conception birth i n f a n c y c h i l d h o o d

  22. Birth certificate records What other data sources can we use for health surveillance? • Autism spectrum disorders • Mental retardation Client Service Records: California Department of Developmental Services Geocoding of residence address at birth X Calculation of prevalence among birth cohorts School Records: California Department of Education Mapping and analysis of possible exposures during pregnancy

  23. Much, much more information:www.catracking.com

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