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Rey-Brandariz J, Santiago-Pérez MI, Candal-Pedreira C, Varela-Lema L, Ruano-Ravina A, López-Vizcaíno E, Guerra-Tort C, Ahluwalia JS, Montes A, Pérez-Ríos M. Impact of the use of small-area models on estimation of attributable mortality at a regional level. Eur J Public Health 2024:ckae104. [PMID: 38905591 DOI: 10.1093/eurpub/ckae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024] Open
Abstract
The objective of this study is to assess the impact of applying prevalences derived from a small-area model at a regional level on smoking-attributable mortality (SAM). A prevalence-dependent method was used to estimate SAM. Prevalences of tobacco use were derived from a small-area model. SAM and population attributable fraction (PAF) estimates were compared against those calculated by pooling data from three national health surveys conducted in Spain (2011-2014-2017). We calculated the relative changes between the two estimates and assessed the width of the 95% CI of the PAF. Applying surveys-based prevalences, tobacco use was estimated to cause 53 825 (95% CI: 53 182-54 342) deaths in Spain in 2017, a figure 3.8% lower obtained with the small-area model prevalences. The lowest relative change was observed in the Castile-La Mancha region (1.1%) and the highest in Navarre (14.1%). The median relative change between regions was higher for women (26.1%), population aged ≥65 years (6.6%), and cardiometabolic diseases (9.0%). The differences between PAF by cause of death were never greater than 2%. Overall, the differences between estimates of SAM, PAF, and confidence interval width are small when using prevalences from both sources. Having these data available by region will allow decision-makers to implement smoking control measures based on more accurate data.
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Affiliation(s)
- Julia Rey-Brandariz
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
| | - María I Santiago-Pérez
- Epidemiology Department, Directorate-General of Public Health, Galician Regional Health Authority, Santiago de Compostela, Spain
| | - Cristina Candal-Pedreira
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
| | - Leonor Varela-Lema
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Spain
| | | | - Carla Guerra-Tort
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
- Department of Medicine, Alpert Medical School, Brown University, Providence, RI, United States
- Legorreta Cancer Center, Brown University, Providence, RI, United States
| | - Agustín Montes
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Spain
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Santiago-Pérez MI, López-Vizcaíno E, Pérez-Ríos M, Guerra-Tort C, Rey-Brandariz J, Varela-Lema L, Martín-Gisbert L, Ruano-Ravina A, Schiaffino A, Galán I, Candal-Pedreira C, Montes A, Ahluwalia J. Small-area models to assess the geographical distribution of tobacco consumption by sex and age in Spain. Tob Induc Dis 2023; 21:63. [PMID: 37215189 PMCID: PMC10194049 DOI: 10.18332/tid/162379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/31/2023] [Accepted: 03/19/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Complete and accurate data on smoking prevalence at a local level would enable health authorities to plan context-dependent smoking interventions. However, national health surveys do not generally provide direct estimates of smoking prevalence by sex and age groups at the subnational level. This study uses a small-area model-based methodology to obtain precise estimations of smoking prevalence by sex, age group and region, from a population-based survey. METHODS The areas targeted for analysis consisted of 180 groups based on a combination of sex, age group (15-34, 35-54, 55-64, 65-74, and ≥75 years), and Autonomous Region. Data on tobacco use came from the 2017 Spanish National Health Survey (2017 SNHS). In each of the 180 groups, we estimated the prevalence of smokers (S), ex-smokers (ExS) and never smokers (NS), as well as their coefficients of variation (CV), using a weighted ratio estimator (direct estimator) and a multinomial logistic model with random area effects. RESULTS When smoking prevalence was estimated using the small-area model, the precision of direct estimates improved; the CV of S and ExS decreased on average by 26%, and those of NS by 25%. The range of S prevalence was 11-46% in men and 4-37% in women, excluding the group aged ≥75 years. CONCLUSIONS This study proposes a methodology for obtaining reliable estimates of smoking prevalence in groups or areas not covered in the survey design. The model applied is a good alternative for enhancing the precision of estimates at a detailed level, at a much lower cost than that involved in conducting large-scale surveys. This method could be easily integrated into routine data processing of population health surveys. Having such estimates directly after completing a health survey would help characterize the tobacco epidemic and/or any other risk factor more precisely.
