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“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).

On July 16th 1979, the largest by volume radioactive spill in US history took place in Church Rock (Kinłitsosinil), which is located in the southeastern “checkerboard area” of the Navajo Nation (Diné Bikéyah) and northwestern New Mexico. Due to a breach in the former United Nuclear Corporation’s uranium mill tailings dam, an estimated ninety-four (~94) million gallons of radioactive, toxic, and highly acidic effluent spilled into the Puerco River (Brugge et al. 2002; SRIC 2009).

The Church Rock Uranium Mill Tailings Spill marked the disastrous beginning of the end for the uranium mining industry in the Navajo Nation and New Mexico. Ironically, the spill occurred on the very same day as an event 34 years prior that marked the beginning of the uranium boom and the dawn of the atomic age: the Trinity Test of July 16th 1945, “the day the sun rose twice.” (Szasz 1984) Unlike the world’s first nuclear explosion in southern New Mexico, the Church Rock mill spill remains relatively underreported and has not yet registered at a national scale of collective memory.

The authors offer a review of themes within occupational health and environmental public health surveillance over the past decade. In reviewing the history of public health surveillance, the authors highlight key acts of Congress in the 1970s that have made the development of “modern” occupational health and environmental health surveillance possible—but which also failed to develop into a cohesive and well-connected data management systems across federal agencies. Separate agencies were tasked with different data collection, management and intervention tasks in ways that fragmented the surveillance system to the point of ineffectiveness.

The authors argue that effective surveillance for occupational and environmental health demands development of a clear purpose for collecting data and having the data available to make meaningful analysis possible. They turn to the CDC’s childhood lead prevention program to demonstrate these points.