‘Misleading’ health data hid high rate of asthma-related ER visits in St. John Parish, state cites error

The Louisiana Department of Health has publicly misrepresented true rates of asthma-related emergency room visits in places like St. John the Baptist Parish, home to the controversial Denka manufacturing plant, according to Vicki Boothe, an environmental engineer and epidemiologist. , who had spent a joint. 33 years at the US Environmental Protection Agency and the Centers for Disease Control and Prevention.

By presenting “smoothed data” without qualification, the LDH essentially halved the actual number of asthma-related emergency department (ED) visits in any given year in its dataset, said Boothe, who is now retired but Work on a volunteer basis with environmental groups 350 New Orleans and Climate Reality.

Smoothed data borrows from surrounding areas outside a given geographic area, in this case, neighboring parishes. So it may be more practical in some situations, Alison Neill, director of communications for LDH, told The Lens. The CDC smooths its modeling based on state-level data provided by health departments.

Neal said Friday that since at least August 2021, LDH unintentionally displayed the wrong dataset about rates of asthma-related ED visits in the state, and is unable to revert to a different dataset.

“Last year, the smoothed data was inadvertently uploaded,” Neil said. “Unfortunately, a technical issue is preventing any updates to the portal. We continue to work to resolve this.”

While both the smoothed and un-smoothed data sets provided by the CDC have value (for example, the un-smoothed data set allows you to see differences by parish, and the smoothed data set allows you to see other types of breakdowns). allows differences such as gender and race/ethnicity), we generally post un-smoothed data sets because we think it may be more smooth for some,” she wrote.

The agency’s website displays asthma-related ED visits from the years 2010 to 2015, when the agency was a grantee of CDC’s national Environmental Public Health Tracking (EPHT) network.

In response to questions submitted by The Lens, LDH updated its website on Friday to clarify that it is offering easier data under certain circumstances. The agency also directs the public to the CDC’s website, which provides both smoothed and unsmoothed data.

Prior to August 2021, the Louisiana Health Data Portal showed – using raw, or unsmoothed data – that ED visits in St. John Parish from 2010 to 2014 were nearly double the state average, with an average of about 98 annual visits. was. That compares to a statewide average of about 57 visits per 10,000 population, according to a report Boothe shared with The Lens.

But with the smoothed dataset displayed by LDH from last year, the average number of visits dropped to 55 in those years. , said the state agency’s current data presentation effectively misleads the public.

“We were very clear that you should never put [the unsmoothed] data in a chart, you should never put that data in a table,” she said. “And you should never suggest that it would be rates for a particular county or parish, in the case of Louisiana, because of the low population. In areas with , you get a very wide statistical error.”

If the LDH had displayed smooth data on its website during Boothe’s tenure at the CDC, she would, along with her supervisor, “tell them, ‘You can’t do that—you can’t have tables and charts and make suggestions. Those smoothed rates represent the rate for a particular Louisiana parish,” she said.

The CDC did not respond to a request for comment in time for this article’s publication.

But on a podcast produced by the CDC, Heather Strossneider, epidemiologist and current section chief of the EPHT tracking section, said that “the smooth visualization is a average above Many counties. It should not be interpreted as a rate for a particular county,” (italics added in the CDC’s written transcript). The “smoothing view,” he added, is to consolidate datasets from smaller geographic areas, such as counties.

That’s “sort of the average for the geographic area,” she said. “The results come from combining data from one county with data from neighboring counties; So the network calculates an average to allow a pattern to emerge within the region.

Boothe recalled participating in discussions during his time at the CDC in which he and his colleagues debated the merits of offering the Smoothed dataset to all states, he told The Lens. They ultimately decided to do so for the benefit of rural counties in states such as Maine and Wisconsin, she said.

But it appears that Louisiana is alone among other states with rural counties that, like New York, Maine, and Wisconsin, enjoy EPHT-granting status in displaying smooth data at the county, or parish level, for asthma-related ED visits. have taken.

