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

基本信息

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
项目类别：
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

项目摘要

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 年里，真菌病已成为一个紧迫的健康问题，发病率不断上升显着增加，新病原体出现，抗真菌药物耐药性上升且流行免疫抑制病症有所增加。气候变化可能会加剧真菌病风险改变病原体适宜的环境栖息地，延长孢子的传播季节，增加孢子动员的极端气候事件的频率并进一步限制适应能力的弱势群体。对气候对人类影响的机械、定量和因果理解真菌病的分布和严重程度对于保护该地区高危人群的健康至关重要未来几十年，并解决导致社会脆弱性各轴健康差异的因素。到迄今为止，美国真菌病的流行病学研究仅限于时空范围和样本量，排除了气候和极端事件对真菌病影响的可靠表征风险。虽然作为调查真菌病、电子健康记录 (EHR) 和传染病监测系统生成大量健康数据集，可用于估计风险真菌感染的因素，包括念珠菌病、隐球菌病、曲霉病、芽生菌病、组织胞浆菌病、球孢子菌病和皮肤真菌病。通过与 Cerner（密苏里州堪萨斯城）合作，我们将分析 de- 确定了超过 9600 万患者、14 亿次就诊和 47 亿个临床事件的 EHR 数据。的一个子集数据库中包含患者 3 位数邮政编码的地理位置。我们还将分析监控自 2000 年以来加利福尼亚州所有报告的球孢子菌病病例 (>95,000) 的数据，对患者进行地理定位地址。在解决 EHR 中的错误分类、选择和缺失数据偏差后，我们的团队将估计美国真菌病发病率、住院率和死亡率的区域趋势。我们将应用现代时间序列方法来了解气候变化的影响，包括温度、降水和湿度对真菌病害的发病率和地理出现的影响。我们将调查热浪、沙尘暴、热带气旋和洪水等极端事件对发病率和影响检查基础设施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会因社会经济地位和种族而改变，并确定调节社会劣势之间关系的个人和社区层面的因素真菌感染和严重后果，例如先前存在的合并症和住房质量。我们将应用我们估计的暴露-疾病关系来量化自以来真菌病发病率的比例 2000 年归因于人为气候变化，并预测本世纪中叶和末期的重点疾病的分布和负担。该项目将加深对气候流行病学的了解美国主要真菌病的发病率，以及社会劣势和复原力在缓解未来影响中的作用。