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Schenker C, Wertli MM, Räber L, Haynes AG, Chiolero A, Rodondi N, Panczak R, Aujesky D. Regional variation and temporal trends in transcatheter and surgical aortic valve replacement in Switzerland: A population-based small area analysis. PLoS One 2024; 19:e0296055. [PMID: 38190381 PMCID: PMC10773935 DOI: 10.1371/journal.pone.0296055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Aortic valve stenosis (AS) is the most common valvular heart disease and if severe, is treated with either transcatheter (TAVR) or surgical aortic valve replacement (SAVR). We assessed temporal trends and regional variation of these interventions in Switzerland and examined potential determinants of geographic variation. METHODS We conducted a population-based analysis using patient discharge data from all Swiss public and private acute care hospitals from 2013 to 2018. We generated hospital service areas (HSAs) based on patient flows for TAVR. We calculated age-standardized mean procedure rates and variation indices (extremal quotient [EQ] and systematic component of variation [SCV]). Using multilevel regression, we calculated the influence of calendar year and regional demographics, socioeconomic factors (language, insurance status), burden of disease, and number of cardiologists/cardiovascular surgeons on geographic variation. RESULTS Overall, 8074 TAVR and 11,825 SAVR procedures were performed in 8 HSAs from 2013 to 2018. Whereas the age-/sex-standardized rate of TAVR increased from 12 to 22 procedures/100,000 persons, the SAVR rate decreased from 33 to 24 procedures during this period. After full adjustment, the predicted TAVR and SAVR rates varied from 12 to 22 and 20 to 35 per 100,000 persons across HSAs, respectively. The regional procedure variation was low to moderate over time, with a low overall variation in TAVR (EQ 1.9, SCV 3.9) and SAVR (EQ 1.6, SCV 2.2). In multilevel regression, TAVR rates increased annually by 10% and SAVR rates decreased by 5%. Determinants of higher TAVR rates were older age, male sex, living in a German speaking area, and higher burden of disease. A higher proportion of (semi)private insurance was also associated with higher TAVR and lower SAVR rates. After full adjustment, 10.6% of the variance in TAVR and 18.4% of the variance in SAVR remained unexplained. Most variance in TAVR and SAVR rates was explained by language region and insurance status. CONCLUSION The geographic variation in TAVR and SAVR rates was low to moderate across Swiss regions and largely explained by differences in regional demographics and socioeconomic factors. The use of TAVR increased at the expense of SAVR over time.
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Affiliation(s)
- Carla Schenker
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria M. Wertli
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Arnaud Chiolero
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- School of Population and Global Health, McGill University, Montreal, Canada
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Radoslaw Panczak
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Stoller N, Wertli MM, Haynes AG, Chiolero A, Rodondi N, Panczak R, Aujesky D. Large regional variation in cardiac closure procedures to prevent ischemic stroke in Switzerland a population-based small area analysis. PLoS One 2024; 19:e0291299. [PMID: 38166018 PMCID: PMC10760725 DOI: 10.1371/journal.pone.0291299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 08/23/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Percutaneous closure of a patent foramen ovale (PFO) or the left atrial appendage (LAA) are controversial procedures to prevent stroke but often used in clinical practice. We assessed the regional variation of these interventions and explored potential determinants of such a variation. METHODS We conducted a population-based analysis using patient discharge data from all Swiss hospitals from 2013-2018. We derived hospital service areas (HSAs) using patient flows for PFO and LAA closure. We calculated age-standardized mean procedure rates and variation indices (extremal quotient [EQ] and systematic component of variation [SCV]). SCV values >5.4 indicate a high and >10 a very high variation. Because the evidence on the efficacy of PFO closure may differ in patients aged <60 years and ≥60 years, age-stratified analyses were performed. We assessed the influence of potential determinants of variation using multilevel regression models with incremental adjustment for demographics, cultural/socioeconomic, health, and supply factors. RESULTS Overall, 2574 PFO and 2081 LAA closures from 10 HSAs were analyzed. The fully adjusted PFO and LAA closure rates varied from 3 to 8 and from 1 to 9 procedures per 100,000 persons per year across HSAs, respectively. The regional variation was high with respect to overall PFO closures (EQ 3.0, SCV 8.3) and very high in patients aged ≥60 years (EQ 4.0, SCV 12.3). The variation in LAA closures was very high (EQ 16.2, SCV 32.1). In multivariate analysis, women had a 28% lower PFO and a 59% lower LAA closure rate than men. French/Italian language areas had a 63% lower LAA closure rate than Swiss German speaking regions and areas with a higher proportion of privately insured patients had a 86% higher LAA closure rate. After full adjustment, 44.2% of the variance in PFO closure and 30.3% in LAA closure remained unexplained. CONCLUSIONS We found a high to very high regional variation in PFO closure and LAA closure rates within Switzerland. Several factors, including sex, language area, and insurance status, were associated with procedure rates. Overall, 30-45% of the regional procedure variation remained unexplained and most probably represents differing physician practices.
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Affiliation(s)
- Nina Stoller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria M. Wertli
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Internal Medicine, Kantonsspital Baden, Baden, Switzerland
| | | | - Arnaud Chiolero
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- School of Population and Global Health, McGill University, Montreal, Canada
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Radoslaw Panczak
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Cao P, Pan J. Understanding Factors Influencing Geographic Variation in Healthcare Expenditures: A Small Areas Analysis Study. Inquiry 2024; 61:469580231224823. [PMID: 38281114 PMCID: PMC10823849 DOI: 10.1177/00469580231224823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/09/2023] [Accepted: 12/15/2023] [Indexed: 01/29/2024]
Abstract
Dramatic geographic variations in healthcare expenditures were documented by developed countries, but little is known about such variations under China's context, and what causes such variations. This study aims to examine variations of healthcare expenditures among small areas and to determine the associations between demand-, supply-factors, and per capita inpatient expenditures. This cross-sectional study utilized hospital discharge data aggregated within delineated hospital service areas (HSAs) using the small-area analysis approach. Linear multivariate regression modeling with robust standard errors was used to estimate the sources of variation of per capita inpatient expenditures across HSAs covering the years 2017 to 2019; the Shapley value decomposition method was used to measure the respective contributions of demand-, supply-side to such variations. Among 149 HSAs, demand factors explained most of the (87.4%) overall geographic variation among HSAs. With each 1% increase in GDP per capita and urbanization rate was associated with 0.099% and 0.9% increase in inpatient expenditure per capita, respectively, while each 1% increase in the share of females and the unemployment rate was associated with a 0.7% and 0.4% reduction in the per capita inpatient expenditures, respectively. In supply-side, for every 1 increase in hospital beds per 1000 population, the per capita inpatient expenditures rose by 2.9%, while with every 1% increase in the share of private hospitals, the per capita inpatient expenditures would decrease by 0.4%. With Herfindahl-Hirschman Index decrease 10%, the per capita inpatient expenditures would increase 1.06%. This study suggests demand-side factors are associated with large geographic variation in per capita inpatient expenditures among HSAs, while supply-side factors played an important role. The evaluation of geographic variations in per capita inpatient expenditures as well as its associated factors have great potential to provide an indirect approach to identify possibly existing underutilized or overutilized healthcare procedures.
