Using massive, multi-regional EHR data to estimate the impacts of climate change on fungal disease epidemiology in the U.S.

使用大量、多区域 EHR 数据来估计气候变化对美国真菌病流行病学的影响

• 批准号: 10681813
• 负责人: Mark Hoffman
• 金额: $ 82.31万
• 依托单位: UNIVERSITY OF MISSOURI KANSAS CITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10681813
• 关键词: Address; Affect; Age; Antifungal Agents; Area; Arthrodermataceae; Aspergillosis; Blastomycosis; California; Candidiasis; Case Study; Cities; Climate; Clinical; Coccidioidomycosis; Communicable Diseases; Communities; Coupled; Cryptococcosis; Cryptococcus gattii; Data; Data Set; Databases; Digit structure; Disease; Disease Outcome; Disease Surveillance; Economics; Electronic Health Record; Environment; Environmental Risk Factor; Epidemiology; Ethnic Origin; Event; Face; Floods; Frequencies; Fungal Drug Resistance; Future; Geographic Distribution; Geographic Locations; Geography; Habitats; Health; Health protection; Heat Waves; Heterogeneity; Histoplasmosis; Hospitalization; Housing; Human; Humidity; Hurricane; Immunocompromised Host; Incidence; Income; Individual; Infrastructure; Investments; Kansas; Location; Longitudinal trends; Mediating; Meta-Analysis; Methods; Modernization; Mycoses; Neighborhoods; Outcome; Patients; Policy Maker; Population; Precipitation; Prevalence; Public Health; Race; Reproduction spores; Research; Resources; Risk; Risk Estimate; Risk Factors; Role; Sample Size; Seasons; Series; Severities; Socioeconomic Status; Soil; Surveys; System; Temperature; Testing; Time; Tornadoes; Visit; Vulnerable Populations; anthropogenesis; climate change; climate impact; climate variability; clinical encounter; community-level factor; comorbidity; deprivation; disease disparity; disorder risk; dust storms; emerging pathogen; epidemiology study; experience; health data; health disparity; health equity; high risk population; improved; indexing; low socioeconomic status; mortality; pathogen; pathogenic fungus; payment; prevent; resilience; response; social disparities; social vulnerability; socioeconomics; soft tissue; spatiotemporal; surveillance data; transmission process; trend

ABSTRACT In the past 40 years, fungal diseases have emerged as a pressing health concern, as incidence rates have increased markedly, novel pathogens have emerged, resistance to antifungal drugs has risen and prevalence of immunosuppressive conditions has increased. Changes in climate may exacerbate fungal disease risks by shifting the suitable environmental habitat for pathogens, lengthening the transmission season of spores, increasing the frequency of extreme climate events that mobilize spores and further straining adaptive capacity of vulnerable populations. A mechanistic, quantitative, and causal understanding of the effects of climate on the distribution and severity of fungal diseases will be critical to protecting the health of high-risk groups in the coming decades, and to addressing factors leading to health disparities across axes of social vulnerability. To date, epidemiologic studies of fungal diseases in the U.S. have been limited in spatiotemporal scope and sample size, precluding robust characterization of the impact of climate and extreme events on fungal disease risk. While largely untapped as a resource for investigating fungal disease, electronic health record (EHR) and infectious disease surveillance systems generate massive health datasets that can be used to estimate risk factors for fungal infections, including candidiasis, cryptococcosis, aspergillosis, blastomycosis, histoplasmosis, coccidioidomycosis and dermatomycosis. Via partnership with Cerner (Kansas City, MO), we will analyze de- identified EHR data for over 96 million patients, 1.4 billion visits, and 4.7 billion clinical events. A subset of the databases is available with geographic locations of patient 3-digit zip codes. We will also analyze surveillance data on all reported cases (>95,000) of coccidioidomycosis in California since 2000, geolocated to patient address. After addressing misclassification, selection, and missing data biases in the EHR, our team will estimate regional trends in incidence, hospitalization and mortality rates for fungal diseases in the U.S. We will apply modern time series approaches to understand the effects of climate variability, including in temperature, precipitation, and humidity, on fungal disease incidence and geographic emergence. We will investigate the impacts of extreme events such as heat waves, dust storms, tropical cyclones and flooding on incidence and examine whether investment in infrastructure can mitigate effects. We will determine whether exposure- response relationships between climate and fungal infection are modified by socio-economic status and race, and identify individual- and community-level factors that mediate the relationship between social disadvantage and fungal infections and severe outcomes, such as preexisting comorbidities and housing quality. We will apply our estimated exposure-disease relationships to quantify the proportion of fungal disease incidence since 2000 that is attributable to anthropogenic climate change, and project mid- and end-of-century estimates of the distribution and burden of key diseases. The project will yield robust understanding of the climate epidemiology of major mycoses in the U.S., and the role of social disadvantage and resilience in moderating future impacts.

抽象的 在过去的40年中，真菌疾病已成为紧迫的健康问题，因为发病率已有 明显增加了新的病原体，对抗真菌药物的耐药性已上升和患病率 免疫抑制条件有所增加。气候变化可能会加剧真菌疾病的风险 转移病原体的合适环境栖息地，延长孢子的传输季节， 增加了动员孢子并进一步应变适应能力的极端气候事件的频率 脆弱人群。对气候影响的机械，定量和因果理解 真菌疾病的分布和严重程度对于保护高风险群体的健康至关重要 未来几十年，并解决导致社会脆弱性轴的健康差异的因素。到 日期，美国真菌疾病的流行病学研究在时空范围和 样本量，排除气候和极端事件对真菌疾病的影响的强大表征 风险。虽然在很大程度上尚未被视为研究真菌疾病，电子健康记录（EHR）和 传染病监视系统产生可用于估计风险的大量健康数据集 真菌感染的因素，包括念珠菌病，隐球菌病，曲霉菌病，囊性病，组织胞浆病， 球虫病和皮肤病。通过与Cerner（密苏里州堪萨斯城）的合作伙伴关系，我们将分析 确定了超过9600万患者，14亿次就诊和47亿次临床事件的EHR数据。一个子集 数据库可提供患者3位邮政编码的地理位置。我们还将分析监视 自2000年以来，加利福尼亚州所有报道的球菌病病例（> 95,000例）的数据，将其分解为患者 地址。在解决了EHR中的错误分类，选择和缺少数据偏见之后，我们的团队将 估计美国真菌疾病的发生率，住院和死亡率的区域趋势 采用现代时间序列方法来了解气候变异性的影响，包括在温度下 关于真菌疾病发生率和地理出现的降水和湿度。我们将调查 极端事件的影响，例如热浪，沙尘暴，热带气旋以及发病率和洪水 检查基础设施的投资是否可以减轻影响。我们将确定是否暴露 - 气候和真菌感染之间的反应关系通过社会经济地位和种族修改， 并确定介导社会劣势之间关系的个人和社区级别的因素 以及真菌感染和严重的结果，例如早期存在和住房质量。我们将 应用我们估计的暴露症关系来量化真菌疾病发生率的比例，因为 2000年归因于人为气候变化，以及中期和本世纪中期的估计值 关键疾病的分配和负担。该项目将对气候流行病学产生强烈的理解 美国主要的mycoses，以及社会劣势和韧性在调节未来影响方面的作用。