142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Technology-driven asthma data can support surveillance efforts: The public health perspective

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 1:30 PM - 1:50 PM

LaQuandra Nesbitt, MD, MPH , Louisville Metro Public Health & Wellness, Louisville, KY
Meredith Barrett, PhD , Propeller Health, San Francisco, CA
Olivier Humblet, ScD , Propeller Health, San Francisco, CA
Justine Marcus, BA , Propeller Health, San Francisco, CA
Ted Smith, PhD , Economic Growth and Innovation, Louisville Metro Government, Louisville, KY
David Van Sickle, PhD , Propeller Health, Madison, WI

Louisville, Kentucky, is one of the top 20 “most challenging” cities in which to live with asthma. It failed to meet the National Ambient Air Quality Standard for PM2.5 in 2010, and asthma was the sixth leading cause of inpatient hospitalizations in the county. The asthma burden is not distributed uniformly across Louisville; disparities in asthma morbidity exist for specific geographic areas, low income communities and communities of color. African American males are almost twice as likely to be hospitalized for asthma compared with other groups in Louisville. Current public health programs rely on hospitalization data as a proxy for poor asthma outcomes.


The city partnered with Propeller Health to pilot a sensor-driven asthma program to help supplement these data, strengthen surveillance efforts and target interventions.


Program participants received electronic inhaler sensors that tracked the frequency and location of rescue inhaler use for 13 months. These aggregated and anonymized data were then combined with socioeconomic and environmental data, and hotspots of high asthma inhaler use were identified.


Geographic hotspots of asthma inhaler use will inform the targeting of public health programming, such as home-based environmental evaluations that could be paired with existing lead testing programs. Predictive modeling identified areas of high risk where interventions such as community greening and traffic reductions should be prioritized.


Real-time, sensor-collected asthma data can add value to public health surveillance when combined with existing data on asthma hospitalizations and socioeconomic and environmental drivers. When conducted at a population level, this type of vertically-integrated asthma surveillance program could provide policy and programmatic recommendations to the reduce asthma burden and disparities. Future iterations of this program should deploy more sensors over diverse areas within the county and address the methodological limitations of clustered participation’s effect on the representativeness of asthma hotspots.

Learning Areas:

Chronic disease management and prevention
Environmental health sciences
Public health or related research

Learning Objectives:
Describe asthma burden and disparities within the Louisville metro region. Discuss the current state of public health surveillance structure and data in Louisville and its limitations. Identify applications of public health data tracking that can help address socioeconomic determinants of health through programmatic action.

Keyword(s): Public Health Research, Air Pollution & Respiratory Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Director of the Louisville Metro Public Health & Wellness Department, and previously held top positions at the D.C. Health Department and University Of Maryland School of Medicine. A practicing physician, my academic interests include racial and ethnic disparities in health care and improving access to care for the uninsured and underinsured. I earned a Master of Public Health in Health Care Management from the Harvard School of Public Health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.