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Affiliation(s)
- Peiya Cao
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Johnsen SP, Jensen M, Münster AM, Frost L, Harboe L, Poulsen PB, Albertsen IE, Vinter N, Grove EL, Larsen TB. Small-Area Analysis of Treatment and Clinical Outcomes in Patients with Venous Thromboembolism in Denmark: A Nationwide Cohort Study. Thromb Haemost 2023; 123:978-988. [PMID: 37054981 DOI: 10.1055/a-2073-4336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVES To investigate geographical variation in initiation and extended treatment with anticoagulants and clinical outcomes among patients hospitalized with first-time venous thromboembolism (VTE) in Denmark between 2007 and 2018. METHODS Using nationwide health care registries, we identified all patients with a first-time VTE hospital diagnosis supported by imaging data from 2007 to 2018. Patients were grouped according to residential region (5) and municipality (98) at the time of VTE diagnosis. Cumulative incidence of initiation of and extended (beyond 365 days) anticoagulation treatment as well as clinical outcomes, including recurrent VTE, major bleeding, and all-cause death, were assessed. Sex- and age-adjusted relative risks (RRs) of the outcomes were computed when comparing across individual regions and municipalities. Overall geographic variation was quantified by computing the median RR. RESULTS We identified 66,840 patients with a first-time VTE hospitalization. A difference in initiation of anticoagulation treatment of more than 20 percentage points between regions was observed (range: 51.9-72.4%, median RR: 1.09, 95% confidence interval [CI]: 1.04-1.13). Variation was also observed for extended treatment (range: 34.2-46.9%, median RR: 1.08, 95% CI: 1.02-1.14). The cumulative incidence of recurrent VTE ranged from 3.6 to 5.3% at 1 year (median RR: 1.08, 95% CI: 1.01-1.15). The difference remained after 5 years, and variation was also observed for major bleeding (median RR: 1.09, 95% CI: 1.03-1.15), whereas it appeared smaller for all-cause mortality (median RR: 1.03, 95% CI: 1.01-1.05). CONCLUSION Substantial geographical variation in anticoagulation treatment and clinical outcomes occurs in Denmark. These findings indicate a need for initiatives to ensure uniform high-quality care for all VTE patients.
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Affiliation(s)
- Søren P Johnsen
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Martin Jensen
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Anna Marie Münster
- Unit for Thrombosis Research, Hospital of South West Jutland, Esbjerg, Denmark
| | - Lars Frost
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | | | - Ida E Albertsen
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Nicklas Vinter
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Erik L Grove
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Torben B Larsen
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Colucci M, Fonzo M, Miccolis L, Amoruso I, Mondino S, Trevisan A, Cazzaro R, Baldovin T, Bertoncello C. Emergency Department Syndromic Surveillance to Monitor Tick-Borne Diseases: A 6-Year Small-Area Analysis in Northeastern Italy. Int J Environ Res Public Health 2023; 20:6822. [PMID: 37835091 PMCID: PMC10572455 DOI: 10.3390/ijerph20196822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
Tick-borne diseases (TBD) are endemic in Europe. However, surveillance is currently incomplete. Alternative strategies need to be considered. The aim of this study was to test an Emergency Department Syndromic Surveillance (EDSyS) system as a complementary data source to describe the impact of tick bites and TBD using a small-area analysis approach and to monitor the risk of TBD to target prevention. ED databases in the Local Health Authority 8 District (Veneto, Italy) were queried for tick-bite and TBD-related visits between January 2017 and December 2022. Hospitalisations were also collected. Events involving the resident population were used to calculate incidence rates. A total of 4187 ED visits for tick-bite and 143 for TBD were recorded; in addition, 62 TBD-related hospitalisations (of which 72.6% in over 50 s and 22.6% in over 65 s). ED visits peaked in spring and in autumn, followed by a 4-week lag in the increase in hospital admissions. The small-area analysis identified two areas at higher risk of bites and TBD. The use of a EDSyS system allowed two natural foci to be identified. This approach proved useful in predicting temporal and geographic risk of TBD and in identifying local endemic areas, thus enabling an effective multidisciplinary prevention strategy.
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Affiliation(s)
- Massimiliano Colucci
- Hospital Direction, Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, 36100 Vicenza, Italy
| | - Marco Fonzo
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Liana Miccolis
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Irene Amoruso
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Sara Mondino
- Hospital Direction, Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, 36100 Vicenza, Italy
| | - Andrea Trevisan
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Romina Cazzaro
- Hospital Direction, Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, 36100 Vicenza, Italy
| | - Tatjana Baldovin
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Chiara Bertoncello
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
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Song J, Gasparrini A, Fischer T, Hu K, Lu Y. Effect Modifications of Overhead-View and Eye-Level Urban Greenery on Heat-Mortality Associations: Small-Area Analyses Using Case Time Series Design and Different Greenery Measurements. Environ Health Perspect 2023; 131:97007. [PMID: 37728899 PMCID: PMC10510815 DOI: 10.1289/ehp12589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The protective effect of urban greenery from adverse heat impacts remains inconclusive. Existing inconsistent findings could be attributed to the different estimation techniques used. OBJECTIVES We investigated how effect modifications of urban greenery on heat-mortality associations vary when using different greenery measurements reflecting overhead-view and eye-level urban greenery. METHODS We collected meteorological and daily mortality data for 286 territory planning units between 2005 and 2018 in Hong Kong. Three greenery measurements were extracted for each unit: a) the normalized difference vegetation index (NDVI) from Landsat remote sensing images, b) the percentage of greenspace based on land use data, and c) eye-level street greenery from street view images via a deep learning technique. Time-series analyses were performed using the case time series design with a linear interaction between the temperature term and each of the three greenery measurements. Effect modifications were also estimated for different age groups, sex categories, and cause-specific diseases. RESULTS Higher mortality risks were associated with both moderate and extreme heat, with relative risks (RRs) of 1.022 (95% CI: 1.000, 1.044) and 1.045 (95% CI: 1.013, 1.079) at the 90th and 99th percentiles of temperatures relative to the minimum mortality temperature (MMT). Lower RRs were observed in greener areas whichever of the three greenery measurements was used, but the disparity of RRs between areas with low and high levels of urban greenery was more apparent when using eye-level street greenery as the index at high temperatures (99th percentile relative to MMT), with RRs for low and high levels of greenery, respectively, of 1.096 (95% CI: 1.035, 1.161) and 0.985 (95% CI: 0.920, 1.055) for NDVI (p = 0.0193 ), 1.068 (95% CI: 1.021, 1.117) and 0.990 (95% CI: 0.906, 1.081) for the percentage of greenspace (p = 0.1338 ), and 1.103 (95% CI: 1.034, 1.177) and 0.943 (95% CI: 0.841, 1.057) for eye-level street greenery (p = 0.0186 ). Health discrepancies remained for nonaccidental mortality and cardiorespiratory diseases and were more apparent for older adults (≥ 65 years of age) and females. DISCUSSION This study provides new evidence that eye-level street greenery shows stronger associations with reduced heat-mortality risks compared with overhead-view greenery based on NDVI and percentage of greenspace. The effect modification of urban greenery tends to be amplified as temperatures rise and are more apparent in older adults and females. Heat mitigation strategies and health interventions, in particular with regard to accessible and visible greenery, are needed for helping heat-sensitive subpopulation groups in coping with extreme heat. https://doi.org/10.1289/EHP12589.
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Affiliation(s)
- Jinglu Song
- Department of Urban Planning and Design, Xi’an Jiaotong-Liverpool University, Suzhou, China
| | - Antonio Gasparrini
- Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas Fischer
- Environmental Assessment and Management Research Centre, Department of Geography and Planning, School of Environmental Sciences, University of Liverpool, Liverpool, UK
- Research Unit for Environmental Sciences and Management, Faculty of Natural and Agricultural Sciences, North West University, Potchefstroom, South Africa
| | - Kejia Hu
- Institute of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, China
| | - Yi Lu
- Department of Architecture and Civil Engineering, City University of Hong Kong, Kowloon Tong, Hong Kong, China
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Burlotos A, Pierre TJ, Johnson W, Wiafe S, Joseph M. Small area analysis methods in an area of limited mapping: exploratory geospatial analysis of firearm injuries in Port-au-Prince, Haiti. Int J Health Geogr 2023; 22:19. [PMID: 37596625 PMCID: PMC10436655 DOI: 10.1186/s12942-023-00337-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/12/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND The city of Port-au-Prince, Haiti, is experiencing an epidemic of firearm injuries which has resulted in high burdens of morbidity and mortality. Despite this, little scientific literature exists on the topic. Geospatial research could inform stakeholders and aid in the response to the current firearm injury epidemic. However, traditional small-area geospatial methods are difficult to implement in Port-au-Prince, as the area has limited mapping penetration. Objectives of this study were to evaluate the feasibility of geospatial analysis in Port-au-Prince, to seek to understand specific limitations to geospatial research in this context, and to explore the geospatial epidemiology of firearm injuries in patients presenting to the largest public hospital in Port-au-Prince. RESULTS To overcome limited mapping penetration, multiple data sources were combined. Boundaries of informally developed neighborhoods were estimated from the crowd-sourced platform OpenStreetMap using Thiessen polygons. Population counts were obtained from previously published satellite-derived estimates and aggregated to the neighborhood level. Cases of firearm injuries presenting to the largest public hospital in Port-au-Prince from November 22nd, 2019, through December 31st, 2020, were geocoded and aggregated to the neighborhood level. Cluster analysis was performed using Global Moran's I testing, local Moran's I testing, and the SaTScan software. Results demonstrated significant geospatial autocorrelation in the risk of firearm injury within the city. Cluster analysis identified areas of the city with the highest burden of firearm injuries. CONCLUSIONS By utilizing novel methodology in neighborhood estimation and combining multiple data sources, geospatial research was able to be conducted in Port-au-Prince. Geospatial clusters of firearm injuries were identified, and neighborhood level relative-risk estimates were obtained. While access to neighborhoods experiencing the largest burden of firearm injuries remains restricted, these geospatial methods could continue to inform stakeholder response to the growing burden of firearm injuries in Port-au-Prince.
