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Hacker K, Kaufmann R. Chronic Disease Mapping, an Important Strategy and Tool for Health Promotion. Prev Chronic Dis 2024; 21:E28. [PMID: 38662510 PMCID: PMC11048367 DOI: 10.5888/pcd21.240110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Affiliation(s)
- Karen Hacker
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta GA 30341
| | - Rachel Kaufmann
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Cuadros DF, Devi C, Singh U, Olivier S, Castle AC, Moosa Y, Edwards JA, Kim HY, Siedner MJ, Wong EB, Tanser F. Convergence of HIV and non-communicable disease epidemics: geospatial mapping of the unmet health needs in an HIV hyperendemic community in South Africa. BMJ Glob Health 2024; 9:e012730. [PMID: 38176743 PMCID: PMC10773360 DOI: 10.1136/bmjgh-2023-012730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 11/25/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION As people living with HIV (PLHIV) are experiencing longer survival, the co-occurrence of HIV and non-communicable diseases has become a public health priority. In response to this emerging challenge, we aimed to characterise the spatial structure of convergence of chronic health conditions in an HIV hyperendemic community in KwaZulu-Natal, South Africa. METHODS In this cross-sectional study, we used data from a comprehensive population-based disease survey conducted in KwaZulu-Natal, South Africa, which collected data on HIV, diabetes and hypertension. We implemented a novel health needs scale to categorise participants as: diagnosed and well-controlled (Needs Score 1), diagnosed and suboptimally controlled (Score 2), diagnosed but not engaged in care (Score 3) or undiagnosed and uncontrolled (Score 4). Scores 2-4 were indicative of unmet health needs. We explored the geospatial structure of unmet health needs using different spatial clustering methods. RESULTS The analytical sample comprised 18 041 individuals. We observed a similar spatial structure for HIV among those with combined needs Score 2-3 (diagnosed but uncontrolled) and Score 4 (undiagnosed and uncontrolled), with most PLHIV with unmet needs clustered in the southern urban and peri-urban areas. Conversely, a high prevalence of need Scores 2 and 3 for diabetes and hypertension was mostly distributed in the more rural central and northern part of the surveillance area. A high prevalence of need Score 4 for diabetes and hypertension was mostly distributed in the rural southern part of the surveillance area. Multivariate clustering analysis revealed a significant overlap of all three diseases in individuals with undiagnosed and uncontrolled diseases (unmet needs Score 4) in the southern part of the catchment area. CONCLUSIONS In an HIV hyperendemic community in South Africa, areas with the highest needs for PLHIV with undiagnosed and uncontrolled disease are also areas with the highest burden of unmet needs for other chronic health conditions, such as diabetes and hypertension. Our study has revealed remarkable differences in the distribution of health needs across the rural to urban continuum even within this relatively small study site. The identification and prioritisation of geographically clustered vulnerable communities with unmet health needs for both HIV and non-communicable diseases provide a basis for policy and implementation strategies to target communities with the highest health needs.
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Affiliation(s)
- Diego F Cuadros
- Digital Epidemiology Laboratory, University of Cincinnati, Cincinnati, OH, USA
| | - Chayanika Devi
- Digital Epidemiology Laboratory, University of Cincinnati, Cincinnati, OH, USA
| | - Urisha Singh
- Africa Health Research Institute, Durban, South Africa
- Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Alison C Castle
- Africa Health Research Institute, Durban, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical Shool, Boston, MA, USA
| | - Yumna Moosa
- Africa Health Research Institute, Durban, South Africa
| | - Johnathan A Edwards
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
- International Institute for Rural Health, University of Lincoln, Lincolnshire, UK
| | - Hae-Young Kim
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Mark J Siedner
- Africa Health Research Institute, Durban, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical Shool, Boston, MA, USA
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Emily B Wong
- Africa Health Research Institute, Durban, South Africa
- Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, AL, USA
| | - Frank Tanser
- Centre for Epidemic Response and Innovation (CERI), School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
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Gizamba JM, Wilson JP, Mendenhall E, Ferguson L. A review of place-related contextual factors in syndemics research. Health Place 2023; 83:103084. [PMID: 37437495 DOI: 10.1016/j.healthplace.2023.103084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
This review investigates the extent to which a place-based approach has been used to conceptualize context, as well as the place-related contextual factors explored in studies that explicitly invoked a syndemic framework. The literature search focused on 29 peer-reviewed empirical syndemic studies. Only 11 studies used a place-based approach to define and measure contextual factors and the spatial context was denoted using administrative boundaries such as census tracts, counties, and countries. A narrow range of place-related contextual factors were explored and most of them were related to social and economic factors that were used to define a place. Methodological gaps like a paucity of multilevel studies and studies using a place-based approach to measure context were identified. Future syndemics research should leverage multidimensional geospatial approaches to decipher the role of place-related contextual factors in syndemic dynamics.
