Geographic Distribution of Eosinophilic Fasciitis Cases in Massachusetts and Associated Environmental Triggers

Bina Kassamali, BA
Department of Dermatology
Division of Preventive Medicine
Poster Overview

Background: Eosinophilic fasciitis (EF) is an uncommon disorder in which tissue under the skin becomes thick and inflamed. It is associated with high morbidity and reduced quality of life, but we still do not know what causes the disease. Assessment of geographic clusters is crucial to understanding disease onset. The purpose of this study is to map the location of patients with EF in Massachusetts and to compare that to environmental triggers.

Methods: We mapped the zip codes of homes of eighty-one patients with EF. We compared this to maps of environmental toxins and environmental justice, seeing that areas where minority and low-income populations may face greater risk or proximity to exposures like facilities.

Results: Cases of EF were more prevalent among low-income and minority communities, and particularly in neighborhoods of Revere, Charlestown, Westwood, North Andover, and Saugus. More patients with EF lived near landfills, chemical release sites, ash pollution, and combustion facilities. Medical records also revealed concomitant autoimmune disease (26%) and a high proportion of smokers (49%).

Conclusions: To our knowledge, this is the first study to explore EF geographic distribution. Case clustering suggests that environmental pollutants and racial and socioeconomic disparities may influence EF onset. Additional investigation is warranted.

Scientific Abstract

Background: Eosinophilic fasciitis (EF) is a rare fibrosing disorder of the fascia associated with high morbidity and reduced quality of life. To date, the etiologic triggers remain unknown. Assessment of geographic clusters is crucial to understanding disease onset. The purpose of this study is to determine the distribution of EF cases in Massachusetts in relation to potential environmental triggers.

Methods: Demographic and geographic data was extracted from 294 potential EF cases at Mass General and Brigham. Eighty-one cases confirmed by dermatologists or rheumatologists were mapped by residential zip codes and compared to environmental and social justice maps using ArcGIS.

Results: Elevated EF case counts were observed in Revere, Charlestown, Westwood, North Andover, and Saugus. Affected regions were in proximity to landfills, chemical release sites, ash pollution, and combustion facilities. Cases were more prevalent among low-income and minority communities. Medical records revealed a history of concomitant autoimmune disease (26%), high proportion of smokers (49%), and positive testing for monoclonal gammopathy (25%).

Conclusions: To our knowledge, this is the first study to explore EF geographic distribution. Case clustering suggests that environmental pollutants and racial and socioeconomic disparities may influence EF onset. Additional investigation using larger cohorts is warranted.

Clinical Implications
Knowledge of environmental triggers to disease onset will allow medical professionals to 1) develop preventative strategies and counsel patients, 2) distribute medical care into high-risk areas, and 3) advocate for policy enforcement to protect communities disproportionately impacted.
Research Areas
Authors
Bina Kassamali, BA, Ruth Ann Vleugels, MD, MPH, Avery LaChance, MD, MPH
Principal Investigator
Avery LaChance, MD, MPH

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