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Affiliation(s)
- María I. Santiago-Pérez
- Epidemiology Department, Directorate-General of Public Health, Galician Regional Health Authority, Santiago de Compostela, Spain
| | - Esther López-Vizcaíno
- Diffusion and Information Service, Galician Institute of Statistics, Santiago de Compostela, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Carla Guerra-Tort
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Julia Rey-Brandariz
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Leonor Varela-Lema
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Lucía Martín-Gisbert
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Anna Schiaffino
- Directorate-General of Health Planning, Health Department, Catalonian Regional Authority, Barcelona, Spain
| | - Iñaki Galán
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Department of Preventive Medicine and Public Health, Autonomous University of Madrid/IdiPAZ, Madrid, Spain
| | - Cristina Candal-Pedreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Agustín Montes
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Jasjit Ahluwalia
- Department of Medicine, Alpert School of Medicine, Brown University, Providence, United States
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, United States
- Legoretta Cancer Center, Division of Biology and Medicine, Brown University, Providence, United States
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Montero R, Vargas M, Vásquez D. Segregation and Life Satisfaction. Front Psychol 2021; 11:604194. [PMID: 33613361 PMCID: PMC7894574 DOI: 10.3389/fpsyg.2020.604194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022] Open
Abstract
Our aim is to cast light on socioeconomic residential segregation effects on life satisfaction (LS). In order to test our hypothesis, we use survey data from Chile (Casen) for the years 2011 and 2013. We use the Duncan Index to measure segregation based on income at the municipality level for 324 municipalities. LS is obtained from the CASEN survey, which considers a question about self-reported well-being. Segregation’s impact upon LS is not clear at first glance. On one hand, there is evidence telling that segregation’s consequences are negative due to the spatial concentration of poverty and all the woes related to it. On the other hand, segregation would have positive effects because people may feel stress, unhappiness, and alienation when comparing themselves to better-off households. Additionally, there is previous evidence regarding the fact that people prefer to neighbor people of a similar socioeconomic background. Hence, an empirical test is needed. In order to implement it, we should deal with two problems, first, the survey limited statistical significance at the municipal level, hence we use the small area estimation (SAE) methodology to improve the estimations’ statistic properties, and second, the double causality between segregation and LS; to deal with the latter, we include lagged LS as a regressor. Our findings indicate that socioeconomic segregation has a positive effect on LS. This result is robust to different econometric specifications.
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Affiliation(s)
- Rodrigo Montero
- Facultad de Economía y Negocios, Universidad Andrés Bello, Santiago, Chile
| | - Miguel Vargas
- Facultad de Economía y Negocios, Universidad Andrés Bello, Santiago, Chile
| | - Diego Vásquez
- Observatorio Social, Ministerio de Desarrollo Social, Santiago, Chile
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Zhang X, Holt JB, Yun S, Lu H, Greenlund KJ, Croft JB. Validation of multilevel regression and poststratification methodology for small area estimation of health indicators from the behavioral risk factor surveillance system. Am J Epidemiol 2015; 182:127-37. [PMID: 25957312 DOI: 10.1093/aje/kwv002] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/06/2015] [Indexed: 12/14/2022] Open
Abstract
Small area estimation is a statistical technique used to produce reliable estimates for smaller geographic areas than those for which the original surveys were designed. Such small area estimates (SAEs) often lack rigorous external validation. In this study, we validated our multilevel regression and poststratification SAEs from 2011 Behavioral Risk Factor Surveillance System data using direct estimates from 2011 Missouri County-Level Study and American Community Survey data at both the state and county levels. Coefficients for correlation between model-based SAEs and Missouri County-Level Study direct estimates for 115 counties in Missouri were all significantly positive (0.28 for obesity and no health-care coverage, 0.40 for current smoking, 0.51 for diabetes, and 0.69 for chronic obstructive pulmonary disease). Coefficients for correlation between model-based SAEs and American Community Survey direct estimates of no health-care coverage were 0.85 at the county level (811 counties) and 0.95 at the state level. Unweighted and weighted model-based SAEs were compared with direct estimates; unweighted models performed better. External validation results suggest that multilevel regression and poststratification model-based SAEs using single-year Behavioral Risk Factor Surveillance System data are valid and could be used to characterize geographic variations in health indictors at local levels (such as counties) when high-quality local survey data are not available.