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Affiliation(s)
- Athanasios Burlotos
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tayana Jean Pierre
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Universite Notre Dame D'Haiti, Faculte de Medecine, Port-au-Prince, Haïti
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Walter Johnson
- Loma Linda University School of Public Health, Loma Linda, CA, USA
| | - Seth Wiafe
- Loma Linda University School of Public Health, Loma Linda, CA, USA
| | - Michelle Joseph
- Clinical Trials Unit, University of Warwick, Coventry, CV2 2DX, United Kingdom.
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
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Lee HY, Rana MJ, Kim R, Subramanian SV. Small Area Variation in the Quality of Maternal and Newborn Care in India. JAMA Netw Open 2022; 5:e2242666. [PMID: 36441555 PMCID: PMC9706367 DOI: 10.1001/jamanetworkopen.2022.42666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE In India, the district serves as the primary policy unit for implementing and allocating resources for various programs aimed at improving key developmental and health indicators. Recent evidence highlights that high-quality care for mothers and newborns is critical to reduce preventable mortality. However, the geographic variation in maternal and newborn health service quality has never been investigated. OBJECTIVE To examine the variation between smaller areas within districts in the quality of maternal and newborn care in India. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study assessed data from women aged 15 to 49 years on the most recent birth (singleton or multiples) in the 5 years that preceded the fifth National Family Health Survey (June 17, 2019, to April 30, 2021). EXPOSURES Maternal and newborn care in 36 states and union territories (UTs), 707 districts, and 28 113 clusters (small areas) in India. MAIN OUTCOMES AND MEASURES The composite quality score of maternal and newborn care was defined as the proportion of components of care received of the total 11 essential components of antenatal and postnatal care. Four-level logistic and linear regression was used for analyses of individual components of care and composite score, respectively. Precision-weighted prevalence of each component of care and mean composite score across districts as well as their between-small area SD were calculated. RESULTS The final analytic sample for the composite score was composed of 123 257 births nested in 28 113 small areas, 707 districts, and 36 states/UTs. For the composite score, 58.3% of the total geographic variance was attributable to small areas, 29.3% to states and UTs, and 12.4% to districts. Of 11 individual components of care, the small areas accounted for the largest proportion of geographic variation for 6 individual components of care (ranging from 42.3% for blood pressure taken to 73.0% for tetanus injection), and the state/UT was the largest contributor for 4 components of care (ranging from 41.7% for being weighed to 52.3% for ultrasound test taken). District-level composite score and prevalence of individual care components and their variation across small areas within the districts showed a consistently strong negative correlation (Spearman rank correlation ρ = -0.981 to -0.886). Low-quality scores and large between-small area disparities were not necessarily concentrated in aspirational districts (mean district composite score [SD within districts], 92.7% [2.1%] among aspirational districts and 93.7% [1.8%] among nonaspirational districts). CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that the policy around maternal and child health care needs to be designed more precisely to consider district mean and between-small area heterogeneity in India. This study may have implications for other low- and middle-income countries seeking to improve maternal and newborn outcomes, particularly for large countries with geographic heterogeneity.
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Affiliation(s)
- Hwa-Young Lee
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Institute of Convergence Science, Convergence Science Academy, Yonsei University, Seoul, South Korea
| | - Md Juel Rana
- Korea University Research and Business Foundation, Seoul, South Korea
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - S. V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Frei AN, Gellad WF, Wertli MM, Haynes AG, Chiolero A, Rodondi N, Panczak R, Aujesky D. Trends and regional variation in vertebroplasty and kyphoplasty in Switzerland: a population-based small area analysis. Osteoporos Int 2021; 32:2515-2524. [PMID: 34156489 PMCID: PMC8608764 DOI: 10.1007/s00198-021-06026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
UNLABELLED Regional variation in procedure use often reflects the uncertainty about the risks and benefit of procedures. In Switzerland, regional variation in vertebroplasty and balloon kyphoplasty rates was high, although the variation declined between 2013 and 2018. Substantial parts of the variation remained unexplained, and likely signal unequal access and differing physician opinion. PURPOSE To assess trends and regional variation in percutaneous vertebroplasty (VP) and balloon kyphoplasty (BKP) use across Switzerland. METHODS We conducted a population-based analysis using patient discharge data from all Swiss acute care hospitals for 2013-2018. We calculated age/sex-standardized mean procedure rates and measures of variation across VP/BKP-specific hospital areas (HSAs). We assessed the influence of potential determinants of variation using multilevel regression models with incremental adjustment for demographics, cultural/socioeconomic, health, and supply factors. RESULTS We analyzed 7855 discharges with VP/BKP from 31 HSAs. The mean age/sex-standardized procedure rate increased from 16 to 20/100,000 persons from 2013 to 2018. While the variation in procedure rates across HSAs declined, the overall variation remained high (systematic component of variation from 56.8 to 6.9 from 2013 to 2018). Determinants explained 52% of the variation. CONCLUSIONS VP/BKP procedure rates increased and regional variation across Switzerland declined but remained at a high level. A substantial part of the regional variation remained unexplained by potential determinants of variation.
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Affiliation(s)
- A N Frei
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - W F Gellad
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M M Wertli
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A G Haynes
- CTU Bern, University of Bern, Bern, Switzerland
| | - A Chiolero
- Population Health Laboratory, (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - N Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - R Panczak
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - D Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Zgodic A, Eberth JM, Breneman CB, Wende ME, Kaczynski AT, Liese AD, McLain AC. Estimates of Childhood Overweight and Obesity at the Region, State, and County Levels: A Multilevel Small-Area Estimation Approach. Am J Epidemiol 2021; 190:2618-2629. [PMID: 34132329 PMCID: PMC8796862 DOI: 10.1093/aje/kwab176] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/30/2021] [Accepted: 06/10/2021] [Indexed: 11/12/2022] Open
Abstract
Local-level childhood overweight and obesity data are often used to implement and evaluate community programs, as well as allocate resources to combat overweight and obesity. The most current substate estimates of US childhood obesity use data collected in 2007. Using a spatial multilevel model and the 2016 National Survey of Children's Health, we estimated childhood overweight and obesity prevalence rates at the Census regional division, state, and county levels using small-area estimation with poststratification. A sample of 24,162 children aged 10-17 years was used to estimate a national overweight and obesity rate of 30.7% (95% confidence interval: 27.0%, 34.9%). There was substantial county-to-county variability (range, 7.0% to 80.9%), with 31 out of 3,143 counties having an overweight and obesity rate significantly different from the national rate. Estimates from counties located in the Pacific region had higher uncertainty than other regions, driven by a higher proportion of underrepresented sociodemographic groups. Child-level overweight and obesity was related to race/ethnicity, sex, parental highest education (P < 0.01 for all), county-level walkability (P = 0.03), and urban/rural designation (P = 0.02). Overweight and obesity remains a vital issue for US youth, with substantial area-level variability. The additional uncertainty for underrepresented groups shows surveys need to better target diverse samples.
