%0 Journal Article
%@ 2561-326X
%I JMIR Publications
%V 6
%N 4
%P e32357
%T Development and Application of an Open Tool for Sharing and Analyzing Integrated Clinical and Environmental Exposures Data: Asthma Use Case
%A Fecho,Karamarie
%A Ahalt,Stanley C
%A Appold,Stephen
%A Arunachalam,Saravanan
%A Pfaff,Emily
%A Stillwell,Lisa
%A Valencia,Alejandro
%A Xu,Hao
%A Peden,David B
%+ Renaissance Computing Institute, University of North Carolina at Chapel Hill, 100 Europa Drive, Suite 540, Chapel Hill, NC, 27517, United States, 1 919 445 9640, kfecho@copperlineprofessionalsolutions.com
%K open patient data
%K electronic health records
%K airborne pollutant exposures
%K socioeconomic exposures
%K medication exposures
%K asthma exacerbation
%D 2022
%7 1.4.2022
%9 Original Paper
%J JMIR Form Res
%G English
%X 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. 
%M 35363149
%R 10.2196/32357
%U https://formative.jmir.org/2022/4/e32357
%U https://doi.org/10.2196/32357
%U http://www.ncbi.nlm.nih.gov/pubmed/35363149