@Article{info:doi/10.2196/32357,
author="Fecho, Karamarie
and Ahalt, Stanley C
and Appold, Stephen
and Arunachalam, Saravanan
and Pfaff, Emily
and Stillwell, Lisa
and Valencia, Alejandro
and Xu, Hao
and Peden, David B",
title="Development and Application of an Open Tool for Sharing and Analyzing Integrated Clinical and Environmental Exposures Data: Asthma Use Case",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="1",
volume="6",
number="4",
pages="e32357",
keywords="open patient data; electronic health records; airborne pollutant exposures; socioeconomic exposures; medication exposures; asthma exacerbation",
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 ($\alpha$=.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 $\mu$m (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. ",
issn="2561-326X",
doi="10.2196/32357",
url="https://formative.jmir.org/2022/4/e32357",
url="https://doi.org/10.2196/32357",
url="http://www.ncbi.nlm.nih.gov/pubmed/35363149"
}