Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Thien F, Beggs PJ, Csutoros D, et al. The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors. Lancet Planet Health 2018; 2: e255 63.
The Melbourne epidemic thunderstorm asthma event 2016: a multidisciplinary investigation of environmental triggers, health service impact and patient risk factors SUPPLEMENTARY METHODS Methods Ambulance, ED and hospital admission data The Victorian Emergency Minimum Dataset (VEMD) was used to examine all public hospital ED presentations of the major diagnostic block of respiratory system illness defined by ICD-10-AM codes. The Victorian Admitted Episodes Dataset (VAED), a comprehensive minimum dataset of admitted patient episodes, was used to analyse public hospital admissions. Excess presentations and admissions were calculated using averages derived from the corresponding time periods from the preceding 3 years. Country of birth registered on hospital admissions for asthma in this time period was also analysed. Emergency Department follow-up In the aftermath of the event, eight Melbourne Health Services collaborated to develop a unified approach for clinical follow-up. A standardized telephone questionnaire was developed to contact and follow-up ETSA patients. Questions included persistence of symptoms, previous asthma diagnosis, undiagnosed asthma symptoms, rhinitis severity, preventer usage, asthma control, action plan and healthcare utilization. Hospital staff and supervised medical student volunteers then telephoned the ETSA patients 3-4 weeks after the thunderstorm event. Clinic review was offered, triaged to an appropriate urgency based on a questionnaire structured to assess clinical risk. In the questionnaire, Asian was defined as Chinese, Vietnamese, East or South-East Asian, and Indian/subcontinental
included Sri Lankan, Pakistani and Bangladeshi. Approval from individual institutional review boards was obtained to pool de-identified data from all sites for combined analysis. ICU data All public hospital ICUs as well as private ICUs attached to a hospital with an emergency department in the state of Victoria were contacted. Approval was obtained from the Melbourne Health Human Research Ethics Committee (LNR/16/MH/406). Asthma was defined as an Acute Physiology and Chronic Health Evaluation (APACHE) III-J code 209, Australian and New Zealand Paediatric Intensive Care (ANZPIC) code 431. Census data Census data were interrogated using Census Table Builder (available at http://www.abs.gov.au/) and the following 23 local government areas (comprising a population of 3.2 million) within the eight Health Services (Alfred, Austin, Eastern, Melbourne, Monash, Peninsula, St Vincent s, Western) were surveyed: Banyule, Bayside, Boroondara, Brimbank, Casey, Darebin, Frankston, Glen Eira, Greater Dandenong, Hobsons Bay, Kingston, Knox, Manningham, Maribyrnong, Maroondah, Melbourne, Monash, Moonee Valley, Moreland, Port Phillip, Stonnington, Whitehorse, Yarra. Ancestry coded and identified as Asian were: South-East Asian (not further defined [nfd]), Mainland South-East Asian (nfd), Anglo-Burmese, Burmese, Hmong, Khmer (Cambodian), Lao, Thai, Vietnamese, Karen, Mon, Chin, Rohingya, Mainland South-East Asian (not elsewhere classified [nec]), Maritime South-East Asian (nfd), Filipino, Indonesian, Javanese, Madurese, Malay, Sundanese, Timorese, Acehnese, Balinese, Bruneian, Kadazan, Singaporean, Temoq, Maritime South-East Asian (nec), North-East Asian (nfd), Chinese Asian (nfd), Chinese Taiwanese, Chinese Asian (nec), Other North-East Asian (nfd), Japanese, Korean, Mongolian, Tibetan, Other North-East Asian (nec). Ancestry coded and identified as Indian were: Southern Asian (nfd), Southern and Central Asian (nfd), Anglo-Indian, Bengali, Burgher, Gujarati, Indian, Malayali, Nepalese, Pakistani, Punjabi, Sikh, Sinhalese, Maldivian,
Bangladeshi, Bhutanese, Fijian Indian, Kashmiri, Parsi, Sindhi, Sri Lankan, Sri Lankan Tamil, Indian Tamil, Tamil (nfd), Telugu. SUPPLEMENTARY APPENDIX FIGURES Figure S1. Monthly rainfall deciles for Victoria, September (Panel A), October (Panel B), and November (Panel C) 2016. Source: Australian Bureau of Meteorology. Figure S2. Monthly Normalized Difference Vegetation Index (NDVI) standardized anomaly for Victoria in October (Panel A) and November (Panel B) 2016. Source: Australian Bureau of Meteorology. Figure S3. Daily average airborne grass, weed, and tree pollen and fungal spore concentrations at Parkville (Panel A) and Burwood (Panel B) in Melbourne, November 16-27, 2016. Also shown are daily average airborne ruptured pollen concentrations. Sources: The University of Melbourne and Deakin University. Figure S4. PM 10 five-minute averages measured during November 21, 2016 at six air quality monitoring stations across greater Melbourne (Alphington, Brooklyn, Dandenong, Footscray, Geelong South, and Mooroolbark). Source: Environment Protection Authority Victoria.
Figure S1 Figure S2 Figure S3
Figure S4