Update on CDC’s National Environmental Public Health Tracking Program

Judith R. Qualters, PhDChief, Environmental Health Tracking Branch Division of Environmental Hazards and Health EffectsNational Center for Environmental HealthCenters for Disease Control and PreventionJune 4, 2008

Environmental Public Health Tracking

Pew Commission Study America’s Environmental

Health Gap

Congressional funding Program initiated, 2002

Mission: To provide information from a nationwide network of integrated health and environmental data that drives actions to improve the health of communities

Tracking = Surveillance

2002 to 2006: Building Capacity and Demonstrating Utility

CDC’s Tracking Program, 2008

Tracking Network: At-A-Glance

Functions: Provide Nationally

Consistent Data and Measures

Describe and Discover Data

Exchange Data Provide Data

Management and Analysis Tools

Inform and Interact with the Public

A web-based information system that exists at the local, state, and national level that serves the public,

environmental public health agencies, health care providers and researchers

Network Goes Live in 2008!

Building the National Network:

Design principles• Re-use existing software and

infrastructure• Metadata for everything• Adopt standards that exist• Provide a flexible framework

for Network

Iterative Process Involves partners Continues beyond 2008

EPHTN Partner

Report

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Grantee Tracking Portals

Asthma Report

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TOOLS, METHODS, AND OTHER RESOURCES

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MethodsTools

DATA CLASS; INPUT NAME $ AGE HEIGHT WEIGHT; If age < 13 then group = else group = 'teen'; logwt = log10(weight); /* transform variables */ rootht= sqrt(height);

SAS Code

.EXE

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NATIONAL GATEWAY

PHIN Receiver

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EPHTN Secured

NCM

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METADATA SERVICES

MD CreationEPHTN Profiles

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MD Registry

MD Records

Find

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PARTNER INTERFACES

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MetadataRegistry

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PARTNER DATA

NCDMs

GRANTEE DATA

GRANTEE GATEWAY

AND CLIENTGRANTEE DATA

National Public Portal Place to disseminate information Provides the public and policy makers with integrated

one-stop access to health and environment information Allows for feedback and input from information users

Under Development!

Under Development!

National Secure Portal

Supports secure communication and collaboration among multiple partners

Integrates health, exposure, hazard, and other data

Allows for sharing of methods, tools, and ideas Serves as drawing board for turning data into

information

Examples of State Network Requirements and Recommendations

Grantee Portal Comply with Section 508

standards

Analysis Visualization & Reporting Support the means to

generate visual displays of data, including maps, charts, tables, & graphs

Data Content & Discovery Provide the capability to

execute queries to obtain data

Documentation Provide on-line

documentation

Metadata Allow for the search &

discovery of metadata

Secure Access Provide a secure login

where users will be authenticated & authorized to use data & services

Collaborative Development Process

CDC

ProgramMarketing & OutreachWorkgroup

ContentWorkgroup

• Network Architecture• Security• Geography & Locational Referencing• Metadata

• Health Disparities• Data Stewards• Outreach• Content Messaging

• Air• Water• Cancer• Lead• Birth Defects• CO Poisoning• Vital Statistics – Births• Hospitalizations – Asthma/CVD

Standards& Network

DevelopmentWorkgroup

Portal Analysis and Visualization Team

Content Workgroup

NCDM recommendations to CDC Identify, adopt/adapt/develop,

pilot indicators/measures• Rationale• Data sources• Limitations• Future directions• How-to-guides

Data to support measures Presentation Public health messages

Vital Statistics - Birth Outcome Team

Members Co-chaired by CA Tracking Program and NAPHSIS State and academic tracking grantees ASTHO, other state health depts. CDC Tracking Program

Consult or review: CDC DRH; NCHS

Surveillance goals Identify populations at risk for adverse reproductive outcomes and

infertility Assist health providers in targeting medical care resources (e.g.

prenatal care) Examine changes in temporal and spatial patterns of reproductive

outcomes which may provide clues on contributing factors and etiology

Team Recommendations

Indicator of Prematurity a.Incidence (Percent) of preterm births among singleton

live born infantsb.Incidence (Percent) of very preterm births among

singleton live born infantsc. Incidence (Percent) very low birth weight births

(<1500 g) among singleton live born births

Indicator of Growth Retardation a.Incidence (Percent) low birth weight births (<2500 g)

among term singleton live born births

Indicator of Mortality a.Infant Mortality Rateb.Neonatal Mortality Ratec. Perinatal Mortality Rated.Post-Neonatal Mortality Rate

Team Recommendations

Geographic scale for national portal: county, state

CDC Tracking Program obtain through NCHS

Indicator of Fertility a.Total Fertility Rateb.Infertility Rate (developmental) – not adopted