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Affiliation(s)
| | - John P Wilson
- Spatial Science Institute, University of Southern California, Los Angeles, USA
| | - Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, USA
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Cuadros DF, Devi C, Singh U, Olivier S, Castle A, Moosa Y, Edwards JA, Kim HY, Siedner MJ, Wong EB, Tanser F. Convergence of HIV and non-communicable disease epidemics: Geospatial mapping of the unmet health needs in a HIV Hyperendemic South African community. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.27.23287807. [PMID: 37034610 PMCID: PMC10081404 DOI: 10.1101/2023.03.27.23287807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Background As people living with HIV (PLHIV) are experiencing longer survival, the co-occurrence of HIV and non-communicable diseases has become a public health priority. In response to this emerging challenge, we aimed to characterize the spatial structure of convergence of chronic health conditions in a HIV hyperendemic community in KwaZulu-Natal, South Africa. Methods We utilized data from a comprehensive population-based disease survey conducted in KwaZulu-Natal, South Africa, which collected data on HIV, diabetes, and hypertension. We implemented a novel health needs scale to categorize participants as: diagnosed and well-controlled (Needs Score 1), diagnosed and sub-optimally controlled (Score 2), diagnosed but not engaged in care (Score 3), or undiagnosed and uncontrolled (Score 4). Scores 2-4 were indicative of unmet health needs. We explored the geospatial structure of unmet health needs using different spatial clustering methods. Findings The analytical sample comprised of 18,041 individuals. We observed a similar spatial structure for HIV among those with a combined needs Score 2-3 (diagnosed but uncontrolled) and Score 4 (undiagnosed and uncontrolled), with most PLHIV with unmet needs clustered in the southern peri-urban area, which was relatively densely populated within the surveillance area. Multivariate clustering analysis revealed a significant overlap of all three diseases in individuals with undiagnosed and uncontrolled diseases (unmet needs Score 4) in the southern part of the catchment area. Interpretation In a HIV hyperendemic community in South Africa, areas with the highest needs for PLHIV with undiagnosed and uncontrolled disease are also areas with the highest burden of unmet needs for other chronic health conditions, such as diabetes and hypertension. The identification and prioritization of geographically clustered vulnerable communities with unmet health needs for both HIV and non-communicable diseases provide a basis for policy and implementation strategies to target communities with the highest health needs. Funding Research reported in this publication was supported by the Fogarty International Center (R21 TW011687; D43 TW010543), the National Institute of Mental Health, the National Institute of Allergy and Infectious Diseases (K24 HL166024; T32 AI007433) of the National Institutes of Health, and Heart Lung and Blood Institute (K24 HL166024, T32 AI007433). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the funders.
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Affiliation(s)
- Diego F Cuadros
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA
| | - Chayanika Devi
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA
| | - Urisha Singh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Stephen Olivier
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Alison Castle
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Johnathan A Edwards
- International Institute for Rural Health, University of Lincoln, Lincolnshire, UK
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Biomedical Informatics, Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Hae-Young Kim
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Mark J. Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Emily B Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, AL, USA
| | - Frank Tanser
- Centre for Epidemic Response and Innovation (CERI), School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
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Krzyśko M, Wołyńki W, Szymkowiak M, Wojtyła A. A Spatio-Temporal Analysis of the Health Situation in Poland Based on Functional Discriminant Coordinates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031109. [PMID: 33513775 PMCID: PMC7908150 DOI: 10.3390/ijerph18031109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate if the provinces of Poland are homogeneous in terms of the observed spatio-temporal data characterizing the health situation of their inhabitants. The health situation is understood as a set of selected factors influencing inhabitants' health and the healthcare system in their area of residence. So far, studies concerning the health situation of selected territorial units have been based on data relating to a specific year rather than longer periods. The task of assessing province homogeneity was carried out in two stages. In stage one, the original spatio-temporal data space (space of multivariate time series) was transformed into a functional discriminant coordinates space. The resulting functional discriminant coordinates are synthetic measures of the health situation of inhabitants of particular provinces. These measures contain complete information regarding 8 diagnostic variables examined over a period of 6 years. In the second stage, the Ward method, commonly used in cluster analysis, was applied in order to identify groups of homogeneous provinces in the space of functional discriminant coordinates. Sixteen provinces were divided into four clusters. The homogeneity of the clusters was confirmed by the multivariate functional coefficient of variation.
