Using Public Health Data to Assess Vulnerability and

Cumulative Impacts to Health

Jerald A. Fagliano, M.P.H., Ph.D.Environmental and Occupational Health Surveillance Program

New Jersey Department of Health and Senior Services

April 13, 2011Clean Air Council

Outline

• What public health data sets are available?

• Data resources:– Environmental Public Health Tracking– http://nj.gov/health/epht– NJ State Health Assessment Data (NJ SHAD)– http://nj.gov/health/shad

• Using public health data to assess cumulative impacts

Key Data Sets Relevant to Environmental Public Health

• Vital Events– Births– Deaths– Infant and fetal deaths

• Health Outcome Registries– Cancers– Birth defects

• Administrative Data– In-patient hospitalization and emergency department

• Laboratory Reports on Exposure – Childhood blood lead

EPHT and NJ SHAD

• State Health Assessment Data (NJ SHAD) system, a public health data resource– Includes custom data query, public health

indicators, and links to reports

• NJ Environmental Public Health Tracking program supports and uses NJ SHAD as its data portal– Part of national EPHT Network with CDC, 25

States, and New York City

Health Disparity Priority Areas:

AsthmaCancer

Heart DiseaseKidney Disease

DiabetesHIV/AIDS

ImmunizationInfant Mortality

ObesityInjuries

Violence

Environmental Public Health

Tracking:Air Quality

Drinking WaterLead ExposureBirth OutcomesInfant Outcomes

CancersCO Poisoning

AsthmaHeart Attack

Occup. Injuries

Age-Adjusted Death Rate due to Heart Disease, NJ

and US,2000-2006

Age-Adjusted Death Rate due to Heart

Disease, by Race/Ethnicity,

2006

Percent of Live Births with Low Birth Weight ,

2001-2005

Percent of Children Under Age 5 Years of Age Living in Poverty, 2000

Percent of Infants with Low Birth

Weight, by Mother’s

Education and Prenatal Care,

2000-2007

Diseases of the heart

Malignant neoplasms Cerebrovascular diseases

All causes of death

Age-Adjusted Death Rates by Race/Ethnicity,

State of NJ,2000-2006

Age-Adjusted Death Rate due to

Cancers, by County and

Race/Ethnicity,2004-2006

Planned Improvements to NJ SHAD

• Dynamic mapping of query output

• Additional data sets:– Hospitalization and emergency department– Childhood lead exposure– Cancer

• Secure portal for access to data at finer geographic and temporal scales

Public Health Measures as Cumulative Impact Measures

• Public health measures are measures of “cumulative impact” from:– Heritable risk factors– Personal behaviors– Community/social stressors – Environmental and occupational exposures

• Challenge is in understanding how these factors interact to produce health impacts

• May indicate degree of potential vulnerability to added environmental stressors

Health Outcome Indicators of Vulnerability to Environmental Impact

• General measures of health– Mortality (age-adjusted rates)

• Overall, cardiovascular, cancer

– Infant and fetal mortality– Low birth weight among singleton, term births

• More specific measures– Childhood lead exposure – Hospitalization and emergency department use due to asthma or

heart attack– Cancer incidence

• Leukemia, lymphoma, bladder, lung

– Birth defects• Clefts, neural tube defects, heart anomalies

For more information:

• Environmental Public Health Tracking– http://nj.gov/health/epht– http://ephtracking.cdc.gov

• NJ State Health Assessment Data– http://nj.gov/health/shad

• Strategic Plan to Eliminate Health Disparities in New Jersey– http://nj.gov/health/omh/plan