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Abstract
Recent headlines highlight disparities in childhood lead poisoning in urban areas yet discourse does not address the lack of primary prevention options. Previous geographic information systems (GIS) approaches, concentrated on census tracts or ZIP codes, miss contextual understanding of lead exposure and make intervention impractical. Through the combination of electronic medical record (EMR) data from an urban children's hospital and spatial video geonarrative (SVG), we show how blood lead level researchers, clinicians, and public health planners can become more proactive in prediction and intervention strategies through the development of an environmental lead index (ELI). Kernel density estimation (KDE) clusters of geocoded locations of children with elevated blood lead (EBL), from 2012 to 2014, were identified using GIS. Analyses identify an increased relative risk for African American and Asian patients compared to white patients and Nepali and non-English-speaking patients compared to English-speaking patients. Fine-scale analyses of EBL clusters reveal nuances of exposure and environmental characteristics that are not identifiable at an aggregate level. Initial testing of the ELI was conducted using identified locations of EBL and non-EBL test results. The mean ELI score was higher among EBL parcels, and comparison proportions of ELI variables between EBL and non-EBL parcels found a statistically significant increase in four variables. Preliminary results support the use of the ELI as a predictive tool; further validation is needed. The technology and the method are translatable to other environments and health conditions.
晚近的新闻头条，强调城市地区儿童铅中毒的不均分佈，但该论述却未着手处理关键防治选项的缺乏。过往的地理信息系统（GIS）方法聚焦人口普查区或邮政编号，因而错失了对于铅暴露率的脉络化理解，并使得介入变得不实际。我们透过结合一座城市儿童医院的电子医疗记录（EMR）以及空间录像地理叙事（SVG），展现如何能够透过建立环境铅指标（ELI），让血液铅含量的研究者，临床医生与公共健康规划师， 在预测与介入策略上能够更为主动。本研究运用地理信息系统，指认 2012 年至 2014 年间，血铅（EBL）上升的孩童的地理编码区位的核密度评估（KDE）集群。这些分析指认出，相较于白人病患，非裔美国与亚裔病患的相对风险有所增加；而与说英语的病患相较之下，尼泊尔和不说英语的病患的风险亦有所增加。 EBL 集群的微尺度分析，揭露了在总层级上无法指认的细微暴露与环境特徵。本研究并运用 EBL 与EBL检测结果之指认区位，进行初期的ELI检验。在 EBL 的区块中， ELI 的平均数较高，且 EBL 与非 EBL 区块之间的 ELI 变数的比较比例，在四个变项中皆有统计上的显着成长。初步的结果，支持运用 ELI 作为预测的工具，但需要进一步的确认。该技术与方法可转移至其他的环境与健康条件。
Titulares recientes destacan las disparidades en envenenamiento de la niñez con plomo en áreas urbanas, aunque el discurso no aboca la falta de opciones primarias de prevención. Enfoques anteriores con sistemas de información geográfica (SIG), concentrados en distritos censales o en códigos ZIP, fallan en la comprensión contextualizada de la exposición al plomo y hacen impráctica la intervención. Mediante la combinación de datos del registro médico electrónico (EMR) de un hospital infantil urbano y la geonarrativa del video espacial (SVG), mostramos la manera como quienes investigan el nivel de plomo en la sangre, los médicos clínicos y los planificadores de salud pública pueden llegar a ser más proactivos en estrategias de predicción e intervención a través del desarrollo de un índice de plomo ambiental (ELI). Con el uso de SIG se identificaron agrupamientos del kernel de estimación de densidad (KDE) de locaciones geocodificadas de niños que registran presencia elevada de plomo en la sangre (EBL), del 2012 al 2014. Los análisis detectan un riesgo relativo en aumento en pacientes afroamericanos y asiáticos en comparación con pacientes blancos, y de pacientes nepalíes y no hablantes de inglés comparados con pacientes hablantes del inglés. Los análisis de escala fina de agrupamientos con EBL revelan matices de exposición y características ambientales que no son identificables en un nivel agregado. La prueba inicial del ELI se realizó usando localizaciones identificadas con resultados de pruebas para EBL y para no–EBL. El marcador medio de ELI fue más alto entre las parcelas con EBL, y las proporciones de comparación de las variables de ELI entre las parcelas EBL y no–EBL hallaron un aumento estadísticamente significativo en cuatro variables. Los resultados preliminares apoyan el uso del ELI como una herramienta de predicción; se requiere validación adicional. La tecnología y el método son susceptibles de traslado a otros entornos y condiciones sanitarias.
