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“Misleading” health data obscured higher rates of asthma-related ER visits in St. John Parish, state cites error



According to Vickie Boothe, an environmental engineer and epidemiologist who spent time together, the Louisiana Department of Health and Human Services publicly misrepresented the true rates of asthma-related emergency room visits in places like St. John the Baptist Parish, home of the controversial Denka manufacturing facility 33 years ago the US Environmental Protection Agency and the Centers for Disease Control and Prevention.

By presenting “smoothed data” without constraint, LDH essentially halved the actual number of asthma emergency department (ED) visits in a given year in its dataset, said Boothe, who is now retired but on a voluntary basis with the Environmental Groups 350 works New Orleans and the climate reality.

Smoothed data is borrowed from surrounding areas outside of a given geographic area, in this case neighboring communities. It may therefore be more workable in certain situations, LDH communications director Alyson Neel told The Lens. The CDC smoothes state-level data provided by health authorities based on its modeling.

Since at least August 2021, LDH has been unintentionally showing the wrong dataset regarding rates of asthma-related ED visits in the state and is unable to reference another dataset due to a technical glitch, Neel said Friday.

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“Last year, the smoothed data was accidentally uploaded,” Neel said. “Unfortunately, a technical problem prevents any update of the portal. We continue to work on a solution.”

”While both the smoothed and unsmoothed datasets provided by CDC are valuable (e.g., the unsmoothed dataset allows you to look at differences by community and the smoothed dataset allows you to view other types of breakdowns such as differences in gender and race/ethnicity), we typically release the unsmoothed dataset because we think it may be more intuitive to some,” she wrote.

The agency’s website shows asthma-related ED visits for the years 2010 through 2015, when the agency was a grantee of the CDC’s National Environmental Public Health Tracking (EPHT) Network.

In response to questions from The Lens, LDH updated its website on Friday to clarify that it is presenting smoothed data in 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 the raw or unsmoothed data — that ED visits in St. John Parish from 2010 to 2014 were approximately double the state average and averaged nearly 98 annual visits per year reached a population of 10,000, compared to the national average of nearly 57 visits, according to a report Boothe produced and shared with The Lens.

But with the smoothed data set that LDH is showing since last year, the average number of visits over those years dropped to 55. Boothe, who worked on the EPHT team that funded state health agencies to submit asthma data when Louisiana was a full-fledged grantee, said the state agency’s current data presentation effectively misleads the public.

“It was very, very clear to us that you should never put that down [the unsmoothed] Data in a chart, you should never put that data in a table,” she said. “And you should never suggest that these are the rates for a specific county or, in the case of Louisiana, a municipality, because you get a very large statistical error in the less populated areas.”

Had LDH displayed the smoothed data on its website during Boothe’s tenure at the CDC, she, along with her supervisor, “would have told them, ‘You can’t do this — you can’t have the tables and charts and suggest these smooth rates and put the rate for represents a certain community in Louisiana,’” she said.

The CDC did not respond in a timely manner to a request for comment regarding the publication of this article.

But in a podcast produced by the CDC, Heather Strosnider, an epidemiologist and current EPHT tracking section chief, said that “the smoothed view is one Average Above many counties. It should not be construed as the phrase for any particular county” (italics added in the CDC written transcript). The “smoothed view” is intended to strengthen datasets from small geographic areas like counties, she said.

It’s “like an average for a geographic area,” she said. “The results come from combining data from one county with data from neighboring counties; then the network calculates an average to create a pattern within the range.”

Boothe recalls participating in discussions during her time at the CDC, in which she and her colleagues debated the merits of offering states smoothed datasets in the first place, she told The Lens. They ultimately chose to do so for the benefit of rural counties in states like Maine and Wisconsin, she said.

But it appears that among other states with rural counties enjoying EPHT grantee status, such as New York, Maine, and Wisconsin, Louisiana is the only one showing smoothed county- or community-level data for asthma-related ED visits .

When asked by Adrienne Katner, associate professor of environmental and occupational medicine at LSU Health New Orleans School of Public Health, why there was a discrepancy on the website in August 2021, Kate Friedman, environmental health scientist, explained that the agency failed to mentioning this the “info tab/metadata” that smoothed data was used.

“We apologize for the oversight and are now working to correct it,” she said. “We’re having some discussion here about whether to keep the smoothed data or go back to the original. I prefer the original data, but due to the COVID surge, we at BWI do not have the resources to assist us in stratifying the actions required for the grant,” she said, referring to behavioral health integration.

Friedman did not mention a technical issue that prevented the agency from updating its data. She provided an appendix containing the unsmoothed dataset.

Title VI Investigation, other research

Meanwhile, the EPA found evidence that LDH and the Louisiana Department of Environmental Quality killed Black residents living near the Denka facility in the community of St. John the Baptist, along with those living throughout the industrial corridor, disproportionately vulnerable to harmful pollutants, a letter the federal agency sent out last month.

In particular, the EPA’s initial investigation shows that LDH may have failed to provide these residents with important information in a timely manner about the cancer risks associated with living near the Denka facility, given exposure to chloroprene, Lilian Dorka, deputy Assistant Administrator for External Civil Rights, EPA said in the letter sent to LDEQ and LDH.

The EPA has found evidence that two state agencies tasked with protecting public health — the Louisiana Department of Environmental Quality (LDEQ) and the Louisiana Department of Health (LDH) — left black residents living nearby Those living at the Denka facility in the parish of St. John the Baptist, along with those living throughout the industrial corridor, are disproportionately vulnerable to harmful pollutants, according to a letter the federal agency sent out last month.

The EPA-recommended maximum annual average air standard for chloroprene is set at 0.2 micrograms per cubic meter of air — equivalent to a 100 in 1 million risk of cancer. But chloroprene levels remained at 23.677 micrograms per cubic meter of air in the parish of St. John the Baptist through September 2021, according to EPA data, legal nonprofit Earthjustice said in its January complaint on behalf of the St. John and Sierra Club groups Concerned Citizens.

For his part, Denka previously pointed out to The Lens the investments the company has made to reduce emissions, but said there is no evidence its emissions are causing any health problems.

However, a study conducted by the University Network for Human Rights found that cancer rates among residents living near the Denka facility are significantly higher than would be likely after accounting for age, race and gender. The study also found that residents’ cancer rates were positively correlated with their proximity to the Denka facility.

These results could be relevant to concerns about using smoothed datasets in general, Kim Terrell, research scientist and director of community engagement at Tulane Environmental Law Clinic (TELC), told The Lens. That’s because the hyperlocal differences the University Network researchers identified demonstrate the dangers of averaging data from different geographic areas.

“We know from research that air quality varies on a fairly small scale,” she said. “And air quality is one of the top reasons for asthma, or maybe even the top one.” For example, one study showed that air quality standards in parts of California varied from block to block.

Terrell also helped create a study at TELC, first reported by The Times-Picayune, showing that black residents live in the state’s industrial corridor between Baton Rouge and New Orleans, dubbed “Cancer Alley” by some environmental groups and community members. are disproportionately exposed to harmful air pollutants compared to their white counterparts. The study, which was submitted for peer review, could help support the EPA’s Title VI investigation, Terrell said.

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

While asthma is of course a different disease than others that might be top priorities for people concerned about the well-being of communities in the state’s industrial corridor, its impact should not be underestimated, Boothe told The Lens. The severity of the disease underscores the need to properly report its prevalence, she said.

“I know people don’t think of asthma as a deadly disease, but hospitalizations are very serious,” she said, adding that children die from it in extreme situations.