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Affiliation(s)
| | | | | | | | | | | | - Alexander C McLain
- Correspondence to Dr. Alexander C. McLain, Department of Epidemiology and Biostatistics Arnold School of Public Health University of South Carolina 915 Greene Street Room 450 Columbia, SC 29208 (e-mail: )
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11
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Clark SN, Bennett JE, Arku RE, Hill AG, Fink G, Adanu RM, Biritwum RB, Darko R, Bawah A, Duda RB, Ezzati M. Small area variations and factors associated with blood pressure and body-mass index in adult women in Accra, Ghana: Bayesian spatial analysis of a representative population survey and census data. PLoS Med 2021; 18:e1003850. [PMID: 34762663 PMCID: PMC8584976 DOI: 10.1371/journal.pmed.1003850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Body-mass index (BMI) and blood pressure (BP) levels are rising in sub-Saharan African cities, particularly among women. However, there is very limited information on how much they vary within cities, which could inform targeted and equitable health policies. Our study aimed to analyse spatial variations in BMI and BP for adult women at the small area level in the city of Accra, Ghana. METHODS AND FINDINGS We combined a representative survey of adult women's health in Accra, Ghana (2008 to 2009) with a 10% random sample of the national census (2010). We applied a hierarchical model with a spatial term to estimate the associations of BMI and systolic blood pressure (SBP) and diastolic blood pressure (DBP) with demographic, socioeconomic, behavioural, and environmental factors. We then used the model to estimate BMI and BP for all women in the census in Accra and calculated mean BMI, SBP, and DBP for each enumeration area (EA). BMI and/or BP were positively associated with age, ethnicity (Ga), being currently married, and religion (Muslim) as their 95% credible intervals (95% CrIs) did not include zero, while BP was also negatively associated with literacy and physical activity. BMI and BP had opposite associations with socioeconomic status (SES) and alcohol consumption. In 2010, 26% of women aged 18 and older had obesity (BMI ≥ 30 kg/m2), and 21% had uncontrolled hypertension (SBP ≥ 140 and/or DBP ≥ 90 mm Hg). The differences in mean BMI and BP between EAs at the 10th and 90th percentiles were 2.7 kg/m2 (BMI) and in BP 7.9 mm Hg (SBP) and 4.8 mm Hg (DBP). BMI was generally higher in the more affluent eastern parts of Accra, and BP was higher in the western part of the city. A limitation of our study was that the 2010 census dataset used for predicting small area variations is potentially outdated; the results should be updated when the next census data are available, to the contemporary population, and changes over time should be evaluated. CONCLUSIONS We observed that variation of BMI and BP across neighbourhoods within Accra was almost as large as variation across countries among women globally. Localised measures are needed to address this unequal public health challenge in Accra.
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Affiliation(s)
- Sierra N. Clark
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- MRC Centre for Environment and Health, Imperial College London, United Kingdom
| | - James E. Bennett
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- MRC Centre for Environment and Health, Imperial College London, United Kingdom
| | - Raphael E. Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Allan G. Hill
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Richard M. Adanu
- Department of Population, Family, and Reproductive Health, University of Ghana, Accra, Ghana
| | | | - Rudolph Darko
- School of Medicine, University of Ghana, Accra, Ghana
| | - Ayaga Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Rosemary B. Duda
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- MRC Centre for Environment and Health, Imperial College London, United Kingdom
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, United Kingdom
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12
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Wang K, Law CK, Zhao J, Hui AYK, Yip BHK, Yeoh EK, Chung RYN. Measuring health-related social deprivation in small areas: development of an index and examination of its association with cancer mortality. Int J Equity Health 2021; 20:216. [PMID: 34579732 PMCID: PMC8474923 DOI: 10.1186/s12939-021-01545-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The small-area deprivation indices are varied across countries due to different social context and data availability. Due to lack of chronic disease-related social deprivation index (SDI) in Hong Kong, China, this study aimed to develop a new SDI and examine its association with cancer mortality. METHODS A total of 14 socio-economic variables of 154 large Tertiary Planning Unit groups (LTPUGs) in Hong Kong were obtained from 2016 population by-census. LTPUG-specific all-cause and chronic condition-related mortality and chronic condition inpatient episodes were calculated as health outcomes. Association of socio-economic variables with health outcomes was estimated for variable selection. Candidates for SDI were constructed with selected socio-economic variables and tested for criterion validity using health outcomes. Ecological association between the selected SDI and cancer mortality were examined using zero-inflated negative binomial regression. RESULTS A chronic disease-related SDI constructed by six area-level socio-economic variables was selected based on its criterion validity with health outcomes in Hong Kong. It was found that social deprivation was associated with higher cancer mortality during 2011-2016 (most deprived areas: incidence relative risk [IRR] = 1.40, 95% confidence interval [CI]: 1.27-1.55; second most deprived areas: IRR = 1.34, 95%CI: 1.21-1.48; least deprived areas as reference), and the cancer mortality gap became larger in more recent years. Excess cancer death related to social deprivation was found to have increased through 2011-2016. CONCLUSIONS Our newly developed SDI is a valid and routinely available measurement of social deprivation in small areas and is useful in resource allocation and policy-making for public health purpose in communities. There is a potential large improvement in cancer mortality by offering relevant policies and interventions to reduce health-related deprivation. Further studies can be done to design strategies to reduce the expanding health inequalities between more and less deprived areas.
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Affiliation(s)
- Kailu Wang
- JC School of Public Health and Primary Care, Faculty of Medicine
, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Chi-Kin Law
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW Australia
| | - Jiaying Zhao
- School of Demography, The Australian National University, Canberra, Australia
| | - Alvin Yik-Kiu Hui
- JC School of Public Health and Primary Care, Faculty of Medicine
, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Benjamin Hon-Kei Yip
- JC School of Public Health and Primary Care, Faculty of Medicine
, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Eng Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine
, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Roger Yat-Nork Chung
- JC School of Public Health and Primary Care, Faculty of Medicine
, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
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Shi C, Aparicio-Ting F, Faris P, Patterson S, McLaren L. Small-area contextual effects on children's dental caries in Alberta: a multilevel analysis. Can J Public Health 2021; 112:773-781. [PMID: 33844239 PMCID: PMC8225721 DOI: 10.17269/s41997-021-00485-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of this study was to examine the presence of small-area-level effects on children's dental caries in Alberta, Canada, where dental public health programming is targeted in nature, based on an area-level measure of socio-economic circumstances. METHODS This cross-sectional study included data on tooth decay (from an intra-oral examination conducted by dental hygienists at school) and socio-demographic and behavioural information (from a parent questionnaire) from 5677 grade 1 and 2 schoolchildren attending schools in public or Catholic school systems in Calgary and Edmonton in 2013/2014. Area-level socio-economic circumstances were quantified using the Pampalon Material Deprivation Index derived from census data, applied to the dissemination area (DA) of the child's school. The outcome variable was presence (vs. absence) of tooth decay (cavitation). Data were analyzed using multilevel modeling with two levels: individual level (level 1) and school dissemination area (DA) (level 2). RESULTS We observed a small but statistically significant area-level effect on children's caries experience, above and beyond individual-level characteristics. CONCLUSION Study findings are relevant to dental public health programming in Alberta and other jurisdictions that use targeted strategies. Multilevel interventions, including universal approaches, are necessary to reduce inequities in children's dental caries.
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Affiliation(s)
- Congshi Shi
- Alberta Health Services, Calgary, Alberta Canada
| | - Fabiola Aparicio-Ting
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, Alberta T2N 4Z6 Canada
| | - Peter Faris
- Alberta Health Services, Calgary, Alberta Canada
| | - Steven Patterson
- School of Dentistry, University of Alberta, Edmonton, Alberta Canada
| | - Lindsay McLaren
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, Alberta T2N 4Z6 Canada
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Rohleder S, Bozorgmehr K. Monitoring the spatiotemporal epidemiology of Covid-19 incidence and mortality: A small-area analysis in Germany. Spat Spatiotemporal Epidemiol 2021; 38:100433. [PMID: 34353525 DOI: 10.21203/rs.3.rs-34572/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/26/2021] [Accepted: 05/10/2021] [Indexed: 05/21/2023]
Abstract
Timely monitoring of incidence risks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and associated deaths at small-area level is essential to inform containment strategies. We analysed the spatiotemporal epidemiology of the SARSCoV- 2 pandemic at district level in Germany to develop a tool for disease monitoring. We used a Bayesian spatiotemporal model to estimate the district-specific risk ratios (RR) of SARS-CoV-2 incidence and the posterior probability (PP) for exceedance of RR thresholds 1, 2 or 3. Of 220 districts (55% of 401 districts) showing a RR > 1, 188 (47%) exceed the RR threshold with sufficient certainty (PP ≥ 80%) to be considered at high risk. 47 districts show very high (RR > 2, PP ≥ 80%) and 15 extremely high (RR > 3, PP ≥ 80%) risks. The spatial approach for monitoring the risk of SARS-CoV-2 provides an informative basis for local policy planning.