When asked by Adrienne Kattner, associate professor of environmental and occupational health sciences at the LSU Health New Orleans School of Public Health, why the discrepancy was on the website during August 2021, environmental health scientist Kate Freedman said the agency neglected to mention . “Info tab / Metadata” that it was using the smoothed data.

“We apologize for the oversight and are now working to fix it,” she said. “We are having some discussions here on whether to keep the smoothed data or go back to the original. I prefer the original data, but due to the COVID surge, we have the grants to help us stratify the measures needed BHI doesn’t have the resources to do that,” she said, referring to behavioral health integration.

Friedman didn’t mention any technical issues that would prevent the agency from updating its data. He provided an attachment that contained the unsmoothed dataset.

Title VI Investigations, Other Research

Meanwhile, the EPA has found evidence that LDH and the Louisiana Department of Environmental Quality have exposed black residents living near the Denka facility in St. John the Baptist Parish, as well as people living throughout the industrial corridor, to harmful pollutants. Insecurely vulnerable to. A letter was sent by the federal agency last month.

Specifically, EPA’s preliminary investigation suggests that LDH may have failed to provide timely, critical information to those residents about the cancer risks associated with living near the Denka facility, chloroprene, Lillian Dorka, External Being in contact with the deputy assistant administrator for civil rights, the EPA said in the letter addressed to the LDEQ and LDH.

The EPA has found evidence that two state agencies charged with protecting public health – the Louisiana Department of Environmental Quality (LDEQ) and the Louisiana Department of Health (LDH) – black residents living near the Denka facility in St. John Baptist Parish left it. People living along the entire industrial corridor are disproportionately vulnerable to harmful pollutants, according to a letter sent out last month by the federal agency.

The EPA’s recommended maximum annual mean air standard for chloroprene is set at 0.2 micrograms per cubic meter of air—the equivalent of a 1 in 100 cancer risk. But chloroprene levels remained as high as 23.677 micrograms per cubic meter of air in St. John the Baptist Parish as of September 2021, according to EPA data, the legal nonprofit EarthJustice said in its complaint in January on behalf of the groups. St. John and the Sierra Club.

Denka, for his part, previously pointed to The Lens the investments the company has made to reduce emissions, yet said there is no evidence its emissions are causing adverse health problems. .

But a study by the University Network for Human Rights found cancer rates were significantly higher for residents living near the Denka facility after controlling for factors such as age, race and gender. The study also found that residents’ cancer rates were positively correlated with their proximity to the DENCA facility.

Kim Terrell, research scientist and director of community engagement at the Tulane Environmental Law Clinic (TELC), told The Lens that those findings may be relevant to concerns surrounding the use of smoothed datasets in general. That’s because the hyper-local differences that University Network researchers identified demonstrate the dangers of averaging data from different geographic regions.

“We know from research that air quality varies on very small scales,” she said. “And air quality is one of the main drivers of asthma, or maybe the main driver.” One study showed that air quality standards vary from block-to-block in some parts of California, for example.

Terrell also helped produce a study at TELC, first reported by The Times-Picayune, that featured black residents in the state’s industrial corridor between Baton Rouge and New Orleans, which some environmental Called “Cancer Alley” by groups and community members who are disproportionately exposed. harmful air pollutants than their white counterparts. Terrell said the study, which has been submitted for peer review, could help strengthen the EPA’s Title VI investigation.

“For more than 60 years, St. James Parish has concentrated heavy industry in the same two black neighborhoods on each side of the Mississippi River,” Gail LeBoeuf, St. James resident and co-founder of Inclusive Louisiana, said of Tulane study.

Of course, asthma is a disease different from others, which may be most important to those concerned about the well-being of communities in the state’s industrial corridor, Boothe told The Lens, but its effects shouldn’t be underestimated. He said the seriousness of the disease underscores the need to properly report its spread.

“I know people don’t think of asthma as a fatal disease, but it is serious enough to require hospitalization,” he said, adding that children die from it in extreme cases.

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