Childhood Asthma and Hazardous Substances

Childhood Asthma and Hazardous Substances
In 1999, ATSDR entered a 3-year cooperative agreement with the Utah Department of Health and the Massachusetts Department of Public Health to conduct asthma research. Studies conducted under this cooperative agreement will examine patterns of asthma among children in relation to estimates of exposure to hazardous substances. The purposes of this program are threefold:

to use available data sources on asthma to evaluate the contribution of environmental exposures to asthma among children,


to provide generalizable scientific information about the association between hazardous substances and childhood asthma, and


to develop a methodology that could be useful in responding to questions about the health impact of air releases of hazardous substances.

Asthma is the most common chronic disease of childhood and a leading cause of disability among children in the United States. Since 1980, asthma incidence has increased dramatically in children. From 1980 to 1995, asthma incidence among persons aged 0-17 years increased approximately 5% each year (1).

Several agencies and institutes within the Department of Health and Human Services, including ATSDR, together developed a national strategic plan that outlines four priority areas for action against asthma (2). ATSDR research contributes to two of the plan's priority areas:

to reduce the burden of asthma for people with the disease, and


to eliminate the disproportionate health burden of asthma in minority populations and those living in poverty.




Analysis of Childhood Asthma and Hazardous Sites in Utah
Under this project, the Utah Department of Health will study variations in the risk for childhood asthma in four urban counties and determine whether rates of asthma increase in children living near hazardous waste sites or industrial emission sources. Data from almost 20 hospitals in four urban counties will be used to obtain data on asthma for children zero to 14 years of age. This project will use geographic information systems (GIS) to identify high-risk areas, which can lead to public health action. Analyses will identify areas with high incidences of childhood asthma and assess the cases of asthma alone and in relation to sources of potential hazardous substances.

Pediatric Asthma in the Merrimack Valley, Massachusetts
In a two-part study, the Massachusetts Department of Public Health aims to

assess whether the pediatric asthma rate in each community in the Merrimack Valley is higher than the rate from a demographically similar comparison community and


compare pediatric asthma rates in areas in the valley where the possibility is higher for exposure to incinerator emissions to areas where the possibility for exposure is lower.
The project will use school health records to identify students with asthma and will collect environmental data from the Massachusetts Department of Environmental Protection. GIS will be used to map the locations of the pediatric asthma cases and sources of exposure.

Prevalence of Multiple Sclerosis Near Hazardous Waste Sites
In cooperation with state and local public health partners, ATSDR is developing a capacity to

respond to community concerns about MS and


more fully understand the epidemiology of MS.
Under a grant funded by ATSDR, the Texas Department of Health recently completed an investigation of MS among members of a community living next to a metal smelter. The number of MS cases among this cohort was twofold higher than expected (3). ATSDR has also entered into cooperative agreements with the Ohio Department of Health; the Jackson County, Missouri, Health Department; and the Texas Department of Health. Investigators will use neurologists' records to determine age-specific and sex-specific MS prevalence rates in the study areas of Lorain County, Ohio, Independence and Sugar Creek, Missouri, and a 19-county area around Lubbock, Texas. The three geographically and ethnically diverse study areas include more than 800,000 people. Researchers expect to gather information on 475 to 775 MS cases. The Texas study area also will allow for an estimation of prevalence among Hispanics, a population for which no reliable MS data exist.


Multiple sclerosis (MS) is a chronic disease of the central nervous system. MS is believed to be caused by a combination of environmental, genetic, and immunologic factors. The majority of persons with MS are 40-60 years old and suffer moderate to severe disability (4). MS is approximately twice as common in women than in men, and the number of women reporting MS as a cause of disability has doubled in recent years (4). Estimates of the number of people with MS in the United States have ranged from 125,000 to 350,000 (4, 5, and 6). Residents of several communities living near hazardous waste sites have expressed concerns about perceived elevated rates of MS and the possible association with environmental contaminants. Because no registries for MS exist at the federal, regional, or state level, health agencies have found it difficult to respond to these concerns.



In addition to establishing background MS prevalence estimates for three geographically and ethnically diverse areas, the three grantees will work with local MS support groups and other community groups to help identify individuals with MS and to communicate project findings. In collaboration with ATSDR, grantees will help to develop procedures and data collection instruments to be used for case ascertainment and case verification in other communities concerned about MS. These cooperative agreements will serve as a basis for future studies of MS and an investigation of potential environmental risk factors.

Conclusion
The epidemiology of chronic diseases possibly linked to conditions in the environment must be better understood. Through these collaborative projects, ATSDR will enhance the ability of state and local health departments to work with a variety of data sources and, when feasible, evaluate the contribution of environmental exposures to these conditions.

ATSDR will announce the availability of funding during fiscal year 2003 to support additional activities similar to those described previously. Please check the Federal Register notices for more information, or contact the project coordinators directly at 404-498-0104. These continued efforts are consistent with recommendations made by the Pew Environmental Health Commission in its September 2000 report, America's Environmental Health Gap: Why the Country Needs a Nationwide Health Tracking Network (7). The results of these projects will provide generalizable scientific information and allow the development of a methodology that other state and local health departments could use in responding to questions about the health impact of hazardous substances at specific sites.