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Affiliation(s)
- Sven Rohleder
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501 Bielefeld, Bielefeld, Germany; Section for Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden (Turm West), Im Neuenheimer Feld 130.3, 69120 Heidelberg, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501 Bielefeld, Bielefeld, Germany; Section for Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden (Turm West), Im Neuenheimer Feld 130.3, 69120 Heidelberg, Heidelberg, Germany.
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15
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Roca-Barceló A, Nardocci A, de Aguiar BS, Ribeiro AG, Failla MA, Hansell AL, Cardoso MR, Piel FB. Risk of cardiovascular mortality, stroke and coronary heart mortality associated with aircraft noise around Congonhas airport, São Paulo, Brazil: a small-area study. Environ Health 2021; 20:59. [PMID: 33985498 PMCID: PMC8120910 DOI: 10.1186/s12940-021-00746-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Noise pollution is increasingly recognised as a public health hazard, yet limited evidence is available from low- and middle-income countries (LMIC), particularly for specific sources. Here, we investigated the association between day-night average (Ldn) aircraft noise and the risk of death due to cardiovascular disease (CVD), stroke and coronary heart disease (CHD) at small-area level around São Paulo's Congonhas airport, Brazil during the period 2011-2016. METHODS We selected 3259 census tracts across 16 districts partially or entirely exposed to ≥50 dB aircraft noise levels around the Congonhas airport, using pre-modelled 5 dB Ldn noise bands (≤50 dB to > 65 dB). We estimated the average noise exposure per census tract using area-weighting. Age, sex and calendar year-specific death counts for CVD, stroke and CHD were calculated by census tract, according to the residential address at time of death. We fitted Poisson regression models to quantify the risk associated with aircraft noise exposure, adjusting for age, sex, calendar year and area-level covariates including socioeconomic development, ethnicity, smoking and road traffic related noise and air pollution. RESULTS After accounting for all covariates, areas exposed to the highest levels of noise (> 65 dB) showed a relative risk (RR) for CVD and CHD of 1.06 (95% CI: 0.94; 1.20) and 1.11 (95%CI: 0.96; 1.27), respectively, compared to those exposed to reference noise levels (≤50 dB). The RR for stroke ranged between 1.05 (95%CI: 0.95;1.16) and 0.91 (95%CI: 0.78;1.11) for all the noise levels assessed. We found a statistically significant positive trend for CVD and CHD mortality risk with increasing levels of noise (p = 0.043 and p = 0.005, respectively). No significant linear trend was found for stroke. Risk estimates were generally higher after excluding road traffic density, suggesting that road traffic air and noise pollution are potentially important confounders. CONCLUSIONS This study provides some evidence that aircraft noise is associated with increased risk of CVD and CHD mortality in a middle-income setting. More research is needed to validate these results in other LMIC settings and to further explore the influence of residual confounding and ecological bias. Remarkably, 60% of the study population living near the Congonhas airport (~ 1.5 million) were exposed to aircraft noise levels > 50 dB, well above those recommended by the WHO (45 dB), highlighting the need for public health interventions.
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Affiliation(s)
- Aina Roca-Barceló
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Adelaide Nardocci
- Department of Environmental Health, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Breno Souza de Aguiar
- Epidemiology and Information Department, Municipal Health Secretariat of São Paulo, São Paulo, Brazil
| | - Adeylson G. Ribeiro
- Department of Environmental Health, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Marcelo Antunes Failla
- Epidemiology and Information Department, Municipal Health Secretariat of São Paulo, São Paulo, Brazil
| | - Anna L. Hansell
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Maria Regina Cardoso
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Frédéric B. Piel
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Environmental Exposures and Health, London, UK
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Hamman MK. Disparities in COVID-19 mortality by county racial composition and the role of spring social distancing measures. Econ Hum Biol 2021; 41:100953. [PMID: 33360736 PMCID: PMC8671641 DOI: 10.1016/j.ehb.2020.100953] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/07/2020] [Accepted: 11/18/2020] [Indexed: 05/07/2023]
Abstract
Available COVID-19 data shows higher shares of cases and deaths occur among Black Americans, but reporting of data by race is poor. This paper investigates disparities in county-level mortality rates across counties with higher and lower than national average Black population shares using nonlinear regression decomposition and estimates potential differential impact of social distancing measures. I find counties with Black population shares above the national share have mortality rates 2 to 3 times higher than in other counties. Observable differences in living conditions, health, and work characteristics reduce the disparity to approximately 1.25 to 1.65 overall, and explain 100% of the disparity at 21 days after the first case. Though higher rates of comorbidities in counties with higher Black population shares are an important predictor, living situation factors like single parenthood and population density are just as important. Higher rates of co-residence with grandchildren explain 11% of the 21 day disparity but do not appear important by 42 days, suggesting families may have been better able to protect vulnerable family members later in the epidemic. To analyze differential effects of social distancing measures use two approaches. First, I exploit the timing of interventions relative to the first case among counties that began their epidemic at the same time. Second, I use event study analysis to analyze within-county changes in mortality. Findings for social distancing measures are not always consistent across approaches. Overall, I find no evidence that school closures were less effective in counties with larger Black population shares, and some estimates suggest closures may have disproportionately helped more diverse counties and counties with high rates of grandparent and grandchild co-residence. Conversely, stay at home orders are less clearly associated with mortality in any counties, reaching peak unemployment did not reduce mortality in any models, and some estimates indicate reaching peak unemployment before the first case was associated with higher mortality rates, especially in more diverse counties.
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Affiliation(s)
- Mary K Hamman
- University of Wisconsin La Crosse, N26878 Nelson, Blair, WI 54616, United States.
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Ruck DJ, Bentley RA, Borycz J. Early warning of vulnerable counties in a pandemic using socio-economic variables. Econ Hum Biol 2021; 41:100988. [PMID: 33636583 PMCID: PMC8054145 DOI: 10.1016/j.ehb.2021.100988] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 01/11/2021] [Accepted: 01/29/2021] [Indexed: 05/31/2023]
Abstract
In the U.S. in early 2020, heterogenous and incomplete county-scale data on COVID-19 hindered effective interventions in the pandemic. While numbers of deaths can be used to estimate actual number of infections after a time lag, counties with low death counts early on have considerable uncertainty about true numbers of cases in the future. Here we show that supplementing county-scale mortality statistics with socioeconomic data helps estimate true numbers of COVID-19 infections in low-data counties, and hence provide an early warning of future concern. We fit a LASSO negative binomial regression to select a parsimonious set of five predictive variables from thirty-one county-level covariates. Of these, population density, public transportation use, voting patterns and % African-American population are most predictive of higher COVID-19 death rates. To test the model, we show that counties identified as under-estimating COVID-19 on an early date (April 17) have relatively higher deaths later (July 1) in the pandemic.
