TY  - JOUR
AU  - Fecho, Karamarie
AU  - Ahalt, Stanley C
AU  - Appold, Stephen
AU  - Arunachalam, Saravanan
AU  - Pfaff, Emily
AU  - Stillwell, Lisa
AU  - Valencia, Alejandro
AU  - Xu, Hao
AU  - Peden, David B
PY  - 2022
DA  - 2022/4/1
TI  - Development and Application of an Open Tool for Sharing and Analyzing Integrated Clinical and Environmental Exposures Data: Asthma Use Case
JO  - JMIR Form Res
SP  - e32357
VL  - 6
IS  - 4
KW  - open patient data
KW  - electronic health records
KW  - airborne pollutant exposures
KW  - socioeconomic exposures
KW  - medication exposures
KW  - asthma exacerbation
AB  - 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. 
SN  - 2561-326X
UR  - https://formative.jmir.org/2022/4/e32357
UR  - https://doi.org/10.2196/32357
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35363149
DO  - 10.2196/32357
ID  - info:doi/10.2196/32357
ER  -