Indicator of Sex ratio at birth a.Sex Ratio at Birth

Indicator of Early Puberty a.Age at menarche (developmental) – not adopted

Issues Being Addressed

Communicating any difference between Tracking and standard VS measures E.g. singleton vs. all births

Data used by State Tracking Programs Options for generating measures for use on

state portals Multi-state analysis

Carbon Monoxide Team

Members Co-chaired by NYC [ME] Tracking Program and CDC/APRHB State Tracking grantees RMPDC, Hartford Hospitals, other state health depts.,

NAHDO, VMMC CDC Tracking Program

Surveillance goals Develop and implement a sustainable approach for national

CO surveillance Standardize methodology for routine and disaster-related

CO surveillance including the development of a standardized case definition and measures for surveillance

CO Team Recommendations – Vital Statistics Data

Carbon Monoxide Poisoning Mortalitya. Annual number of deaths from CO poisoning by

State, County and Cause/Intent (Fire-related, non-fire related, unknown)

b. Annual crude rate of death from CO poisoning per 100,000 population by State, County and Cause/Intent (Fire-related, non-fire related, unknown)

c. Annual age-adjusted rate of death from CO poisoning per 100,000 population by State, County and Cause/Intent (Fire-related, non-fire related, unknown)

CDC Tracking Program obtain through NCHS

Childhood Lead Poisoning TeamMembers

Co-chaired by CDC Tracking Program and CDC/LPPB State/local/academic Tracking grantees State CLPPP CDC Tracking Program

Surveillance goals Identify communities where children are at high risk for lead poisoning for

the purposes of guiding & evaluating testing within those communities Understand spatial and temporal patterns of risk for lead poisoning at

national, state, and local levels Evaluate testing of high risk children

Recommendation: Number & % of children tested for lead poisoning prior to 36 mos of age (by

birth year cohort)

Example of Type of Data Needed for National Tracking

Network

county state diagnosis agegroup sex race ethnicity other variables countFulton GA CO poisoning 20 to 24 F W NH fire related 2Fulton GA CO poisoning 20 to 24 F B NH fire related 1

suppression

county state diagnosis agegroup sex race ethnicity other variables countFulton GA CO poisoning 20 to 24 F W NH fire related suppressedFulton GA CO poisoning 20 to 24 F B NH fire related suppressed

aggregatepartiallyDe-identified

fully de-identified

Secure Portal:

Public Portal:

Public Portal: Providing Information, Protecting

PrivacyUsers want to perform:Rate readout tasksPattern recognition

tasksPattern comparison

tasksTime series tasks

We want to:Enable and inform

the userConvey

uncertainty & comparability issues

Minimize disclosure risk

Data Re-release Plan Guidance: CDC re-release policy; CDC-CSTE workgroup recommendations

Key principles in development: Utility Privacy

• match or exceed current protection standards• meet data stewards requirements

Science

EPHT plan: Prevent display of non-zero counts < 6 for geographic units with population <

100,000 and associated crude rates or percentages Flag as unstable any rates with a RSE >30% Or, as determined by DSA with national partner

National Public Portal: Products and Procedures to Protect

PrivacyProduct Procedure

Prepared reports

1. aggregation & variable restriction2. primary and complementary

suppression3. warning of statistical instability

Pre-configured tables,

charts, & maps

1. aggregation & variable restriction2. primary and complementary

suppression3. warning of statistical instability

User-defined queries

1. aggregation & variable restriction2. presentation of health and

biomonitoring data as smoothed or age-adjusted measures

3. warning of statistical instability

National Secure Portal

Federal IT Security Stds. Registered users

1. Authentication – CDC Secure Data Network2. Authorization –

• Application Level – role based• Data access – role and use based

State provided data – approval by state Federal/federally held data – as determined by DSA

Tracking and Vital Statistics Partnership

Improved data Better tools and methods Available technical

expertise/resources Increased workforce

capacity Communications &

outreach DATA

INFORMATION

KNOWLEDGE

ACTION

Example: Methods and ToolsRapid Inquiry Facility (RIF)

Developed by Small Area Health Statistics Unit (SAHSU), Imperial College

Performs risk analysis around hazardous sources and disease mapping No in-depth knowledge of GIS

required Empirical Bayes smoothing Additional adjustment

• Race/Ethnicity• Socio-Economic Indicators• Others

Can export data for use in WinBUGS and StaTScan

Weber County

The Great Salt Lake

Hill AFBHill AFB

Utah

Weber & Davis County contaminated groundwater plumes

Tracking data are essential to successful public health Provides for better

determination of the need for environmental health studies and public health interventions

Important to link people, programs, resources

Significant “up front” work Requires a multi-tiered approach Staged implementation

Summary

Questions?

For more information: www.cdc.gov/nceh/tracking