Acknowledgments
Laura Schuch would like to acknowledge the support of the Akron Children's Hospital Research Foundation and the contribution of Wallace Chambers, Cuyahoga County Board of Health, for his guidance regarding the initial development of the ELI. Also, thank you to the dedicated staff members at the Summit County Health Department, Renee Dell and Jane Trinter, who provided critical insight into the lead risk assessment process. Andrew Curtis would like to acknowledge the ongoing generosity and support of Lee Abraham, Steven Hughes, Mick Moss, and Rob Reed.
Notes
1. It should be noted that there are also problems associated with using the residential address for individual-level blood exposure data, such as the uncertain geographic context problem (UGCoP; Kwan Citation2012), which includes, for example, exposure through the activity space beyond the home residence. Residential mobility can also be a confounder as the exposure might have occurred at a previous residence.
2. Grant assistance through the local health department requires presence of a child under six years old. At-risk populations are identified through the blood lead screening and age of housing (ODH 2014). The health department advertises the available grant funds through various outreach activities.
3. Institutional review board approval was provided before data extraction was initiated.
4. The transformation is not reported so as to limit the possibility of reengineering (Curtis, Mills, and Leitner Citation2006).
5. Examples of comments related to each of these characteristics are as follows:Peeling paint
Lead paint has a very distinct way of deteriorating. … Lead paint has a very blocky, it almost looks like alligator skin. If you look across the top of the ceiling where the house numbers are, see where it is really blocky.Like that one right there, you can tell. For sure. See the posts on the front? That is typical lead paint, very blocky.Original featuresI can tell by the old components that they have. … That lattice is original lattice.Whatever was painted when they built the house in 1947 would be lead paint. They have newer aluminum windows, but they didn't change the trim.Exposed soilAnd the other issue for the home is the bare dirt, because over the years chips have fallen in the dirt. The dog walks through that, so the dog can bring that in to the living room.Water damageAnd that is water damage. Because the gutters are overflowing. You don't see any downspouts. So that is the beginning of paint issues, the water. … The leaks start the ceiling paint flaking, which is a hazard because when you walk across it, it pulverizes into dust which gets tracked into the house.Gardening activitiesI could easily see how someone could get poisoned there. Growing pots on porch, it is on a leaded porch, so it could easily get dust on it or in the soil.
6. The Summit County prevalence for 2014 is 3.6 percent.
Additional information
Notes on contributors
Laura Schuch
LAURA SCHUCH is a Doctoral Candidate in the Department of Geography at Kent State University, Kent, OH 44343. E-mail: [email protected]. Her research interests include applying geospatial methods to contextualize health challenges, to reduce health disparities, and to develop relevant solutions.
Andrew Curtis
ANDREW CURTIS is a Professor in the Department of Geography and Co-Director of the GIS Health and Hazards Lab at Kent State University, Kent, OH 44242. E-mail: [email protected]. His research interests include the mapping and analysis of problems in challenging environments using novel granular “scale of intervention” geospatial solutions. His projects primarily fall in the area of health and hazards.
Joel Davidson
JOEL DAVIDSON is a General Pediatrician and Clinical Assistant Professor in the Department of Pediatrics at Akron Children's Hospital, Akron, OH 44308. E-mail: [email protected]. His research interests include lead exposure, refugee care, and health care of underserved and vulnerable populations.