Update on CDCs National Environmental Public Health Tracking Program

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Update on CDCs National Environmental Public
Health Tracking Program
Judith R. Qualters, PhD Chief, Environmental
Health Tracking Branch Division of Environmental
Hazards and Health Effects National Center for
Environmental Health Centers for Disease Control
and Prevention June 4, 2008
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Environmental Public Health Tracking

• Pew Commission Study
• Americas Environmental Health Gap
• Congressional funding
• Program initiated, 2002
• Mission To provide information from a nationwide
  network of integrated health and environmental
  data that drives actions to improve the health of
  communities

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Tracking Surveillance
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2002 to 2006 Building Capacity and Demonstrating
Utility
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CDCs Tracking Program, 2008
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Tracking Network At-A-Glance
A web-based information system that exists at the
local, state, and national level that serves the
public, environmental public health agencies,
health care providers and researchers

• Functions
• Provide Nationally Consistent Data and Measures
• Describe and Discover Data
• Exchange Data
• Provide Data Management and Analysis Tools
• Inform and Interact with the Public

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Network Goes Live in 2008!

• Building the National Network
• Design principles
• Re-use existing software and infrastructure
• Metadata for everything
• Adopt standards that exist
• Provide a flexible framework for Network
• Iterative Process
• Involves partners
• Continues beyond 2008

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National Public Portal

• Place to disseminate information
• Provides the public and policy makers with
  integrated one-stop access to health and
  environment information
• Allows for feedback and input from information
  users

Under Development!
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Under Development!
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National Secure Portal

• Supports secure communication and collaboration
  among multiple partners
• Integrates health, exposure, hazard, and other
  data
• Allows for sharing of methods, tools, and ideas
• Serves as drawing board for turning data into
  information

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Examples of State Network Requirements and
Recommendations

• Grantee Portal
• Comply with Section 508 standards
• Analysis Visualization Reporting
• Support the means to generate visual displays of
  data, including maps, charts, tables, graphs
• Data Content Discovery
• Provide the capability to execute queries to
  obtain data

• Documentation
• Provide on-line documentation
• Metadata
• Allow for the search discovery of metadata
• Secure Access
• Provide a secure login where users will be
  authenticated authorized to use data services

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Collaborative Development Process
CDC
Standards Network Development Workgroup
Program Marketing Outreach Workgroup
Content Workgroup

• Air
• Water
• Cancer
• Lead
• Birth Defects
• CO Poisoning
• Vital Statistics Births
• Hospitalizations
• Asthma/CVD

• Network Architecture
• Security
• Geography Locational
• Referencing
• Metadata

• Health Disparities
• Data Stewards
• Outreach
• Content Messaging

Portal Analysis and Visualization Team
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Content Workgroup

• NCDM recommendations to CDC
• Identify, adopt/adapt/develop, pilot
  indicators/measures
• Rationale
• Data sources
• Limitations
• Future directions
• How-to-guides
• Data to support measures
• Presentation
• Public health messages

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Vital Statistics - Birth Outcome Team

• Members
• Co-chaired by CA Tracking Program and NAPHSIS
• State and academic tracking grantees
• ASTHO, other state health depts.
• CDC Tracking Program
• Consult or review CDC DRH NCHS
• Surveillance goals
• Identify populations at risk for adverse
  reproductive outcomes and infertility
• Assist health providers in targeting medical care
  resources (e.g. prenatal care)
• Examine changes in temporal and spatial patterns
  of reproductive outcomes which may provide clues
  on contributing factors and etiology

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Team Recommendations

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Team Recommendations

• Geographic scale for national portal county,
  state
• CDC Tracking Program obtain through NCHS

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Issues Being Addressed

• Communicating any difference between Tracking
  and standard VS measures
• E.g. singleton vs. all births
• Data used by State Tracking Programs
• Options for generating measures for use on state
  portals
• Multi-state analysis

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Carbon Monoxide Team

• Members
• Co-chaired by NYC ME Tracking Program and
  CDC/APRHB
• State Tracking grantees
• RMPDC, Hartford Hospitals, other state health
  depts., NAHDO, VMMC
• CDC Tracking Program
• Surveillance goals
• Develop and implement a sustainable approach for
  national CO surveillance
• Standardize methodology for routine and
  disaster-related CO surveillance including the
  development of a standardized case definition and
  measures for surveillance

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CO Team Recommendations Vital Statistics Data

• CDC Tracking Program obtain through NCHS

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Childhood Lead Poisoning Team

• Members
• Co-chaired by CDC Tracking Program and CDC/LPPB
• State/local/academic Tracking grantees
• State CLPPP
• CDC Tracking Program
• Surveillance goals
• Identify communities where children are at high
  risk for lead poisoning for the purposes of
  guiding evaluating testing within those
  communities
• Understand spatial and temporal patterns of risk
  for lead poisoning at national, state, and local
  levels
• Evaluate testing of high risk children
• Recommendation
• Number of children tested for lead poisoning
  prior to 36 mos of age (by birth year cohort)

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Example of Type of Data Needed for National
Tracking Network
Secure Portal
aggregate partially De-identified
suppression
Public Portal
fully de-identified
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Public Portal Providing Information, Protecting
Privacy

• We want to
• Enable and inform the user
• Convey uncertainty comparability issues
• Minimize disclosure risk

• Users want to perform
• Rate readout tasks
• Pattern recognition tasks
• Pattern comparison tasks
• Time series tasks

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Data Re-release Plan

• Guidance CDC re-release policy CDC-CSTE
  workgroup recommendations
• Key principles in development
• Utility
• Privacy
• match or exceed current protection standards
• meet data stewards requirements
• Science
• EPHT plan
• Prevent display of non-zero counts lt 6 for
  geographic units with population lt 100,000 and
  associated crude rates or percentages
• Flag as unstable any rates with a RSE gt30
• Or, as determined by DSA with national partner

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National Public Portal Products and Procedures
to Protect Privacy
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National Secure Portal

• Federal IT Security Stds.
• Registered users
• Authentication CDC Secure Data Network
• Authorization
• Application Level role based
• Data access role and use based
• State provided data approval by state
• Federal/federally held data as determined by DSA

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Tracking and Vital Statistics Partnership

• Improved data
• Better tools and methods
• Available technical expertise/resources
• Increased workforce capacity
• Communications outreach

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Example Methods and ToolsRapid Inquiry Facility
(RIF)

• Developed by Small Area Health Statistics Unit
  (SAHSU), Imperial College
• Performs risk analysis around hazardous sources
  and disease mapping
• No in-depth knowledge of GIS required
• Empirical Bayes smoothing
• Additional adjustment
• Race/Ethnicity
• Socio-Economic Indicators
• Others
• Can export data for use in WinBUGS and StaTScan

Utah
Weber Davis County contaminated groundwater
plumes
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Summary

• Tracking data are essential to successful public
  health
• Provides for better determination of the need for
  environmental health studies and public health
  interventions
• Important to link people, programs, resources
• Significant up front work
• Requires a multi-tiered approach
• Staged implementation

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Questions?
For more information www.cdc.gov/nceh/tracking