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Kondo MC, Low SC, Henning J, Branas CC. The impact of green stormwater infrastructure installation on surrounding health and safety. Am J Public Health 2015; 105:e114-21. [PMID: 25602887 DOI: 10.2105/ajph.2014.302314] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated the health and safety effects of urban green stormwater infrastructure (GSI) installments. METHODS We conducted a difference-in-differences analysis of the effects of GSI installments on health (e.g., blood pressure, cholesterol and stress levels) and safety (e.g., felonies, nuisance and property crimes, narcotics crimes) outcomes from 2000 to 2012 in Philadelphia, Pennsylvania. We used mixed-effects regression models to compare differences in pre- and posttreatment measures of outcomes for treatment sites (n=52) and randomly chosen, matched control sites (n=186) within multiple geographic extents surrounding GSI sites. RESULTS Regression-adjusted models showed consistent and statistically significant reductions in narcotics possession (18%-27% less) within 16th-mile, quarter-mile, half-mile (P<.001), and eighth-mile (P<.01) distances from treatment sites and at the census tract level (P<.01). Narcotics manufacture and burglaries were also significantly reduced at multiple scales. Nonsignificant reductions in homicides, assaults, thefts, public drunkenness, and narcotics sales were associated with GSI installation in at least 1 geographic extent. CONCLUSIONS Health and safety considerations should be included in future assessments of GSI programs. Subsequent studies should assess mechanisms of this association.
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Affiliation(s)
- Michelle C Kondo
- Michelle C. Kondo, Sarah C. Low, and Jason Henning are with the US Department of Agriculture-Forest Service, Northern Research Station, Philadelphia, PA. Michelle C. Kondo and Charles C. Branas are also with the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Jason Henning is also with Davey Trees, Inc., Philadelphia, PA
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Zhang X, Holt JB, Lu H, Wheaton AG, Ford ES, Greenlund KJ, Croft JB. Multilevel regression and poststratification for small-area estimation of population health outcomes: a case study of chronic obstructive pulmonary disease prevalence using the behavioral risk factor surveillance system. Am J Epidemiol 2014; 179:1025-33. [PMID: 24598867 DOI: 10.1093/aje/kwu018] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A variety of small-area statistical models have been developed for health surveys, but none are sufficiently flexible to generate small-area estimates (SAEs) to meet data needs at different geographic levels. We developed a multilevel logistic model with both state- and nested county-level random effects for chronic obstructive pulmonary disease (COPD) using 2011 data from the Behavioral Risk Factor Surveillance System. We applied poststratification with the (decennial) US Census 2010 counts of census-block population to generate census-block-level SAEs of COPD prevalence which could be conveniently aggregated to all other census geographic units, such as census tracts, counties, and congressional districts. The model-based SAEs and direct survey estimates of COPD prevalence were quite consistent at both the county and state levels. The Pearson correlation coefficient was 0.99 at the state level and ranged from 0.88 to 0.95 at the county level. Our extended multilevel regression modeling and poststratification approach could be adapted for other geocoded national health surveys to generate reliable SAEs for population health outcomes at all administrative and legislative geographic levels of interest in a scalable framework.
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Hirve S, Vounatsou P, Juvekar S, Blomstedt Y, Wall S, Chatterji S, Ng N. Self-rated health: small area large area comparisons amongst older adults at the state, district and sub-district level in India. Health Place 2014; 26:31-8. [PMID: 24361576 PMCID: PMC3944101 DOI: 10.1016/j.healthplace.2013.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 11/05/2013] [Accepted: 12/01/2013] [Indexed: 11/22/2022]
Abstract
We compared prevalence estimates of self-rated health (SRH) derived indirectly using four different small area estimation methods for the Vadu (small) area from the national Study on Global AGEing (SAGE) survey with estimates derived directly from the Vadu SAGE survey. The indirect synthetic estimate for Vadu was 24% whereas the model based estimates were 45.6% and 45.7% with smaller prediction errors and comparable to the direct survey estimate of 50%. The model based techniques were better suited to estimate the prevalence of SRH than the indirect synthetic method. We conclude that a simplified mixed effects regression model can produce valid small area estimates of SRH.