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Affiliation(s)
- Damian J Ruck
- Anthropology Dept., University of Tennessee, Knoxville, TN 37996, USA; Network Science Institute, Northeastern University, Boston, MA 02115, USA
| | | | - Joshua Borycz
- Sarah Shannon Stevenson Science and Engineering Library, Vanderbilt University, Nashville, TN 37203, USA
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Rohleder S, Stock C, Bozorgmehr K. Socioeconomic deprivation is inversely associated with measles incidence: a longitudinal small-area analysis, Germany, 2001 to 2017. Euro Surveill 2021; 26:1900755. [PMID: 33928902 PMCID: PMC8086244 DOI: 10.2807/1560-7917.es.2021.26.17.1900755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 10/06/2020] [Indexed: 11/20/2022] Open
Abstract
BackgroundAlthough measles is endemic throughout the World Health Organization European Region, few studies have analysed socioeconomic inequalities and spatiotemporal variations in the disease's incidence.AimTo study the association between socioeconomic deprivation and measles incidence in Germany, while considering relevant demographic, spatial and temporal factors.MethodsWe conducted a longitudinal small-area analysis using nationally representative linked data in 401 districts (2001-2017). We used spatiotemporal Bayesian regression models to assess the potential effect of area deprivation on measles incidence, adjusted for demographic and geographical factors, as well as spatial and temporal effects. We estimated risk ratios (RR) for deprivation quintiles (Q1-Q5), and district-specific adjusted relative risks (ARR) to assess the area-level risk profile of measles in Germany.ResultsThe risk of measles incidence in areas with lowest deprivation quintile (Q1) was 1.58 times higher (95% credible interval (CrI): 1.32-2.00) than in those with highest deprivation (Q5). Areas with medium-low (Q2), medium (Q3) and medium-high deprivation (Q4) had higher adjusted risks of measles relative to areas with highest deprivation (Q5) (RR: 1.23, 95%CrI: 0.99-1.51; 1.05, 95%CrI: 0.87-1.26 and 1.23, 95%CrI: 1.05-1.43, respectively). We identified 54 districts at medium-high risk for measles (ARR > 2) in Germany, of which 22 were at high risk (ARR > 3).ConclusionSocioeconomic deprivation in Germany, one of Europe's most populated countries, is inversely associated with measles incidence. This association persists after demographic and spatiotemporal factors are considered. The social, spatial and temporal patterns of elevated risk require targeted public health action and policy to address the complexity underlying measles epidemiology.
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Affiliation(s)
- Sven Rohleder
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Christian Stock
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
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Golinelli D, Lenzi J, Adja KYC, Reno C, Sanmarchi F, Fantini MP, Gibertoni D. Small-scale spatial analysis shows the specular distribution of excess mortality between the first and second wave of the COVID-19 pandemic in Italy. Public Health 2021; 194:182-184. [PMID: 33962094 DOI: 10.1016/j.puhe.2021.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objective of the study is to compare excess mortality (EM) patterns and spatial correlation between the first and second wave of the pandemic in Lombardy, the Italian region that paid an extremely high COVID-19-related mortality toll in March and April 2020. STUDY DESIGN We conducted a longitudinal study using municipality-level mortality data. METHODS We investigated the patterns and spatial correlation of EM of men aged ≥75 years during the first two pandemic waves (March-April 2020 vs November 2020) of COVID-19, using the mortality data released by the Italian National Institute of Statistics. EM was estimated at the municipality level to accurately detect the critical areas within the region. RESULTS The areas that were mostly hit during the first wave of COVID-19 were generally spared by the second wave: EM of men aged ≥75 years in the municipality of Bergamo plummeted from +472% in March and April to -13% in November, and in Cremona the variation was from +344% to -19%. Conversely, in November 2020 EM was higher in some areas that had been protected in the first wave of the pandemic. Spatial correlation widely corroborates these findings, as large sections of the hot spots of EM detected in the first wave of the pandemic changed into cold spots in the second wave, and vice versa. CONCLUSIONS Our results reveal the specular distribution of EM between the first and second wave of the pandemic, which may entail the consequences of social distancing measures and individual behaviors, local management strategies, 'harvesting' of the frailer population and, possibly, acquired immune protection. In conclusion, our findings support the need for continuous monitoring and analysis of mortality data using detailed spatial resolution.
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Affiliation(s)
- D Golinelli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy.
| | - J Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
| | - K Y C Adja
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
| | - C Reno
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
| | - F Sanmarchi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
| | - M P Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
| | - D Gibertoni
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
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Amiri S, McDonell MG, Denney JT, Buchwald D, Amram O. Disparities in Access to Opioid Treatment Programs and Office-Based Buprenorphine Treatment Across the Rural-Urban and Area Deprivation Continua: A US Nationwide Small Area Analysis. Value Health 2021; 24:188-195. [PMID: 33518025 DOI: 10.1016/j.jval.2020.08.2098] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To measure access to opioid treatment programs (OTPs) and office-based buprenorphine treatment (OBBTs) at the smallest geographic unit for which the Census Bureau publishes demographic and socioeconomic data (ie, block group) and to explore disparities in access to treatment across the rural-urban and area deprivation continua across the United States. METHODS Access to OTPs and OBBTs at the block group in 2019 was quantified using an innovative 2-step floating catchment area technique that accounts for the supply of treatment facilities relative to the population size, proximity of facilities relative to the location of population in block groups, and time as a barrier within catchments. Block groups were stratified into tertiles based on the rural-urban continuum codes (metropolitan, micropolitan, small town, or rural) and area deprivation index (least-deprived, middle-deprived, most-deprived). The Integrated Nested Laplace Approximation approach was used for statistical analysis. RESULTS Across the United States, 3329 block groups corresponding to 2 915 949 adults lacked access to OTPs within a 2-hour drive of their community and 130 block groups corresponding to 86 605 adults did not have access to OBBTs. Disparities in access to treatment were observed across the urban-rural and area deprivation continua including (1) lowest mean access score to OBBTs were found among most-deprived small towns, and (2) lower mean access score to OTPs were found among micropolitan and small towns. CONCLUSIONS The results of this study revealed disparities in access to medication-assisted treatment. The findings call for creative initiatives and local and regional policies to develop to mitigate access problems.
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Affiliation(s)
- Solmaz Amiri
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
| | - Michael G McDonell
- Behavioral Health Innovations, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Justin T Denney
- Department of Sociology, Washington State University, Pullman, WA, USA
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
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21
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Peters MA, Mohan D, Naphini P, Carter E, Marx MA. Linking household surveys and facility assessments: a comparison of geospatial methods using nationally representative data from Malawi. Popul Health Metr 2020; 18:30. [PMID: 33302989 PMCID: PMC7731755 DOI: 10.1186/s12963-020-00242-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 11/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Linking facility and household surveys through geographic methods is a popular technique to draw conclusions about the relationship between health services and population health outcomes at local levels. These methods are useful tools for measuring effective coverage and tracking progress towards Universal Health Coverage, but are understudied. This paper compares the appropriateness of several geospatial methods used for linking individuals (within displaced survey cluster locations) to their source of family planning (at undisplaced health facilities) at a national level. METHODS In Malawi, geographic methods linked a population health survey, rural clusters from the Woman's Questionnaire of the 2015 Malawi Demographic and Health Survey (MDHS 2015), to Malawi's national health facility census to understand the service environment where women receive family planning services. Individuals from MDHS 2015 clusters were linked to health facilities through four geographic methods: (i) closest facility, (ii) buffer (5 km), (iii) administrative boundary, and (iv) a newly described theoretical catchment area method. Results were compared across metrics to assess the number of unlinked clusters (data lost), the number of linkages per cluster (precision of linkage), and the number of women linked to their last source of modern contraceptive (appropriateness of linkage). RESULTS The closest facility and administrative boundary methods linked every cluster to at least one facility, while the 5-km buffer method left 288 clusters (35.3%) unlinked. The theoretical catchment area method linked all but one cluster to at least one facility (99.9% linked). Closest facility, 5-km buffer, administrative boundary, and catchment methods linked clusters to 1.0, 1.4, 21.1, and 3.3 facilities on average, respectively. Overall, the closest facility, 5-km buffer, administrative boundary, and catchment methods appropriately linked 64.8%, 51.9%, 97.5%, and 88.9% of women to their last source of modern contraceptive, respectively. CONCLUSIONS Of the methods studied, the theoretical catchment area linking method loses a marginal amount of population data, links clusters to a relatively low number of facilities, and maintains a high level of appropriate linkages. This linking method is demonstrated at scale and can be used to link individuals to qualities of their service environments and better understand the pathways through which interventions impact health.
