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ObjectiveTo develop public health adaptation strategies and to project the impacts of climate change on human health, indicators of vulnerability and preparedness along with accurate surveillance data on climate-sensitive health outcomes are needed. We researched and developed environmental health indicators for inputs into human health vulnerability assessments for climate change and to propose public health preventative actions.Data sourcesWe conducted a review of the scientific literature to identify outcomes and actions that were related to climate change. Data sources included governmental and nongovernmental agencies and the published literature.Data extractionSources were identified and assessed for completeness, usability, and accuracy. Priority was then given to identifying longitudinal data sets that were applicable at the state and community level.Data synthesisWe present a list of surveillance indicators for practitioners and policy makers that include climate-sensitive health outcomes and environmental and vulnerability indicators, as well as mitigation, adaptation, and policy indicators of climate change.ConclusionsA review of environmental health indicators for climate change shows that data exist for many of these measures, but more evaluation of their sensitivity and usefulness is needed. Further attention is necessary to increase data quality and availability and to develop new surveillance databases, especially for climate-sensitive morbidity.

This study describes and demonstrates different techniques for surface fitting daily environmental hazards data of particulate matter with aerodynamic diameter less than or equal to 2.5 m (PM 2.5 ) for the purpose of integrating respiratory health and environmental data for the Centers for Disease Control and Prevention (CDC) pilot study of Health and Environment Linked for Information Exchange (HELIX)-Atlanta. It presents a methodology for estimating daily spatial surfaces of ground-level PM 2.5 concentrations using the B-Spline and inverse distance weighting (IDW) surface-fitting techniques, leveraging National Aeronautics and Space Administration (NASA) Moderate Resolution Imaging Spectrometer (MODIS) data to complement U.S. Environmental Protection Agency (EPA) ground observation data. The study used measurements of ambient PM 2.5 from the EPA database for the year 2003 as well as PM 2.5 estimates derived from NASA's satellite data. Hazard data have been processed to derive the surrogate PM 2.5 exposure estimates. This paper shows that merging MODIS remote sensing data with surface observations of PM 2.5 not only provides a more complete daily representation of PM 2.5 than either dataset alone would allow, but it also reduces the errors in the PM 2.5 -estimated surfaces. The results of this study also show that IMPLICATIONSThe described method of estimating concentrations of PM 2.5 by merging NASA MODIS remote sensing data with surface observations provides a more complete daily representation of PM 2.5 than either dataset alone, and it reduces the errors in the PM 2.5 -estimated surfaces with respect to observations. These new data products have the potential to serve as a tool for environmental public health surveillance to monitor trends and as an early warning system for prevention of human exposure to potential hazards. Such continuous spatial surfaces of environmental hazards as those developed in this study would enable linking environmental hazards to health outcomes on the grid-aggregated level as well as the individual level at the geographic locations of patients' residences.

Purpose Receipt of radiation therapy (RT) is a key quality indicator in breast cancer treatment. Prior analyses using population-based tumor registry data have demonstrated substantial underuse of RT for breast cancer, but the validity of such findings remains debated. To address this controversy, we evaluated accuracy of registry RT coding compared to the gold standard of Medicare claims. Methods and Materials Using SEER-Medicare data, we identified 73,077 patients age ≥ 66 diagnosed with breast cancer from 2001-2007. Underascertainment (1-sensitivity), sensitivity, specificity, kappa, and chi-square were calculated for RT receipt determined by registry data vs. claims. Multivariate logistic regression characterized patient, treatment, and geographic factors associated with underascertainment of RT. Findings in the SEER-Medicare registries were compared to three non-SEER registries (Florida, New York, and Texas). Results In the SEER-Medicare registries, 41.6% (n=30,386) of patients received RT according to registry coding versus 49.3% (n=36,047) according to Medicare claims (P<0.001). Underascertainment of RT was more likely if patients resided in a newer SEER registry (OR 1.70, 95%CI 1.60-1.80;P<0.001), rural county (OR 1.34, 95%CI 1.21-1.48;P<0.001) or if RT was delayed (OR 1.006/day, 95%CI 1.006-1.007,P<0.001). Underascertainment of RT receipt in SEER registries was 18.7% (95% CI 18.6-18.8%), compared to 44.3% (95% CI 44.0-44.5%) in non-SEER registries. Discussion Population-based tumor registries are highly variable in ascertainment of RT receipt and should be augmented with other data sources when evaluating quality of breast cancer care. Future work should identify opportunities for the radiation oncology community to partner with registries to improve accuracy of treatment data.