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Affiliation(s)
- Siddhivinayak Hirve
- Vadu Rural Health Program, KEM Hospital Research Center, Pune, India; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | | | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Center, Pune, India.
| | - Yulia Blomstedt
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Stig Wall
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | | | - Nawi Ng
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
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Branas CC, Cheney RA, MacDonald JM, Tam VW, Jackson TD, Ten Have TR. A difference-in-differences analysis of health, safety, and greening vacant urban space. Am J Epidemiol 2011; 174:1296-306. [PMID: 22079788 DOI: 10.1093/aje/kwr273] [Citation(s) in RCA: 208] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Greening of vacant urban land may affect health and safety. The authors conducted a decade-long difference-in-differences analysis of the impact of a vacant lot greening program in Philadelphia, Pennsylvania, on health and safety outcomes. "Before" and "after" outcome differences among treated vacant lots were compared with matched groups of control vacant lots that were eligible but did not receive treatment. Control lots from 2 eligibility pools were randomly selected and matched to treated lots at a 3:1 ratio by city section. Random-effects regression models were fitted, along with alternative models and robustness checks. Across 4 sections of Philadelphia, 4,436 vacant lots totaling over 7.8 million square feet (about 725,000 m(2)) were greened from 1999 to 2008. Regression-adjusted estimates showed that vacant lot greening was associated with consistent reductions in gun assaults across all 4 sections of the city (P < 0.001) and consistent reductions in vandalism in 1 section of the city (P < 0.001). Regression-adjusted estimates also showed that vacant lot greening was associated with residents' reporting less stress and more exercise in select sections of the city (P < 0.01). Once greened, vacant lots may reduce certain crimes and promote some aspects of health. Limitations of the current study are discussed. Community-based trials are warranted to further test these findings.
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Affiliation(s)
- Charles C Branas
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Universityof Pennsylvania, Philadelphia, USA.
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Branas CC, Richmond TS, Culhane DP, Ten Have TR, Wiebe DJ. Investigating the link between gun possession and gun assault. Am J Public Health 2009; 99:2034-40. [PMID: 19762675 DOI: 10.2105/ajph.2008.143099] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We investigated the possible relationship between being shot in an assault and possession of a gun at the time. METHODS We enrolled 677 case participants that had been shot in an assault and 684 population-based control participants within Philadelphia, PA, from 2003 to 2006. We adjusted odds ratios for confounding variables. RESULTS After adjustment, individuals in possession of a gun were 4.46 (P < .05) times more likely to be shot in an assault than those not in possession. Among gun assaults where the victim had at least some chance to resist, this adjusted odds ratio increased to 5.45 (P < .05). CONCLUSIONS On average, guns did not protect those who possessed them from being shot in an assault. Although successful defensive gun uses occur each year, the probability of success may be low for civilian gun users in urban areas. Such users should reconsider their possession of guns or, at least, understand that regular possession necessitates careful safety countermeasures.
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Affiliation(s)
- Charles C Branas
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Room 936 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021, USA.
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Branas CC, Culhane D, Richmond TS, Wiebe DJ. Novel Linkage of Individual and Geographic Data to Study Firearm Violence. HOMICIDE STUDIES 2008; 12:298-320. [PMID: 20617158 PMCID: PMC2898148 DOI: 10.1177/1088767908319756] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Firearm violence is the end result of a causative web of individual-level and geographic risk factors. Few, if any, studies of firearm violence have been able to simultaneously determine the population-based relative risks that individuals experience as a result of what they were doing at a specific point in time and where they were, geographically, at a specific point in time. This paper describes the linkage of individual and geographic data that was undertaken as part of a population-based case-control study of firearm violence in Philadelphia. New methods and applications of these linked data relevant to researchers and policymakers interested in firearm violence are also discussed.
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