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Affiliation(s)
- Michael A. Peters
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Diwakar Mohan
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Patrick Naphini
- Malawi Ministry of Health is the institution, Lilongwe, Malawi
| | - Emily Carter
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Melissa A. Marx
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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22
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Gobaud AN, Kramer MR, Stearns ER, Haley DF. Measuring small-area violent crime: a comparison of observed versus model-estimated crime rates and preterm birth. Ann Epidemiol 2020; 55:27-33. [PMID: 33285260 DOI: 10.1016/j.annepidem.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/24/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Research examining the association between crime and health outcomes has been hampered by a lack of reliable small-area (e.g., census tract or census block group) crime data. Our objective is to assess the accuracy of synthetically estimated crime indices for use in health research by using preterm birth as a case study. METHODS We used violent crime data reported by 47 law enforcement agencies in 15 counties in Atlanta, Georgia and compared them with commercially estimated crime rates from the same year to assess (1) how two measures of crime were correlated and (2) if the associations between violent crime rate indices and preterm birth (PTB) varied as a function of the source of crime index. To assess the association between violent crime and PTB, we used multilevel logistic regression and controlled for potential individual- and neighborhood-level confounders. RESULTS Violent crime, both estimated and observed, was positively correlated with poverty, neighborhood proportion Black, and neighborhood deprivation index; however, the association was stronger using estimated rates as compared with observed crime rates. The association between living in a high violent crime neighborhood and PTB was only consistent for white women across the two crime indices after covariate adjustment. For Black women, the association between living in a high violent crime neighborhood and PTB is systematically underestimated across all models when the estimated crime rate is used. CONCLUSIONS There is evidence that model-estimated crime rates are not reliable proxies for crime in an urban area even when appropriate confounders are adjusted for.
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Affiliation(s)
- Ariana N Gobaud
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.
| | - Michael R Kramer
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | | | - Danielle F Haley
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
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Mohanty I, Niyonsenga T, Cochrane T, Rickwood D. A multilevel mixed effects analysis of informal carers health in Australia: the role of community participation, social support and trust at small area level. BMC Public Health 2020; 20:1801. [PMID: 33243189 PMCID: PMC7690182 DOI: 10.1186/s12889-020-09874-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informal carers suffer from worse health outcomes than non-carers due to their caregiving role. Yet, in a society carers health is as important as that of their care recipients. This study investigated the self-assessed mental and general health outcomes of informal carers in Australia. It evaluated the influence of carers' personal social capital- a logically linked sequence of their social behaviour such as community participation, social support and trust in others- on their health outcomes. The study estimated the magnitude of small area level variation at Statistical Area Level 1 (SA1) along with individual level variation in carers' health outcomes. METHODS The study used a multilevel mixed effects cross-sectional design using data from the Household Income and Labour Dynamics of Australia survey, wave 14. It included Australians aged 15 years and older that were surveyed in the year 2014. The sample consisted of 12,767 individuals and 5004 SA1s. The outcome measures included- mental health, general health and physical functioning, domains of the Short Form 36 Questionnaire, a widely used multi-dimensional measure of health-related quality of life. RESULTS Informal carers suffered from poor mental (Beta = - 0.587, p = 0.003) and general health (Beta = - 0.670, p = 0.001) outcomes compared to non-carers in Australia. These health outcomes exhibited significant variation acrossSA1s in Australia, with 12-13% variation in general and mental health. However, within small local areas, differences at the individual level, accounted for most of the variation in outcomes. Moreover, levels of community participation, personal social connection and trust, as perceived by individuals in the communities, had a positive influence on both mental and general health of carers and non-carers, and were more beneficial for carers compared to non-carers. CONCLUSION It seems that the positive influence of social capital for carers helps them in coping with the negative impact of their caregiving duty on health outcomes. Findings suggested that some targeted community support programs for carers to build on their personal social cohesion and trust in their community could help in improving their poor health profiles. Moreover, improved informal carers' health may help the health system in better managing their resources.
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Affiliation(s)
- Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory 2617 Australia
| | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory 2617 Australia
| | - Tom Cochrane
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory 2617 Australia
| | - Debra Rickwood
- Psychology, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory 2617 Australia
- Headspace National Youth Mental Health Foundation National Office, Melbourne, VIC Australia
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Antoniou T, McCormack D, Campbell T, Sutradhar R, Tadrous M, Lum-Wilson N, Leece P, Munro C, Gomes T. Geographic variation in the provision of naloxone by pharmacies in Ontario, Canada: A population-based small area variation analysis. Drug Alcohol Depend 2020; 216:108238. [PMID: 32891910 DOI: 10.1016/j.drugalcdep.2020.108238] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/15/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Regional variation in pharmacy-dispensed naloxone rates could create access disparities that undermine the effectiveness of this approach. We explored individual and public health unit (PHU)-level determinants of regional variation in naloxone distribution through the Ontario Naloxone Program for Pharmacies. METHODS We conducted a population-based study between April 1, 2017 and March 31, 2018. We calculated age- and sex-standardized pharmacy-dispensed naloxone rates for the 35 Ontario PHUs, and identified determinants of these rates using generalized estimating equations negative binomial regression. RESULTS The age- and sex-standardized pharmacy-dispensed naloxone rate in Ontario was 5.5 (range 1.8-11.6) kits per 1000 population. Variables associated with higher naloxone dispensing rates included opioid use disorder history [rate ratio (RR) 2.27; 95% confidence interval (CI) 1.75-2.96], opioid agonist therapy (RR 11.17; 95% CI 7.15-17.44), and PHU opioid overdose rate (RR 1.09 per 10 deaths; 95% CI 1.06-1.13). Pharmacy-dispensed naloxone rates were lower in rural areas (RR 0.83; 95% CI 0.73-0.94) and among individuals dispensed one (RR 0.72; 95% CI 0.65-0.79), two to five (RR 0.67; 95% CI 0.54-0.84) or 6-10 (RR 0.92; 95% CI 0.74-1.14) opioids in the prior year relative to those receiving no opioids. CONCLUSION Pharmacy-dispensed naloxone programs are important components of a public health response to the opioid overdose crisis. We found considerable variation in pharmacy-dispensed naloxone rates that could limit program effectiveness, particularly in rural settings with limited access to health and harm reduction services..
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Affiliation(s)
- Tony Antoniou
- ICES, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Canada; Unity Health Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Canada
| | | | | | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Mina Tadrous
- ICES, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Canada
| | | | - Pamela Leece
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Public Health Ontario Toronto, Ontario, Canada
| | | | - Tara Gomes
- ICES, Toronto, Ontario, Canada; Unity Health Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Canada.
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Rodriguez-Villamizar LA, Moreno-Corzo FE, Valbuena-Garcia AM, Uribe Pérez CJ, Brome Bohórquez MR, García García HI, Bravo LE, Ortiz Martínez RG, Niederbacher Velásquez J, Osornio-Vargas AR. Childhood Leukemia in Small Geographical Areas and Proximity to Industrial Sources of Air Pollutants in Three Colombian Cities. Int J Environ Res Public Health 2020; 17:E7925. [PMID: 33137878 PMCID: PMC7662935 DOI: 10.3390/ijerph17217925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/24/2020] [Accepted: 10/24/2020] [Indexed: 01/08/2023]
Abstract
Acute leukemia is the most common childhood cancer and has been associated with exposure to environmental carcinogens. This study aimed to identify clusters of acute childhood leukemia (ACL) cases and analyze their relationship with proximity to industrial sources of air pollution in three capital cities in Colombia during 2000-2015. Incident ACL cases were obtained from the population cancer registries for the cities of Bucaramanga, Cali, and Medellín. The inventory of industrial sources of emissions to the air was obtained from the regional environmental authorities and industrial conglomerates were identified. The Kulldorf's circular scan test was used to detect city clusters and to identify clusters around industrial conglomerates. Multivariable spatial modeling assessed the effect of distance and direction from the industrial conglomerates controlling for socioeconomic status. We identified industrials sectors within a buffer of 1 km around industrial conglomerates related to the ACL clusters. Incidence rates showed geographical heterogeneity with low spatial autocorrelation within cities. The spatio-temporal tests identified one cluster in each city. The industries located within 1 km around the ACL clusters identified in the three cities represent different sectors. Exposure to air pollution from industrial sources might be contributing to the incidence of ACL cases in urban settings in Colombia.
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Affiliation(s)
| | - Feisar Enrique Moreno-Corzo
- Public Health Observatory of Santander, Fundación Oftalmológica de Santander, Floridablanca 681003, Colombia; (F.E.M.-C.); (R.G.O.M.)
| | - Ana María Valbuena-Garcia
- Department of Public Health, Universidad Industrial de Santander, Bucaramanga 680002, Colombia;
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá 110111, Colombia
| | - Claudia Janeth Uribe Pérez
- Population Based Cancer Registry of the Metropolitan Area of Bucaramanga, Universidad Autónoma de Bucaramanga, Bucaramanga 681003, Colombia;
| | | | | | - Luis Eduardo Bravo
- Population Based Cancer Registry of Cali, Universidad del Valle, Cali 760043, Colombia;
| | - Rafael Gustavo Ortiz Martínez
- Public Health Observatory of Santander, Fundación Oftalmológica de Santander, Floridablanca 681003, Colombia; (F.E.M.-C.); (R.G.O.M.)
