Environmental Public Health Tracking: Some Records are Vital

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Environmental Public Health Tracking Some
Records are Vital
NAPHSIS/NCHS Joint Meeting, Salt Lake City,
Utah June 5, 2007

• Suzanne K. Condon, Director
• Bureau of Environmental Health
• Massachusetts Department of Public Health

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Outline

• Environmental health and disease concerns
• Collaboration, communication and resource sharing
  with vitals partners
• 24A
• Provision of resources to enhance data quality
  of vital records
• Environmental Public Health Tracking What have
  we learned to date?
• IAQ asthma
• Lupus and 21e sites
• DBPs (TTHMS) low birth weight
• Linking childhood cancer birth outcome data
  with municipal water supply data
• Summary

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I. Environmental Health Disease Concerns
Report of the Pew Commission
Public Perception of Environmental Contribution
to Health

• Source Pew Environmental Health Commission 2000

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Annual Calls Taken Regarding Perceived
Environment and Disease Clusters
Source MDPH (extrapolated from Community
Assessment Program Telephone Tracking System)
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Collaboration, communication and resource sharing
with vitals partners

• 24A
• M.G.L. c. 111, 24A authorizes the Commissioner
  of MDPH to approve scientific studies and
  research which have for their purpose the
  reduction of morbidity and mortality within the
  commonwealth. Receiving 24A approval protects
  any data or other information collected for
  purposes of the research as confidential.

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Collaboration, communication and resource sharing
with vitals partners

• Provision of resources to enhance data quality of
  vital records
• Geo-coding of birth and death records

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III. Environmental Public Health Tracking
What have we accomplished to date?
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Density of Tier-Classified 21e Sites with
Lupus-Suspected Chemicals and Neighborhoods with
the Highest Rates of Lupus
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Asthma Prevalence in Massachusetts Schools with
Moisture/Mold Problems12003/2004 - 2005/2006
School Years
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Scientific Purpose in Linking Birth Outcomes and
DBPs in Drinking Water

• Several epidemiological studies have shown
  increased risk of impaired fetal growth
  associated with exposures to disinfection
  byproducts (e.g., Bove et al. 1995, 2002
  Infante-Rivard 2004 Savitz et al. 2005)
• Third trimester of pregnancy time during which
  fetal growth and birth weight may be most
  sensitive to environmental exposure opportunities
  (Kline et al. 1989)

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Variables Available for Linkage

• Environmental Data
• Water Quality Data
• Health Data
• Low Birth Weight Data

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Linkage Variables - Environmental Data

• Drinking water quality data from municipal water
  supplies are housed in Massachusetts Department
  of Environmental Protection Water Quality System
  database
• Water quality data from approximately
  1988-present are computerized, with most complete
  data beginning in 1993 for public water supply
  (PWS) systems
• This linkage project focused on total
  trihalomethane (TTHM) data

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Linkage Variables - Health

• Low birth weight data obtained from Massachusetts
  Registry of Vital Records and Statistics, housed
  in the Massachusetts Department of Public Health
• Collect information on nearly 80,000 annual
  births in Massachusetts
• Computerized since 1969 and available in Access
  database

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Health Data

• Low birth weight data
• Low birth weight defined as infant weight of less
  than 2,500 grams at birth
• Key variables readily available include date of
  birth, maternal address at birth, birth weight,
  gender, some maternal risk factor information
  (e.g., smoking status)

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Linkage Goals

• Assess low birth weight data in relation to
  nearest TTHM sampling location in community for
  possible relationships (i.e., greater occurrence
  of low birth weight babies in areas with higher
  TTHM levels)
• Assign each live birth to nearest TTHM sampling
  location based on maternal address at birth
• Assign TTHM level corresponding to the last
  trimester of pregnancy for each live birth
• Calculate total low birth weight odds ratios
  according to TTHM exposure categories ( 40 ppb,
  40-80 ppb, 80 ppb) across all communities

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(No Transcript)
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ResultsLinkage Analyses for Greater Boston Area

• Communities served by the Massachusetts Water
  Resources Authority (MWRA), improves exposure
  assessment by relying on weekly, rather than
  quarterly, monitoring data (1999-2001). In
  addition, the water treatment regimens employed
  by the treatment system studies minimize the
  geographic variability of TTHMs
• In addition to third trimester risk estimates
  typically derived in such studies, first, second
  and full pregnancy estimates were also calculated

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Term Low Birth Weight Exposure (all races N780)
Using logistic regression, a statistically
significant increased risk for TLBW was found
among those with high (70 ug/L) TTHM exposure.
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Results, cont.

• Using logistic regression and adjusting for
  potential confounding factors, a statistically
  significant risk for term low birth weight was
  found among those with high (70 ppb) TTHM
  exposure
• To account for the potential impact of geographic
  variation in TTHM, a crude sensitivity analysis
  was conducted
• Using existing exposure values assigned to each
  mother, the values were weighted on the basis of
  TTHM data from a single sampling site closest to
  the mothers residence
• This analysis raised the possibility that some
  unaccounted for geographic variation in TTHM data
  could lead to different exposure results and thus
  different overall results

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IV. Linking Childhood Cancer Birth Outcome Data
with Municipal Water Supply Data

• Overall Goal
• To assess opportunities for exposure to VOCs
  during fetal development and the risk of
  childhood cancer

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Linkage

• Cancer registry records and Registry of Vital
  Statistics records are linked to identify the
  maternal residence at time of birth for childhood
  cancer cases

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Linkage Files

• Registry of Vital Records
• Childs name
• Childs DOB
• Childs gender
• Maternal residence at birth

• MA Cancer Registry
• Childs name
• Childs DOB
• Cancer diagnosis
• Date of Diagnosis

Linkage Variables
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Linkage Steps

• Records in Cancer Registry and Vitals Registry
  each have a separate ID number
• To maintain privacy of confidential cancer data,
  personal identifiers are not share with
  researcher
• Using name and DOB, MDPH Privacy Officer matches
  Cancer Registry and Vitals Registry files, and
  assigns a unique Match ID number to matched
  records
• Using the registry ID number and Match ID number,
  an analytic file is created that contains cancer
  type, DOB, and maternal residence (city/town, zip
  code) but not name
• The analytic file is used by the researcher to
  assign exposure values and determine the risk of
  cancer while protecting privacy

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V. Summary

• Public remains concern about health impacts and
  possible environmental exposures
• Use of vital records is often critical in
  responding to concerns
• Linkage of existing data sets alone cannot answer
  complex environmental health questions
• Data sharing agreements are important, but more
  important is the collaboration with data stewards
  and when possible the sharing of resources