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Affiliation(s)
- Mirosław Krzyśko
- Interfaculty Institute of Mathematics and Statistics, Calisia University-Kalisz, 62-800 Kalisz, Poland;
| | - Waldemar Wołyńki
- Faculty of Mathematics and Computer Science, Adam Mickiewicz University, 61-614 Poznań, Poland
- Correspondence:
| | - Marcin Szymkowiak
- Institute of Informatics and Quantitative Economics, Poznań University of Economics and Business, 61-875 Poznań, Poland;
- Statistical Office in Poznań, 60-624 Poznań, Poland
| | - Andrzej Wojtyła
- Health Sciences Faculty, Calisia University-Kalisz, 62-800 Kalisz, Poland;
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Prochaska JD, Jupiter DC, Horel S, Vardeman J, Burdine JN. Rural-urban differences in estimated life expectancy associated with neighborhood-level cumulative social and environmental determinants. Prev Med 2020; 139:106214. [PMID: 32693175 PMCID: PMC10797641 DOI: 10.1016/j.ypmed.2020.106214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 01/05/2023]
Abstract
Diverse neighborhood-level environmental and social impacts on health are well documented. While studies typically examine these impacts individually, examining potential health impacts from multiple sources as a whole can provide a broader context of overall neighborhood-level health impacts compared to examining each component independently. This study examined the association between cumulative neighborhood-level potential health impacts on health and expected life expectancy within neighborhoods (census tracts) across Texas using the Neighborhood Potential Health Impact Score tool. Among urban census tract neighborhoods, a difference of nearly 5 years was estimated between neighborhoods with the least health promoting cumulative health impacts compared to neighborhoods with the most health promoting cumulative health impacts. Differences were observed between rural and urban census tract neighborhoods, with rural areas having less variability in expected life expectancy associated with neighborhood-level cumulative potential health impacts compared to urban areas.
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Affiliation(s)
- John D Prochaska
- Department of Preventive Medicine & Population Health, School of Medicine, University of Texas Medical Branch, 301 University Blvd, Route 1153, Galveston, TX 77555, United States of America.
| | - Daniel C Jupiter
- Department of Preventive Medicine & Population Health, School of Medicine, University of Texas Medical Branch, 301 University Blvd, Route 1153, Galveston, TX 77555, United States of America
| | - Scott Horel
- School of Public Health, Texas A&M University Health Science Center, 212 Adriance Lab Rd., College Station, TX 77843, United States of America
| | - Jennifer Vardeman
- Jack J. Valenti School of Communication, University of Houston, 3347 Cullen Blvd., Houston, TX 77204, United States of America
| | - James N Burdine
- School of Public Health, Texas A&M University Health Science Center, 212 Adriance Lab Rd., College Station, TX 77843, United States of America
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Chronic Disease, the Built Environment, and Unequal Health Risks in the 500 Largest U.S. Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082961. [PMID: 32344643 PMCID: PMC7215999 DOI: 10.3390/ijerph17082961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 12/22/2022]
Abstract
Health is increasingly subject to the complex interplay between the built environment, population composition, and the structured inequity in access to health-related resources across communities. The primary objective of this paper was to examine cardiometabolic disease (diabetes, cardiovascular diseases, stroke) markers and their prevalence across relatively small geographic units in the 500 largest cities in the United States. Using data from the American Community Survey and the 500 Cities Project, the current study examined cardiometabolic diseases across 27,000+ census tracts in the 500 largest cities in the United States. Earlier works clearly show cardiometabolic diseases are not randomly distributed across the geography of the U.S., but rather concentrated primarily in Southern and Eastern regions of the U.S. Our results confirm that chronic disease is correlated with social and built environment factors. Specifically, racial concentration (%, Black), age concentration (% 65+), housing stock age, median home value, structural inequality (Gini index), and weight status (% overweight/obese) were consistent correlates (p < 0.01) of cardiometabolic diseases in the sample of census tracts. The paper examines policy-related features of the built and social environment and how they might play a role in shaping the health and well-being of America’s metropolises.
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