NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking...

NJDHSS Lead and Beyond: April 16, 2010 nj.gov/health/epht NJ Environmental Public Health TrackingCopyright 2006 – User Insight, Inc.

Jerald Fagliano, MPH, PhDRichard E. Opiekun, MA, MS, PhD

Lead and Beyond: Progress in Eliminating Lead Poisoning and New Opportunities for Collaboration in New Jersey April 16, 2010

New Jersey’sEnvironmental

Public HealthTracking Network

NJDHSS Lead and Beyond: April 16, 2010 nj.gov/health/epht NJ Environmental Public Health Tracking

Disclaimer

Neither Dr. Fagliano nor Dr. Opiekun have any financial interests with any product, software, website or organization mentioned in this presentation. This presentation does not discuss or endorse any non-FDA approved product or device.


In 2000, the Pew Environmental Health Commission detailed an "environmental health gap," a lack of basic information needed to document links between environmental hazards and chronic disease.


Pew ReportPew Report

“…create a federally supported Nationwide Health Tracking Network with the appropriate privacy protection, that informs consumers, communities, public health practitioners, researchers, and policymakers on chronic diseases and related environmental hazards and population exposures. This will provide the capacity to understand, respond and prevent chronic disease in the country.”


"A successful tracking system will provide our citizens with critical information on the threats to their health posed by the environment and how well we, as a nation, a state, or a community, are dealing with those threats."

Michael McGeehin, PhD Director, Division of Environmental Hazards and Health Effects

National Center for Environmental Health, CDC



Integrated data

Compatible data (exchange-able)

Ability to expand

Linkable data that can be associated epidemiologically

Ability to assess quality of the data

Secure (to protect confidentiality)

Reliable

Vision - Vision - Key Needs of Stakeholders / Users

User friendly

Useful for environmental public health actions and etiologic studies

Provides access to and reporting of data at multiple time scales

Tools to support various types of analyses and communicate the results of those analyses

Tools to search for and find data


What is Environmental Public Health Tracking?

…the ongoing collection, integration, analysis, interpretation, and dissemination of data on human exposure to environmental hazards and health effects that may be related to those exposures.


National Tracking Program State Grantees* and Academic Centers of Excellence

*current as of FY 2010


NJEPHT Demonstration andLinkage Projects

A Look into the Past …


EPHT Can Be Used to Explore

Time trends and geographical patterns in: Environmental hazards Human exposure Disease occurrence

Surveillance of health outcomes by environmental gradient Organizing and linking health and environmental

information Comparison of disease or exposure rates among

areas aggregated according to levels of an environmental hazard


Lung Cancer Incidence, NJ1979-2001

0.020.040.060.080.0

100.0120.0140.0

Male

Female

Time Trends in Selected Cancers

Bladder Cancer Incidence, NJ1979-2001

0102030405060

1979

1982

1985

1988

1991

1994

1997

2000

Year

Rat

e p

er 1

00,0

00

Male

Female

Age-adjusted rates per 100,000

•Smoking-related cancers

•Lung cancer incidence epidemic related to time trends in smoking prevalence by sex

•Though bladder cancer is smoking-related, no apparent time trend


Time Trends in Selected Birth Defects

Rate of Gastroschisis

0.0

0.2

0.4

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

Rat

e p

er 1

000

Bir

ths

Males

Females

Rate of Omphalocele

0.0

0.2

0.4

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

Rat

e p

er 1

000

Bir

ths

Males

Females

Gastroschisis

Omphalocele

•Related birth defects

•Inverse pattern in prevalence at birth related to diagnostic reviews for special study


Time Trend in Population Exposed to Trichloroethylene in Drinking Water

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

Year

Population Exposed

25 +

5 to 25

1 to 5

Maximum Level Enforced

Initial SurveysMandatoryMonitoring

TCE (ug/L)

New Jersey Public Water Supplies, 1978-1990


Proportion of Tested Children with Elevated Blood Lead≥ 10µg/dl ≥ 20µg/dl


Cluster Analysis for High Proportion of Tested Children with Elevated Blood Lead

≥ 10µg/dl ≥ 20µg/dl


Cluster Analysis of Mesothelioma

Incidence,1979-2001

• Associated with historic occupational exposures to asbestos


Difficulties in Interpreting Cluster Analyses

Maximum Cluster up to 50% of State Population

Maximum Cluster up to 1% of State Population


Linking Data: Surveillance of Health Outcomes

by Environmental Gradient

• To understand relationships among:

• environmental hazards

• exposures

• human health outcomes

• To provide scientific basis for public health interventions and evaluation of their effectiveness


Concerns with Data Linkage

• Information technology issues

• Database compatibility

• Common geographic and time scales

• Data quality

• Epidemiological issues

• Plausible hypotheses

• Exposure misclassification

• Confounding factors

• Random statistical associations


Importance of Exposure Assessment

• Cumulative individual exposures over points and times a function of:• Concentrations in air (ambient, indoor)• Individual behavior

• Inhalation rate, time/activity patterns

• Exposure assessment in linkage studies:• Estimated average concentration in ambient air

for an area in a time period• Misclassification of individual exposure is

inevitable


Benzene in Ambient Air and Leukemia Incidence

Relative Risk

0.8

0.9

1

1.1

1.2

<1

.4

1.4

to

<2

.5

2.5

+

<1

.4

1.4

to

<2

.5

2.5

+

Benzene (ug/m3)

