Finding Research Data Sources for

Populations in Rural Virginia

Rural Resident Research Symposium

UVA-Wise, April 28, 2015

Susan L. Meacham, PhD, RDN

Professor of Nutrition Discipline of Family Medicine, Preventive Medicine and Public Health

“The Question”

Where do I find data on rural populations

to answer hypothesis driven

research questions?

Appalachia, VALewisburg, WV

Public Data Sources for Chronic Disease Study in Central Appalachia, Virginia

Appalachian Regional Commission, http://www.arc.gov/

Centers for Disease Control and Prevention, http://www.cdc.gov/

County Health Rankings and Road Maps, http://www.countyhealthrankings.org/

National Center for Health Statistics, http://www.cdc.gov/nchs/

U.S. Energy Information Administration, http://www.eia.gov/,

Virginia Cooperative Extension, http://www.ext.vt.edu/

Virginia Department of Health, http://www.vdh.state.va.us/

Virginia Diabetes Council, http://www.virginiadiabetes.org/

Virginia Rural Health Association, http://vrha.org/

Virginia Tobacco Indemnification and Community Revitalization Commission,

http://www.tic.virginia.gov/

Presentation learning objectives

Identify primary and secondary sources of data

Recognize the procedures needed to obtain approvals to use personal record information in research

Locate common sources of county, district and state level data for rural populations

“Case study” - VCOM’s Study of Chronic Health Conditions in Central Appalachia

Funding source: “This study is sponsored by Initiative for Environmental Science (ARIES). ARIES is an industrial affiliates program at Virginia Tech, supported by members that include companies in the energy sector. The research under ARIES is conducted by independent researchers in accordance with the policies on scientific integrity of their institutions. The views, opinions and recommendations expressed herein are solely those of the authors and do not imply any endorsement by ARIES employees, other ARIES-affiliated researchers or industrial members. Information about ARIES can be found at http://www.energy.vt.edu/ARIES.”

Quick review of human research process*

I. Literature Review (thorough)

1. PubMed, BioMed, Central (free),Clinical trials.gov

2. CINAHL (Cumulative Index to Nursing and Allied Health)

II. Type of research

1. Meta-analysis, Case study or

2. Hypothesis driven vs descriptive report

1. Clinical or Basic science

2. Qualitative (ex: oral histories) or quantitative

3. Plan for statistical evaluation, i.e., power analysis

*Research, def. = “careful or diligent search”, is not necessarily

slow – but deliberate! Encourage team to be patient…

Quick review of human research process

III. Approvals (research is published, adds to body of

knowledge; other communications ‘reports’)

1. Certification of training in the protection of human

subjects* (NIH, CITI) for personnel

2. Institutional Review Board (IRB) approval for protocol

3. Possibly also:

a. Joint or reliance agreement IRBs with partners,

- HIPAA privacy compliant if medical record reviews

b. Business and regulatory agreements, etc.

*subjects vs patients vs clients

IV. Network

Network - access local offices, knowledgeable persons

VCOM ARIES Study

I. Primary sources of data:

A. Data collected, are original and collected for the first

time by the researcher –

a. Ex: surveys, record reviews, measurements

b. Limitations – approvals, costs, time/labor, field

visits

II. Secondary sources of data:

A. Data collected by someone else for their purposes

a. Ex: Cancer, Heart, Diabetes organizations, Health

Dept., Appalachian Regional Commission, etc.

b. Limitation – may not capture everything you want

VCOM Study Information Extracted

I. Outputs – from primary and secondary

A. Demographic data a. Gender, age (> 18 adults only)

b. Geographic – state, health districts, county, zip codes,

distressed areas, latitude/longitude of residence

c. Temporal - Longitudinal (over 50 yrs, 1960-2012)

Cross sectional (point in time, 2011/2012)

d. IDC codes for conditions of interest

e. Personal/Family histories

f. Lifestyle-smoking, physical activity, alcohol, drug use

g. Environment – coal, air, water, soil, fast food, access to care

1980

1980

2008

VA total

Buchanan County

Wise County

(Taber VCOM OMS II, AOF Nominee)

Source: U.S. Energy Information Administration, Government

Coal production in Southwest VA, 1980 - 2008

1980

Tobacco production trends in VA, 1980 - 2008 Gordon Groover, PhD, Virginia Cooperative Extension,

Department of Agricultural and Applied Economics, 2012

Geographic areas in VA

Regional Data

Poverty

Percentage (%)Diabetes Obesity

Southwest (SW), Southside (SS), Eastern VA

Source: Virginia Rural Health Association,

Data Portal, 2012 (discontinued)

Environmental/Economy data –1999-2012 - Tobacco commission gave $458.5 million to farmers;

Communities given $131 mil for agribusiness,

education, economic development, added research and development.

VA counties in Appalachian Regional Commission,1963 (left)

All cause age-adjusted mortality rates for males and

females in SW and SS VA plotted for each decade,

1960-2012 (95% CI)(VCOM, VDH, UPITT).

Results: County Data, Aggregated by decade

Males

Females

What went ‘right’ in tobacco counties?

