As of 2014, approximately 7.4% of U.S. adults had current asthma. The etiology of asthma is complex, involving genetics, behavior, and environmental factors. To explore the association between cumulative environmental quality and asthma prevalence in U.S. adults, we linked the U.S. Environmental Protection Agency's Environmental Quality Index (EQI) to the MarketScan^® Commercial Claims and Encounters Database. The EQI is a summary measure of five environmental domains (air, water, land, built, sociodemographic). We defined asthma as having at least 2 claims during the study period, 2003–2013. We used a Bayesian approach with non-informative priors, implementing mixed-effects regression modeling with a Poisson link function. Fixed effects variables were EQI, sex, race, and age. Random effects were counties. We modeled quintiles of the EQI comparing higher quintiles (worse quality) to lowest quintile (best quality) to estimate prevalence ratios (PR) and credible intervals (CIs). We estimated associations using the cumulative EQI and domain-specific EQIs; we assessed U.S. overall (non-stratified) as well as stratified by rural-urban continuum codes (RUCC) to assess rural/urban heterogeneity. Among the 71,577,118 U.S. adults with medical claims who could be geocoded to county of residence, 1,147,564 (1.6%) met the asthma definition. Worse environmental quality was associated with increased asthma prevalence using the non-RUCC-stratified cumulative EQI, comparing the worst to best EQI quintile (PR:1.27; 95% CI: 1.21, 1.34). Patterns varied among different EQI domains, as well as by rural/urban status. Poor environmental quality may increase asthma prevalence, but domain-specific drivers may operate differently depending on rural/urban status.

截至 2014 年，大约 7.4% 的美国成年人患有哮喘。哮喘的病因很复杂，涉及遗传、行为和环境因素。为了探索累积环境质量与美国成年人哮喘患病率之间的关联，我们将美国环境保护署的环境质量指数 (EQI) 与 MarketScan ^®商业索赔和遭遇数据库联系起来。EQI 是五个环境领域（空气、水、土地、建筑、社会人口）的汇总衡量标准。我们将哮喘定义为在 2003 年至 2013 年研究期间至少有 2 次索赔。我们使用具有非信息先验的贝叶斯方法，通过泊松链接函数实现混合效应回归建模。固定效应变量包括EQI、性别、种族和年龄。随机效应是县。我们对 EQI 的五分位数进行建模，比较较高的五分位数（质量较差）与最低的五分位数（质量最好），以估计患病率 (PR) 和可信区间 (CI)。我们使用累积 EQI 和特定领域的 EQI 来估计关联性；我们评估了美国整体（非分层）以及按城乡连续体代码（RUCC）分层的情况，以评估城乡异质性。在 71,577,118 名拥有医疗索赔且可通过地理编码定位到居住县的美国成年人中，有 1,147,564 名 (1.6%) 符合哮喘定义。使用非 RUCC 分层累积 EQI 比较最差与最佳 EQI 五分位数，更差的环境质量与哮喘患病率增加相关（PR：1.27；95% CI：1.21，1.34）。不同 EQI 领域以及农村/城市状况的模式各不相同。不良的环境质量可能会增加哮喘患病率，但特定领域的驱动因素可能会根据农村/城市状况而有所不同。