Ad

jus

ted

Ra

te R

ati

o

Females Males


Trihalomethanes in Drinking Waterand Bladder Cancer

Relative Risk

0.8

0.9

1

1.1

1.2

0

>0

to

45

45

to

64

65

+ 0

>0

to

45

45

to

64

65

+

Trihalomethane (ug/L)

Ad

jus

ted

Ra

te R

ati

o

Females Males


Lead in Drinking Water andElevated Blood Lead in Children (>10 µg/dL)

• Drinking water lead measurements: 90th percentile of monitoring results by public water system and by year


Distribution of Blood Lead Levels by Drinking Water Lead Category

0

5

10

15

20

25

30

35

40

45

50

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Blood Lead Concentration

Pe

rce

nt

of

Ch

ildre

n

% of cases (≤0.004)

% of cases (0.004 > h2o90th ≤ 0.008)

% of cases (0.008 > h2o90th ≤ 0.011)

% of cases (>0.011)

0

0.05

0.1

0.15

0.2

0.25

0.3

15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30


Relationship between Blood Lead and Drinking Water Lead, by Housing Age Group

0

1

2

3<

0.00

4

0.00

4-0.

008

0.00

8-0.

011

>0.

011

<0.

004

0.00

4-0.

008

0.00

8-0.

011

>0.

011

<0.

004

0.00

4-0.

008

0.00

8-0.

011

>0.

011

<0.

004

0.00

4-0.

008

0.00

8-0.

011

>0.

011

<0.

004

0.00

4-0.

008

0.00

8-0.

011

>0.

011

0-23% pre-1960 23-46% pre-1960 46-63% pre-1960 63-75% pre-1960 >75% pre-1960

90th Percentile Drinking Water Lead by Housing Age Group

Ad

just

ed O

dd

s R

atio

fo

r B

loo

d L

ead

> 1

0 u

g/d

L

95%CI OR


… 2008, 2009, and beyond


Uses for the EPHT Portal

Time trends and geographical patterns in: Environmental hazards Human exposure Disease occurrence

Surveillance of health outcomes by environmental gradient Organizing environmental information Comparison of disease or exposure rates among

areas aggregated according to levels of an environmental hazard


Partnerships are the Key

Center for Health Statistics

State Health Assessment Data System (NJSHAD)

Office of Information

Technology Services

EPHT Project Staff

Data Stewards and Programs in

DHSS and DEP


Features of NJSHAD

• Link to departmental publications

• Display of public health indicators

• Query data sets• Provide contact information

The NJSHAD system is based on Utah’s open-source Indicator Based Information System (IBIS) for Public Health.


EPHT Welcome Page

EPHT Content Pages

SHAD Welcome Page

SHAD Indicator Pages

SHAD Custom

Query Pages

Other Department Welcome PagesFrom the Web:

From the Web:

From the Web:


EPHT/SHAD Implementationat Present

Public Health Indicators 128 total public health indicators

Over 450 views and growing 44 Current EPHT indicators

Air quality, drinking water quality, lead exposure, birth and infant outcomes, asthma hospitalization, heart attack hospitalization, carbon monoxide poisoning

171 views (including charts, graphs and maps) 9 Cancer indicators recently added in March include

Incidence of bladder cancer, adult brain and ONS cancer, child brain and ONS cancer, female breast cancer, adult leukemia, childhood leukemia, lung and bronchus, non-Hodgkin lymphoma, thyroid

Data Queries Births, 1990-2005 Deaths, 2000-2005 Infant (2000-2005) and fetal deaths (2000-2006)


And Now for a Live Demonstration ofthe NJ EPHT Portal and NJ SHAD

The N.J. shad

The N.J. ibis

The N.J. tracking network


Planned Enhancements in Next Year

Mapping Indicator displays (static) Data query output (dynamic)

Additional EPHT indicator categories: Birth defects, cancers Emergency department, mortality and survey data Climate and weather Cumulative impact

Additional data sets for query system: Hospitalization and emergency department Childhood lead exposure Cancer

Secure portal


How Far Have We Come?

• Strengthened infrastructure and capacity with EPHT funding

• New & enhanced:• Partnerships• Surveillance• Communications


Achieving the Full Vision of Tracking Still Requires Work


Big PictureBig Picture

Where do YOU fit in?Where do YOU fit in?

Visit Visit www.nj.gov/health/ephtwww.nj.gov/health/epht to learn more.to learn more.


Support Acknowledgement• The New Jersey Environmental Public Health Tracking Program and

development of the state’s Environmental Public Health Tracking web portal was supported by Cooperative Agreement Number 5 U38EH000196-03 from the Centers for Disease Control and Prevention.

• We would also like to acknowledge those individuals who have provided both scientific and technical assistance with this project without whom our success would not be possible.

Center for Health StatisticsKatherine Hempstead

Maria BaronKenneth O’Dowd

Collette Lamothe-GaletteMarie-Carme Franklin

Office of Information Technology ServicesPaul NicoletteJanet VaranJipsa Patel

Data Stewards and ProgramsDHSSDEP


NJ EPHT Portal

Screen Shots

















Date post:	19-Jan-2016
Category:	Documents
Upload:	leslie-mcgee
View:	214 times
Download:	2 times

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking...

Documents