Hormone therapy is the mainstay of adjuvant treatment for hormone receptor positive (HR-positive) nonmetastatic breast cancer. We evaluated adjuvant hormone therapy (AHT) initiation among Medicaid-insured women aged 21-64 years with stage I-III HR-positive breast cancer. We used multivariable logistic regression to identify independent predictors of AHT initiation. Within 1 year of diagnosis, 68% (1049/1538) initiated AHT; by 18 months, 80% (1168/1461) initiated AHT. In multivariable analysis, women less likely to initiate AHT had more comorbidity (≥ 2 vs none: adjusted odds ratio (AOR) = 0.55; 95% CI = 0.32 to 0.97), more advanced disease (stage III vs I: AOR = 0.27; 95% CI = 0.18 to 0.39), and no radiation after breast conserving surgery (AOR = 0.15; 95% CI = 0.10 to 0.22). Race, age, and history of mental health disorders were not independently associated with initiation of AHT. Among initiators of AHT, 58% (604/1049) were adherent to treatment for the year after initiation. Despite comprehensive prescription coverage, only 39% (604/1538) received optimal AHT including prompt initiation and adherence for the year after treatment. Partnerships between Medicaid programs and cancer registries may help identify at-risk women and facilitate the implementation of quality improvement strategies.

Particulate matter (PM) has been associated with adverse respiratory outcomes in numerous studies that utilized data from emergency room visits, hospital admissions, and mortality records. This study is unique in its investigation of associations of air pollution measures, including components of PM, with health outcomes in an ambulatory-care setting. Visit data were collected from Kaiser Permanente, a not-for-profit health maintenance organization in the metropolitan Atlanta, GA, area. Kaiser Permanente collaborated on the Aerosol Research Inhalation Epidemiological Study (ARIES), which provided detailed information on the characteristics of air pollutants. The Kaiser Permanente study was a time-series investigation of the possible associations between daily levels of suspended PM, inorganic gases, and polar volatile organic compounds and ambulatory care acute visit rates during the 25-month period from August 1, 1998, to August 31, 2000. For this interim analysis, the a priori 0 -2 days lagged moving average, as well as the 3-5 days and 6 -8 days lagged moving averages, of air quality measures were investigated. Single-pollutant Poisson general linear modeling was used to model daily visit counts for asthma and upper and lower respiratory infections (URI and LRI) by selected air quality metrics, controlling for temporal trends and meteorological variables. Most of the statistically significant positive associations were for the 3-5 days lagged air quality metrics with child asthma and LRI. INTRODUCTIONParticulate matter (PM) has been associated with adverse respiratory outcomes in numerous studies using data from emergency room visits, hospital admissions, and mortality records. [1][2][3][4][5][6][7][8][9][10][11][12] The few published studies that investigated associations between air pollution and outpatient visits have varied in methods, including pollutant metrics and lags. 5,13-16 These studies also have been limited in the number and range of pollutants tested. Yet, they were consistent in that they found some significant associations between air pollution and outpatient visits.The objective of this study was to investigate the relationships and lag associations between air pollution and visits for acute respiratory illnesses in an ambulatory care setting. This study had a unique focus on ambulatory care settings in the investigation of health effects of numerous air quality measures, including PM, components of PM with aerodynamic diameter less than 2.5 m (PM 2.5 ), inorganic gases, and polar volatile organic compounds (VOCs).

The purpose of this study was to describe gender differences in asthma in a managed care organization. We collected data from a patient survey, electronic administrative data, and hard-copy chart reviews. Women reported significantly lower general health status, more symptoms and greater severity of asthma, more activity limitations, more use of asthma-relieving medications, and more acute visits for asthma than men. Conversely, women tended to report better asthma care measures. These gender disparities warrant further study to support appropriate adjustment of clinical care and health-care-related services for women.

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