Diabetes Trends US, VA and Appalachian VAhttp://www.cdc.gov/diabetes/statistics/prev/national/figageadult.htm

A. Snyder, OMS III, VCOM Summer Research Award, 2012; AOF Nominee

7.6

20.9

VA Adult (%) Diagnosed Diabetes,

1994 – 2011, CDC

US Adults (%) Diagnosed Diabetes,

1980–2011, CDC

Virginia Diabetes Association, State Plan for Diabetes Management 2008=2017

VDH Vital Statistics

Birth Defects Data

1998

http://www.vdh.virginia.gov/HealthStats/stats.htm

Similar data, different outcomes presented

County Data, secondary

Coal

(N=8)

Mean + SD

Tobacco

(N=12)

Mean + SD

Compare

(N=12)

Mean + SD

VA

total

Air Quality 12.7 + 0.3 12.7 + 0.3 12.9 + 0.212.7

Water

Violations6.4 + 15.4 4.0 + 11.5 + 18.9

6

Poor Mental

Health Days4.0 + 1.1 4.4 + 4.5 + 1.2 3.1

Mental Health

Provider Ratio5005 + 2093 93297 + 4298 + 6277

1027

Motor Vehicle

Crashes26.6 + 9.3 23.6 + 6.7 21.3 + 4.7 11

VCOM Environmental Factor Results –note variability and large standard deviations

Facility #1 Coal – Dependent Community Hospital

Chronic Disease < 99%

Male/Female 52%/47%

Caucasian 99%

Coal Miner 31%

Individual Data, primary

VCOM Phase III Preliminary Results

Electronic Medical Record Review (EMR)

N = 200 records from 2012 admissions, systematic randomization

Diagnosis Confirmed bySelected Clinical Condition

Numbers of Records

Phys’

NoteICD #

Lab

Results

Clinical

Exam

Diabetes Mellitus (ICD9, 250) 62 62 62 61

Other Metabolic and Immunity

Disorders (ICD9, 270-279)111 110 111 108

Mental Disorders (ICD9, 300-316) 96 92 64 92

Ischemic Hrt Dis (ICD9, 410-414) 66 65 66 65

Chronic Bronchitis (ICD9, 491) 86 85 83 85

Other ICD 9 Codes… 155 153 151 149

VCOM EMR Diagnosis Confirmation

Individual Data

EMR review will provide individual level data and location

information with improved geographic specificity, to

provide for improved future health care programming.

VCOM Phase III Outcome expected

Visualization of data

I. Visualization and data display

a. Figures/Tables

b. Maps

c. Video

(from D. Meisha, VCOM, Research Statistician)

http://www.bing.com/videos/search?q=TED%20TALK%20DATA%20VISUALIZAITION%20OF%20COUNTRY%20POPULATION%20CHA

NGE&qs=n&form=QBVR&pq=ted%20talk%20data%20visualizaition%20of%20country%20population%20change&sc=0-29&sp=-

1&sk=#view=detail&mid=1D351C9B4D1BE67595361D351C9B4D1BE6759536

Summary of Future Directions for VCOM

Phase III complete continuing medical record reviews with:

- established relationships in hospital facilities

- geographic, rural, economic comparable disparate health

areas of southern and eastern VA

- further study of VA – WV prevalence rates of chronic

disease, i.e. income comparisons

- expand study of physical environment factors; focus on

air, soil and water quality and links to biochemical

mechanisms

- continue focus on VDH birth data proposal

- continue focus on mental health

Conclusions/Discussion

Our current data confirms inadequate evidence to

support previous publication results on MTM effects on

chronic conditions

Need for multidisciplinary, collaborative approaches to

study mechanisms of cause – effect relationships

Need to know what’s ‘right’ in positive trends in health

disparities

- Medical facilities administration and staff!- VCOM Students

- VCOM OMS III 2015 – A. Snyder, Elective Summer Research

- VCOM OMS II 2016 – T. Taber, A. Whitener, D. Metzger

- VCOM OMS I 2017 – Katie Kennedy, Kristy Atkinson

- Western Illinois University – C. Goessl, Public Health Intern, VT PH - C. Hall

- VCOM Staff – Calvin, Kelly, Angie, Annette….etc…- Development/Outreach – D. J. Sutphin, M. Harris, L. Liechtner, M. Breeding, K. Yancy

- Office of Research – K. Nicewander, G. Reaves, D. Bennett,

- NCAHD – A. Peton, S. Richards , K. Price

- VRHA – B. O’Connor

- OMNEE staff – W. Stevens, T. Maddy, J. Lucas

- VCOM Faculty (DO/MD/PhD/DVM/DDS)

- S. Sukpraprut, R. Hendershot, S. Olgun, H. Misra, J. Mahaney, D. Meisha

- VCOM Administration, D. Tooke-Rawlins, J. Mahaney, D. Sutphin

- ARIES, VA Center for Coal /Energy Research, M. Karmis, J. Craynon

- Virginia Department of Health – D. Woolard, C. Reynolds, J. Rainey

- University of Pittsburgh, J. Buchanich, E. Talbott, A. Potter

Acknowledgements

Thanks to all !