Database offers local information about asthma prevalence, confounding factors

April 02, 2024

6 min read

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Key takeaways:

  • The Asthma Equity Explorer provides data by census tract.
  • Asthma information includes social determinants of health.
  • Researchers, providers and policymakers can use these data to inform decisions.

Approximately 25 million people in the United States — or 7% of the population — has asthma, the Allergy & Asthma Network reports. But that prevalence is not evenly distributed, with wide variation from state to state and even city to city.

“That number continues to change,” De De Gardner, DrPH, RRT, RRT-NPS, FAARC, FCCP, chief research officer with Allergy & Asthma Network (AAN), told Healio. “It’s an extremely prevalent condition that impacts a lot of people’s lives.”

De De Gardner, DrPH

Using multiple data sources, AAN has partnered with MITRE to develop the Asthma Equity Explorer, which provides information about asthma at the census tract level that is available for healthcare providers, policymakers, researchers and even patients to use.

The database includes more than 32 different variables that impact asthma, such as race and ethnicity, income to poverty ratio, education levels, home ownership vs. rental residences, access to healthy food, affordable housing, and smoking and obesity prevalence.

The need for data

“Race and ethnicity are big factors in regard to asthma prevalence,” Gardner said.

Black, Hispanic and Native American populations experience disparities in asthma incidence and access to care, she continued, especially those who live in poor urban areas.

For example, Gardner said, Black children are four and a half times more likely to visit an ED for asthma than white children. Hispanic children are approximately two and a half times more likely to visit an ED for asthma than white children.

“But the strongest number that we have here today is that African American children are dying at a rate of seven times higher than any other child,” Gardner said. “That’s really alarming to me.”

Environmental factors such as exposure to allergens and other social determinants of health contribute to these disparities, Sybil Russell, MD, a technical fellow with MITRE, told Healio.

“People with asthma or allergies may have a broncho-spastic trigger from particulate matter as well,” Russell said.

Sybil Russell

Although previous research has established these associations, MITRE — a nonprofit that conducts independent research and development — recognized the need for a tool that would help stakeholders better understand these disparities.

In 2022, MITRE reached out to AAN to provide feedback as it began developing the Asthma Equity Explorer.

“Fortunately, we found a synergy there and were able to connect and work together,” Russell said.

As a population database, the Asthma Equity Explorer uses publicly available data from the American Community Survey, the CDC, the U.S. Department of Housing and Urban Development and the Atmospheric Composition Analysis Group, in addition to redlining data from the University of Richmond and material from other sources.

“Taking all that information at the population census level, or census tract, really allows users of the database to explore and understand the different relationships between those factors and asthma outcomes,” Russell said.

Users can click on any county or census track in any state via pull-down menus. Next, they can click on various factors in categories including health outcomes, race and ethnicity, education, income, residential segregation and environmental influences.

For example, Census Tract 421 in the Bronx, New York, has an asthma prevalence of 11.8% with particulate matter counts of 7.916 µg/m3. Census Tract 8425 in Cook County, Illinois, has a prevalence of 15.8% and particulate matter counts of 10.1 µg/m3.

Users can conduct similar searches at state, county and tract levels comparing asthma prevalence with smoking rates, lack of access to health care, percentage of residents under poverty level, housing stress, and other factors. Areas can be ranked as well.

“The database is so vast, and it provides such robust information from the different data sources all this information is being pulled in from,” Mitu Patel, MPH, health data analyst with AAN, told Healio.

“Every time a researcher or user goes into the database to access information, they’re going to find something novel and noteworthy,” Patel said.

Applying the results

AAN already is using results from the Asthma Equity Explorer to guide the launch of its Trusted Messengers virtual asthma coaching program’s outreach events in Atlanta this year, which Patel called “a perfect choice to an impactful new year” based on its asthma population.

Mitu Patel

“When you overlay all three of these data points — asthma prevalence, redlining, as well as the African American population together — you see that there’s a significant association between all three of these factors in Atlanta,” Patel said, “emphasizing the need to conduct outreach and bring asthma education to that community.”

AAN is now also examining redlining data and associations with asthma throughout California and in Boston to explore where the Trusted Messengers program could best benefit people with asthma next.

Other organizations are taking advantage of these data too.

“Since the beta launch on Jan. 31, we’ve had 120-plus new users who signed up to access the database, and at least 30% of those have returned for a variety of reasons to do more research,” Patel said.

Users have come from various fields such as industry including pharmaceutical companies as well as from state health departments and academia, Patel said.

Russell said that individual allergy and asthma specialists can take advantage of the database too.

“There’s a lot of different advantages,” she said.

Physicians can share data about how the local environment impacts their patients’ asthma, whether they are traveling or if they are staying at home, so they can make more personalized and impactful decisions, according to Russell.

“Being able to share that type of information with your patients and get a better understanding of what they might be experiencing in their homes or in their areas and neighborhoods is very helpful,” she said.

These data can help physicians decide where they want to practice as well, Gardner said, with details about areas that have the most asthma or the least access to care. These data could also drive other programs such as AAN’s Trusted Messengers, she added.

“Many practitioners are looking to give back to communities or to start community engagement events or opportunities,” Gardner said.

Legislators also can tap the data as they write policy, with additional impacts on funding for research and other programs from stakeholder organizations, she continued.

“Professional societies are trying to be mindful of how they’re spending grant dollars,” Gardner said.

“This database provides great data visualizations for grant writers to demonstrate to reviewers exactly where they’re going to be providing asthma education or other education,” she continued. “Hopefully, funding could funnel in that direction.”

“They can start using the data to inform where they invest in programs or interventions to improve outcomes,” Russell said, “just to have a better understanding of which populations are in need, where the prevalence is, and what other factors they could use to target and therefore create interventions to help people and policies to form programs.”

Russell suggested that the database could be used to identify areas where telemedicine could be expanded to improve access to care, among other strategies.

“If you’ve identified an area that has a large prevalence of asthma and has a difference in amount of transportation, then you could provide transportation vouchers or other types of resources,” she said.

Patel noted previous data indicating associations between ED visits for asthma among children and a lack of green space in socially deprived neighborhoods.

“Find areas that have less green space, and hopefully do some environmental promotion and get some more climate change — good climate change — happening there,” she said.

In May, representatives from AAN will visit Washington, D.C., to advocate for new policies that will improve outcomes for patients with asthma. Gardner said that the organization will be using data from the Asthma Equity Explorer to make its case.

“We’ll be utilizing the maps for each of the states that we’ll be representing,” she said. “We’ll be bringing some of this information there.”

Next steps

The collaboration will continue as the partners maintain and update the database.

“As data becomes available, you want to make sure that researchers have access to this one-stop shop, which is fabulous for them,” Gardner said. “The one thing that people have been asking for is a full U.S. map, and so that’s something that we have on our want-to-do list.”

In addition to increasing the number of users, the partners also want to know how the data are being put to work and how they can refine the experience.

“MITRE would be interested to find out how the researchers and other stakeholders are using this type of information and what ways we can improve it, if there are different functionalities or other capabilities that in addition to other datasets could be added in the future,” Russell said. “Getting that feedback would be really helpful.”

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