title: Proximity to Industrial Food Animal Production and Asthma Exacerbations in Pennsylvania, 2005-2012.
abstract: The research on industrial food animal production (IFAP) and asthma exacerbations in the United States has relied on small sample sizes and/or self-reported outcomes. We assessed associations of proximity to large-scale and densely stocked swine and dairy/veal IFAP with three types of asthma exacerbations: hospitalizations, emergency encounters, and oral corticosteroid (OCS) medication orders from Geisinger Clinic in Pennsylvania. We used a diagnosis code (International Classification of Diseases, 9th Revision, Clinical Modificationcode 493.x) and medication orders from electronic health records to identify these exacerbations among asthma patients (n= 35,269) from 2005-2012. We compared residential proximity to swine or dairy/veal IFAP (dichotomized as <3 miles (4.8 km) or ≥3 miles) among asthma patients with and without exacerbations and estimated odds ratios using multilevel logistic regression. In adjusted models, proximity to IFAP was associated (odds ratio (95% confidence interval)) with OCS orders (1.11 (1.04-1.19)) and hospitalizations (1.29 (1.15-1.46)), but not emergency encounters (1.12 (0.91-1.37)). This study contributes to growing evidence that IFAP may impact health, in this case clinically-documented asthma exacerbations. No prior study has evaluated the association of IFAP and clinically-documented asthma exacerbations in the United States.
authors.affiliation: Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. srasmus7@jhu.edu.
authors.forename: Sara G
authors.initials: SG
authors.lastname: Rasmussen
authors.affiliation: Department of Environmental Science, Policy & Management, University of California, Berkeley, Berkeley, CA 94720, USA. joanacasey@berkeley.edu.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Casey
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. kbandee1@jhu.edu.
authors.forename: Karen
authors.initials: K
authors.lastname: Bandeen-Roche
authors.affiliation: Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. bschwar1@jhu.edu.|Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, PA 17822, USA. bschwar1@jhu.edu.|Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA. bschwar1@jhu.edu.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000822:Animal Husbandry; D000818:Animals; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000209:etiology* / Q000628:therapy; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007221:Industry; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010414:Pennsylvania; D012111:Residence Characteristics; D013552:Swine; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents
keywords: asthma; asthma exacerbation; concentrated animal feeding operation (CAFO)