‘Misleading’ health data hid higher rates of asthma-related emergency visits in St. John Parish, the state cited error

The Louisiana Department of Health has publicly misrepresented the true rates of asthma-related emergency room visits in places like St. John the Baptist, where the controversial Denka manufacturing plant is located, according to Vicki Booth, an environmental engineer and epidemiologist who spent a combined 33 years at the U.S. Environmental Protection Agency and the Centers for Disease Control and Prevention.

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

Smoothed data takes in surrounding areas outside a given geographic area, in this case neighboring parishes. Therefore, it can be more workable in certain situations, Alison Neal, LDH’s director of communications, told The Lens. CDC smooths, based on its modeling, the state-level data that health departments provide.

Since at least August 2021, the LDH has inadvertently been showing the wrong data set about the frequency of asthma-related ED visits in the state and has been unable to revert to a different data set because of a technical glitch, Neal said Friday.

“Last year, the smoothed data was inadvertently uploaded,” Neal said. “Unfortunately, a technical problem does not allow any updates to the portal. We continue to work to resolve it.”

​​”Although both the smoothed and unsmoothed datasets provided by the CDC have value (eg, the unsmoothed dataset allows you to look at differences by parish, and the smoothed dataset allows you to look at other types of breakdowns such as (in gender and race/ethnicity), we generally publish the unsmoothed data because we think it may be more intuitive for some,” she wrote.

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

In response to questions sent by The Lens, LDH updated its website on Friday to clarify that it presents smoothed data in certain circumstances. The agency also directs the public to the CDC 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 roughly twice the state average, averaging nearly 98 annual visits per 10,000 population, compared to the state average of nearly 57 visits, according to a report. prepared by Boothe, which she shared with The Lens.

But with the smoothed data set LDH shows from last year, the average number of visits in those years dropped to 55. Booth, who worked on the EPHT team that funded state health departments to submit asthma data when Louisiana was full beneficiary , said the state agency’s current presentation of data is effectively misleading the public.

“We were very, very clear that you should never place [the unsmoothed] data in a chart, you should never put that data in a table,” she said. “And you should never assume that those would be the rates for any particular county or in the case of Louisiana, parish, because in less populated areas you get a very large statistical error.”

If LDH had displayed the smoothed data on its website during Booth’s tenure at the CDC, she, along with her supervisor, “would have told them, “You can’t do that—you can’t have the tables and charts and offer these smooth rates represents the rate for each specific parish in Louisiana,” she said.

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

But in a podcast produced by the CDC, Heather Strosnider, an epidemiologist and current head of the EPHT Tracking Section, said that “the smoothed view is average over a lot counties. It should not be construed as a percentage for one particular county,” (emphasis added in CDC transcript). The “smoothed view” is intended to strengthen data sets from small geographic areas, such as counties, she said.

That’s “an average for a geographic area,” she said. “The results come from combining data from one county with data from neighboring counties; the network then calculates an average to allow the pattern to appear in the area.

Booth remembers participating in discussions during her time at the CDC in which she and her colleagues discussed the merits of offering smoothed data sets to states at all, she told The Lens. They ultimately decided to do this to benefit rural areas in states like Maine and Wisconsin, she said.

But Louisiana appears to be alone among other states with rural counties that have enjoyed EPHT grantee status like New York, Maine, and Wisconsin in showing smoothed county- or parish-level data for asthma-related ED visits.

When asked by Adrienne Kattner, associate professor of environmental and occupational health sciences at LSU Health New Orleans School of Public Health, why there was a discrepancy on the website in August 2021, Kate Friedman, an environmental health scientist, said the agency failed to mention in the “Info Section/Metadata” that it uses smoothed data.

“We apologize for the omission and are now working to correct it,” she said. “We’re having some discussions here whether to keep the smoothed data or go back to the original. I prefer the original data, but because of the surge in COVID, we don’t have the resources at BHI to help us stratify the measures that are required by the grant,” she said, referring to the integration of behavioral health.

Friedman did not mention a technical problem that would prevent the agency from updating its data. She provided an attachment that includes the unsmoothed data set.

Title VI Investigation, other investigations

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

Specifically, the EPA’s initial investigation indicates that LDH may have failed to provide residents with timely critical information about the cancer risks associated with living near the Denka facility given exposure to chloroprene, Lillian Dorka, Deputy -Assistant Administrator for External Civil Rights at EPA said in the letter addressed to LDEQ and LDH.

The EPA 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) — left black residents living near the Denka facility in St. . John the Baptist, along with those living throughout the industrial corridor, disproportionately vulnerable to harmful pollutants, according to a letter sent by the federal agency last month.

The EPA’s recommended maximum annual average air standard for chloroprene is set at 0.2 micrograms per cubic meter of air – which equates to a 100 in 1 million cancer risk. But chloroprene levels, according to EPA data, remained as high as 23,677 micrograms per cubic meter of air in St. John the Baptist by September 2021, the nonprofit legal organization Earthjustice said in its January complaint on behalf of the groups Concerned Citizens of St. John and Sierra Club.

Denka, for his part, previously pointed The Lens to the investments the company has made to reduce emissions, but at the same time said there is no evidence that its emissions cause adverse health problems.

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

These findings may be relevant to concerns about the use of smoothed data sets in general, Kim Terrell, researcher and director of community engagement at the Tulane Environmental Law Clinic (TELC), told The Lens. That’s because the hyper-local differences identified by University Network researchers 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 main drivers of asthma, or maybe the main driver.” One study showed that air quality standards vary block by block in parts of California, for example.

Terrell also helped create a TELC study first reported by The Times-Picayune that showed black residents 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 has been submitted for peer review, could help strengthen EPA’s Title VI investigations, Terrell said.

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

While asthma is, of course, a different disease than others, which may be most important to those concerned about the well-being of communities in the state’s industrial corridor, its effects should not be underestimated, Booth told The Lens. The seriousness 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 hospitalization is very serious,” she said, adding that children die from it in extreme situations.

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