Abstract
Rising adult asthma prevalence (AAP) rates and asthma emergency room (AER) visits constitute a large burden on public health in Utah (UT), a high-altitude state in the Great Basin Desert, USA. This warrants an investigation of the characteristics of the counties with the highest asthma burden within UT to improve allocation of health resources and for planning. The relations between several predictor environmental, health behavior and socio-economic variables and two health outcome variables, AAP and AER visits, were investigated for UT’s 29 counties. Non-parametric statistical comparison tests, correlation and linear regression analysis were used to determine the factors significantly associated with AER visits and AAP. Regression kriging with Utah small area data (USAD) as well as socio-economic and pollution data enabled local Moran’s I cluster analysis and the investigation of moving correlations between health outcomes and risk factors. Results showed the importance of desert/mining dust and socio-economic status as AAP and AER visits were greatest in the south of the state, highlighting a marked north–south divide in terms of these factors within the state. USAD investigations also showed marked differences in pollution and socio-economic status associated with AAP within the most populous northern counties. Policies and interventions need to address socio-economic inequalities within counties and between the north and south of the state. Fine (PM2.5) and coarse (PM10) particulate matter monitors should be installed in towns in central and southern UT to monitor air quality as these are sparse, but in the summer, air quality can be worse here. Further research into spatiotemporal variation in air quality within UT is needed to inform public health interventions such as expanding clean fuel programs and targeted land-use policies. Efforts are also needed to examine barriers to routine asthma care.
Highlights
Rising adult asthma prevalence (AAP) rates and asthma emergency room (AER) visits constitute a large burden on public health in Utah (UT) and there is considerable variation within the state [1]
Correlations between AER visits and obesity are positive across central, eastern and south eastern UT, whereas negative correlations are concentrated in the far north of the state. These results suggest that the clusters of high AER visits in the south and eastern areas of the state may be linked to rurality and lack of regular doctor visits to keep symptoms under control, which would help in avoiding AER visits
The fact that AAP and AER rates were generally higher and showed statistically significant clusters of high rates in the less PM2.5 polluted south of the state and the analysis suggested that socio-economic factors and related health behaviors may be more important to asthma studies than previously thought
Summary
Rising adult asthma prevalence (AAP) rates and asthma emergency room (AER) visits constitute a large burden on public health in Utah (UT) and there is considerable variation within the state [1].This warrants an investigation of the characteristics of the counties with the highest asthma burden within UT to improve allocation of limited health resources and for planning.According to the 2014 National Health Interview Survey (NHIS), 17.7 million or 7.4% of US adults reported current doctor-diagnosed asthma [2]. Rising adult asthma prevalence (AAP) rates and asthma emergency room (AER) visits constitute a large burden on public health in Utah (UT) and there is considerable variation within the state [1]. This warrants an investigation of the characteristics of the counties with the highest asthma burden within UT to improve allocation of limited health resources and for planning. According to the 2014 National Health Interview Survey (NHIS), 17.7 million or 7.4% of US adults reported current doctor-diagnosed asthma [2]. Res. Public Health 2020, 17, 5251; doi:10.3390/ijerph17145251 www.mdpi.com/journal/ijerph
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