SCH: Pennsylvania Asthma-COPD Syndromic Surveillance (PASS)

PROJECT SUMMARY (See instructions): Fossil-fuel-related outdoor particulate matter, ozone, and first- or second-hand cigarette smoke collectively afflict over 545 million people globally, half of which is made up of chronic obstructive pulmonary disease (COPD) and the other half with asthma cases [1] As of 2020, Pennsylvania led the country with the highest

excess mortality due to air pollution [2]. Lehigh Valley in eastern Pennsylvania, and Allentown, in particular, a city within Lehigh Valley, represents one of the worst metropolitan regions in the nation with one of the highest risks of asthma in the US [2]. However, there is an absolute absence of an early-warning system of

environmentally attributable risks for lower respiratory infection, asthma, and COPD, referred to herein as chronic respiratory syndrome (CRS) for the general US population and vulnerable citizens of Pennsylvania in particular. Furthermore, parsing out the emergent (ie., air pollution-attributable) from the legacy (ie., systemic

built environment, access, and socioeconomic disparity) risks represents a direct answer to the respiratory health needs in Pennsylvania. Our overarching goals focus on instituting an intelligent and agile early-warning system for two primary stakeholders - citizens who can visualize CRS risks in maps and clinical providers in local healthcare settings

who can manage the patient flow through outbreak prediction. Our proposed Pennsylvania Asthma-COPD Syndromic Surveillance (PASS) builds a nimble data analytic infrastructure capable of teasing apart the legacy of underlying health vulnerabilities, apart from emergent environmental risks (e.g., fossil-fuel-related air

pollution), to protect the public from CRS by integrating publicly available secondary data streams. Ours will be the first study to clarify how Pennsylvania's recurrent air pollution episodes and erratic weather patterns contribute to 'outbreaks' of lower respiratory infections in children and asthma and COPD outbreaks in all age

groups within specific geographic locations. Accordingly, we will distinguish the time-varying nature of Pennsylvania population vulnerabilities as a function of pollutant exposure burden, apart from built infrastructure disparity, socioeconomic barriers, as well as the underlying susceptibility of the residents to propose a novel

definition of environmental justice target region (Al M 1 ). We will determine the burden of poor air quality on CRS across Pennsylvania (AIM 2). Finally, we will build syndromic surveillance systems of CRS hotspots by combining air quality data with underlying susceptibilities of the population (defined in terms of health, social,

and resource disparities) (AIM 3).