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. 2022 Apr 1;6(4):e32357.
doi: 10.2196/32357.

Development and Application of an Open Tool for Sharing and Analyzing Integrated Clinical and Environmental Exposures Data: Asthma Use Case

Karamarie Fecho  1 , Stanley C Ahalt  1 , Stephen Appold  2 , Saravanan Arunachalam  3 , Emily Pfaff  4 , Lisa Stillwell  1 , Alejandro Valencia  3 , Hao Xu  1 , David B Peden  4   5   6
Affiliations

Development and Application of an Open Tool for Sharing and Analyzing Integrated Clinical and Environmental Exposures Data: Asthma Use Case

Karamarie Fecho et al. JMIR Form Res. .

Abstract

Background: The Integrated Clinical and Environmental Exposures Service (ICEES) serves as an open-source, disease-agnostic, regulatory-compliant framework and approach for openly exposing and exploring clinical data that have been integrated at the patient level with a variety of environmental exposures data. ICEES is equipped with tools to support basic statistical exploration of the integrated data in a completely open manner.

Objective: This study aims to further develop and apply ICEES as a novel tool for openly exposing and exploring integrated clinical and environmental data. We focus on an asthma use case.

Methods: We queried the ICEES open application programming interface (OpenAPI) using a functionality that supports chi-square tests between feature variables and a primary outcome measure, with a Bonferroni correction for multiple comparisons (α=.001). We focused on 2 primary outcomes that are indicative of asthma exacerbations: annual emergency department (ED) or inpatient visits for respiratory issues; and annual prescriptions for prednisone.

Results: Of the 157,410 patients within the asthma cohort, 26,332 (16.73%) had 1 or more annual ED or inpatient visits for respiratory issues, and 17,056 (10.84%) had 1 or more annual prescriptions for prednisone. We found that close proximity to a major roadway or highway, exposure to high levels of particulate matter ≤2.5 μm (PM2.5) or ozone, female sex, Caucasian race, low residential density, lack of health insurance, and low household income were significantly associated with asthma exacerbations (P<.001). Asthma exacerbations did not vary by rural versus urban residence. Moreover, the results were largely consistent across outcome measures.

Conclusions: Our results demonstrate that the open-source ICEES can be used to replicate and extend published findings on factors that influence asthma exacerbations. As a disease-agnostic, open-source approach for integrating, exposing, and exploring patient-level clinical and environmental exposures data, we believe that ICEES will have broad adoption by other institutions and application in environmental health and other biomedical fields.

Keywords: airborne pollutant exposures; asthma exacerbation; electronic health records; medication exposures; open patient data; socioeconomic exposures.

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Conflict of interest statement

Conflicts of Interest: DBP receives funding from the National Institute of Environmental Health Sciences; the National Institute of Allergy and Infectious Diseases; the National Heart, Lung, and Blood Institute; the US Environmental Protection Agency; and the US Department of Defense. He has been a consultant for GlaxoSmithKline, Teva, and Sanofi. All other authors declare no potential conflicts of interest.

Figures

Figure 1
Figure 1
Associations between age (A,D), sex (B,E), race (C,F) and asthma exacerbations, defined as one or more annual emergency department (ED) or inpatient visits for respiratory issues (A-C) or one or more annual prescriptions for prednisone (D-F) (N = 157,410).
Figure 2
Figure 2
Associations between residential density (A,D), probability of no health insurance (B,E), and median household income (C,F) and asthma exacerbations, defined as one or more annual emergency department (ED) or inpatient visits for respiratory issues (A-C) or one or more annual prescriptions for prednisone (D-F) (N = 157,410).
Figure 3
Figure 3
Associations between proximity to a major roadway or highway (A,D), exposure to particulate matter ≤ 2.5-μm (PM2.5) (B,E), exposure to ozone (C,F) and asthma exacerbations, defined as one or more annual emergency department (ED) or inpatient visits for respiratory issues (A-C) or one or more annual prescriptions for prednisone (D-F). (N = 157,410).
See this image and copyright information in PMC

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