Analyze

“Since asthma surveillance data were not available at the census tract level for most of Louisiana, we estimated asthma burden using the inpatient discharge data available through LDH.”  (4)

“Case counts are not provided for CTs with a 2018 population of less than 800 to safeguard privacy.” (4)

“To minimize the need for suppression, inpatient discharge data was aggregated for the three most recent years available (2017–2019) and average annual crude rates were calculated for cases where asthma (ICD-10 code J45) was the primary diagnosis, as well as where asthma was any diagnosis.” (4)

“Spearman’s Rank Correlation was utilized to analyze the correlation between various social and environmental vulnerability factors, COVID-19 incidence, and the measures of asthma risk by CT.” (4)

“This was performed by first ranking the values in each dataset using RANK.AVG function in MS Excel 2016, followed by applying the PEARSON function to compare two datasets. Significance was set at alpha less than 0.05 (α < 0.05), with degrees of freedom (df) equal to two less than the total number of data points represented in both datasets” (4)

The research team works for the Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health in Baton Rouge. Team members included Arundhati Bakshi; Shanon Soileau; Collete Stewart; Kate Friedman; Collete Maser; Alexis Williams; Kathleen Aubin; and Alicia Van Doren. 

“Currently, much of the environmental focus of the pandemic remains on PM2.5 levels; however, we noted that higher levels of ozone was consistently associated with higher incidence rates of COVID-19, and it was the only environmental factor that appeared to have an additive effect over SVI on COVID-19 incidence (Fig 1).” (11)

“Specifically, our data show a moderately strong positive correlation between SVI due to minority status/language barrier and three health data variables: asthma hospitalization; estimated asthma prevalence; and cumulative COVID-19 incidence at 3 months (Table 2). Interestingly, SVI measures were either negatively or not significantly correlated COVID-19 incidence at the 9-and 12-month time points, indicating that social vulnerability factors may have played a greater role in COVID-19 spread early in the pandemic, but may have been of diminishing importance as the pandemic wore on (Fig 1 and Table 2).” (9)

Bakshi A, Van Doren A, Maser C, Aubin K, Stewart C, Soileau S, et al. (2022) Identifying Louisiana communities at the crossroads of environmental and social vulnerability, COVID-19, and asthma. PLoS ONE 17(2): e0264336. https:// doi.org/10.1371/journal.pone.0264336. 

This document uses data resources from the Center for Disease Control/Agency for Toxic Substances and Disease Registry (CDC/ATSDR), the Environmental Protection Agency (EPA), and the Louisiana Department of Health (LDH).

These data resources include the Social Vulnerability Index (2018 - CDC/ATSDR), the NATA Respiratory Hazard Index (EPA 2014), PM2.5level (average annual concentration in ug/m3, EPA 2016), ozone level (summer seasonal average of daily maximum 8-hour concentration in air in parts per billion, EPA 2016), indoor mold concerns reported to IEQES program (average annual number of calls, LDH 2017-2019), cumulative COVID-19 incidence rate at 3-, 6-, 9- and 12-month increments (LDH March 2020 - March 2021), asthma hospitalization (average annual crude rate, where asthma was a primary diagnosis among hospitalization cases, LDH 2017-2019), and estimated asthma prevalence (average annual crude rate, where asthma was any diagnosis among hospitalization cases, LDH 2017-2019).

https://thaubing.gcaa.org.tw/facility/P5805146#%E5%96%AE%E4%BD%8D%E5%9F…

About Thau Bing: https://www.freiheit.org/taiwan/thaubing-footprint-new-sustainability-m…

The Emergency Medical Treatment and Labor Act is a law requiring that anyone coming into the emergency department will be stabilized and treated no matter what their insurance situation is. In terms of women's health, it is important to note that this means for active labors, medical treatment is necessary and required, no matter the health insurance of the patient. The purpose of this law to prevent certain patients from being turned away in an emergency situation or refused medical treatments if they are unable to pay, putting their health at risk.

EMTALA was enacted by Congress in 1986 and was part of the Consolidated Omnibus Budget Reconciliation Acts of 1985. Congress saw different cases around America where doctors were refusing medical care to patients who could not make a deposit at the time of their admittance to the ER. An example of this is a patient Eugene Barnes, who in 1985 suffered a stab wound and ultimately ended up dying because 6+ doctors refused to help him without payment or some form of compensation. This made national news and other cases began to come to light, such as at Baptist Hospital in Miami and many other areas. News outlets began to follow these cases and this caught attention of government officials. Shortly after, EMTALA was enacted.

http://www.pitt.edu/~kconover/ftp/emtala-draft.pdf

This policy applies to American law and patients who are in need of emergency medical treatment and is to be followed by all emergency departments and personnel alike. 

This was touched upon a little in a previous question. Many cases of patient dumping were popping up around America. Patients in need  of emergency medical care were being cast aside, ignored and delayed due to their inability to pay. In addition to the stab patient, Eugene Barnes that sparked this law, there were dozens of other cases where patients needed to be transferred to larger hospitals but the hospital refused to take patients without insurance, so the patients died. There were cases of people being asked right before surgery for a deposit, and being unable to pay were discharged with no surgery. There was also a very high rate of dead babies that were arising due to the fact that mothers in labor were being turned away because the patient was uninsured. It was then realized by the government that there were no legal duties for a hospital to treat people who are in emergency situations but cannot pay, only ethical and moral duties, which apparently weren't enough in some cases. This led to the birth of the EMTALA, requiring medical attention to all ED patients as well as transfers if needed to stabilize, including mothers in labor.

This policy greatly helped sculpt emergency medicine and public health. By giving the right to the patient to have emergency medical treatment required without proof of insurance or payment, astronomically influenced the amount of patients being turned away and their possibilty of developing worse illnesses or dying. In a paper I read, a young doctor in the late 70s and early 80s remembers watching a woman in labor give birth in the doorway of the hospital and proceed to borht her child in the parking lot after being turned away for not having insurance. By requiring hospitals and doctors to see that all ED patients get care, no patient was at risk of dying or complicating their baby's health and birth due to a lack of insurance, ultimately increasing public health efforts. Not all hospitals turned away their patients, but enough did to make it a public health concern and get Congress involved. EMTALA changed emergency medicine protocols but also public health expectations and actions.

http://www.hhnmag.com/articles/5010-the-law-that-changed-everything-and…

This policy was explicitly made for vulnerable populations who couldn't afford or for whatever reason did not have health insurance. The vulnerable parties that did not have health insurance were at risk of being turned away at hospitals during crucial times of need and emergency situations. This act completely absolved the worries and fears of this vulnerable population without health insurance by making it a law that these ED patients were to receive care and stabilization. This act was made for this specific vulnerable population, to prevent discrimination.