Proximity to industrial food animal production and asthma exacerbations in Pennsylvania, 2005–2012

Sara G. Rasmussen, Joan A. Casey, Karen Bandeen-Roche, Brian S. Schwartz

Research output: Contribution to journalArticlepeer-review


The research on industrial food animal production (IFAP) and asthma exacerbations in the United States has relied on small sample sizes and/or self-reported outcomes. We assessed associations of proximity to large-scale and densely stocked swine and dairy/veal IFAP with three types of asthma exacerbations: hospitalizations, emergency encounters, and oral corticosteroid (OCS) medication orders from Geisinger Clinic in Pennsylvania. We used a diagnosis code (International Classification of Diseases, 9th Revision, Clinical Modification code 493.x) and medication orders from electronic health records to identify these exacerbations among asthma patients (n = 35,269) from 2005–2012. We compared residential proximity to swine or dairy/veal IFAP (dichotomized as <3 miles (4.8 km) or ≥3 miles) among asthma patients with and without exacerbations and estimated odds ratios using multilevel logistic regression. In adjusted models, proximity to IFAP was associated (odds ratio (95% confidence interval)) with OCS orders (1.11 (1.04–1.19)) and hospitalizations (1.29 (1.15–1.46)), but not emergency encounters (1.12 (0.91–1.37)). This study contributes to growing evidence that IFAP may impact health, in this case clinically-documented asthma exacerbations. No prior study has evaluated the association of IFAP and clinically-documented asthma exacerbations in the United States.

Original languageEnglish (US)
Article number362
JournalInternational journal of environmental research and public health
Issue number4
StatePublished - Apr 2017


  • Asthma
  • Asthma exacerbation
  • Concentrated animal feeding operation (CAFO)

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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