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Nguipdop-Djomo P, Rodrigues LC, Abubakar I, Mangtani P. Small-area level socio-economic deprivation and tuberculosis rates in England: An ecological analysis of tuberculosis notifications between 2008 and 2012. PLoS One 2020; 15:e0240879. [PMID: 33075092 PMCID: PMC7571683 DOI: 10.1371/journal.pone.0240879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 10/06/2020] [Indexed: 12/04/2022] Open
Abstract
Background Tuberculosis (TB) rates in England are among the highest in high-income countries. Poverty and historic and current immigration from high TB incidence parts of the world are two major drivers of tuberculosis in England. However, little has been done in recent years to examine socio-economic trends in TB rates in England, and to disentangle the role of deprivation from that of place of birth in the current TB epidemiology. Objectives To assess the association between England’s 2008–2012 TB notification rates and small area-level deprivation, together and separately in the UK-born and foreign-born populations. Methods Ecological analysis of the association between quintiles of England’s 2010 Index of Multiple Deprivation (IMD) and TB rates at the Lower-layer Super Output Area (LSOA; average population ~1500) level, using negative binomial and zero-inflated negative binomial regression models, adjusting for age, sex, urban/rural area classification, and area-level percentage of non-White residents. Results There was a log-linear gradient between area-deprivation levels and TB rates, with overall TB rates in the most deprived quintile areas three times higher than the least deprived quintile after adjustment for age and sex (IRR = 3.35; 95%CI: 3.16 to 3.55). The association and gradient were stronger in the UK-born than the foreign-born population, with UK-born TB rates in the most deprived quintiles about two-and-a-half times higher than the least deprived quintile (IRR = 2.39; 95%CI: 2.19 to 2.61) after controlling for age, sex, urban/rural classification and percentage of non-White residents; whereas the comparable figure for foreign-born persons was 80% higher (IRR = 1.78; 95%CI: 1.66 to 1.91). Conclusions Socio-economic deprivation continues to play a substantial role in sustaining the TB epidemic in England, especially in the UK-born population. This supports the case for further investigations of the underlying social- determinants of TB.
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Affiliation(s)
- Patrick Nguipdop-Djomo
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, and Tuberculosis Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Laura C. Rodrigues
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, and Tuberculosis Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ibrahim Abubakar
- Institute of Epidemiology and Health, and Centre for Infectious Disease Epidemiology, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Punam Mangtani
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, and Tuberculosis Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Wong MS, Steers WN, Hoggatt KJ, Ziaeian B, Washington DL. Relationship of neighborhood social determinants of health on racial/ethnic mortality disparities in US veterans-Mediation and moderating effects. Health Serv Res 2020; 55 Suppl 2:851-862. [PMID: 32860253 PMCID: PMC7518818 DOI: 10.1111/1475-6773.13547] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine mediation and moderation of racial/ethnic all-cause mortality disparities among Veteran Health Administration (VHA)-users by neighborhood deprivation and residential segregation. DATA SOURCES Electronic medical records for 10/2008-9/2009 VHA-users linked to National Death Index, 2000 Area Deprivation Index, and 2006-2009 US Census. STUDY DESIGN Racial/ethnic groups included American Indian/Alaskan Native (AI/AN), Asian, non-Hispanic black, Hispanic, Native Hawaiian/Other Pacific Islander, and non-Hispanic white (reference). We measured neighborhood deprivation by Area Deprivation Index, calculated segregation for non-Hispanic black, Hispanic, and AI/AN using the Isolation Index, evaluated mediation using inverse odds-weighted Cox regression models and moderation using Cox regression models testing for neighborhood*race/ethnicity interactions. PRINCIPAL FINDINGS Mortality disparities existed for AI/ANs (HR = 1.07, 95%CI:1.01-1.10) but no other groups after covariate adjustment. Neighborhood deprivation and Hispanic segregation neither mediated nor moderated AI/AN disparities. Non-Hispanic black segregation both mediated and moderated AI/AN disparities. The AI/AN vs. non-Hispanic white disparity was attenuated for AI/ANs living in neighborhoods with greater non-Hispanic black segregation (P = .047). Black segregation's mediating effect was limited to VHA-users living in counties with low black segregation. AI/AN segregation also mediated AI/AN mortality disparities in counties that included or were near AI/AN reservations. CONCLUSIONS Neighborhood characteristics, particularly black and AI/AN residential segregation, may contribute to AI/AN mortality disparities among VHA-users, particularly in communities that were rural, had greater black segregation, or were located on or near AI/AN reservations. This suggests the importance of neighborhood social determinants of health on racial/ethnic mortality disparities. Living near reservations may allow AI/AN VHA-users to maintain cultural and tribal ties, while also providing them with access to economic and other resources. Future research should explore the experiences of AI/ANs living in black communities and underlying mechanisms to identify targets for intervention.
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Affiliation(s)
- Michelle S. Wong
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP)VA Greater Los Angeles Healthcare SystemLos AngelesCAUSA
| | - W. Neil Steers
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP)VA Greater Los Angeles Healthcare SystemLos AngelesCAUSA
| | - Katherine J. Hoggatt
- San Francisco VA Healthcare SystemSan FranciscoCAUSA
- Department of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Boback Ziaeian
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP)VA Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Division of Cardiology, Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Donna L. Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP)VA Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Division of General Internal Medicine and Health Services Research, Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
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Wertli MM, Schlapbach JM, Haynes AG, Scheuter C, Jegerlehner SN, Panczak R, Chiolero A, Rodondi N, Aujesky D. Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis. PLoS One 2020; 15:e0238287. [PMID: 32956363 PMCID: PMC7505431 DOI: 10.1371/journal.pone.0238287] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 07/29/2020] [Indexed: 12/18/2022] Open
Abstract
Background Compared to other OECD countries, Switzerland has the highest rates of hip (HA) and knee arthroplasty (KA). Objective We assessed the regional variation in HA/KA rates and potential determinants of variation in Switzerland. Methods We conducted a population-based analysis using discharge data from all Swiss hospitals during 2013–2016. We derived hospital service areas (HSAs) by analyzing patient flows. We calculated age-/sex-standardized procedure rates and measures of variation (the extremal quotient [EQ, highest divided by lowest rate] and the systemic component of variation [SCV]). We estimated the reduction in variance of HA/KA rates across HSAs in multilevel regression models, with incremental adjustment for procedure year, age, sex, language, urbanization, socioeconomic factors, burden of disease, and the number of orthopedic surgeons. Results Overall, 69,578 HA and 69,899 KA from 55 HSAs were analyzed. The mean age-/sex-standardized HA rate was 265 (range 179–342) and KA rate was 256 (range 186–378) per 100,000 persons and increased over time. The EQ was 1.9 for HA and 2.5 for KA. The SCV was 2.0 for HA and 2.2 for KA, indicating a low variation across HSAs. When adjusted for procedure year and demographic, cultural, and sociodemographic factors, the models explained 75% of the variance in HA and 63% in KA across Swiss HSAs. Conclusion Switzerland has high HA/KA rates with a modest regional variation, suggesting that the threshold to perform HA/KA may be uniformly low across regions. One third of the variation remained unexplained and may, at least in part, represent differing physician beliefs and attitudes towards joint arthroplasty.
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Affiliation(s)
- Maria M. Wertli
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- * E-mail:
| | - Judith M. Schlapbach
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Alan G. Haynes
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- CTU Bern, University of Bern, Bern, Switzerland
| | - Claudia Scheuter
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Sabrina N. Jegerlehner
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Radoslaw Panczak
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Queensland Centre for Population Research, School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia
| | - Arnaud Chiolero
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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Wang D, Chen H, Song B, Yan T, Zhai Z, Pei X, Cui Z. Supramolecular Hydrogels with Chiral Nanofibril Structures Formed from β-Cyclodextrin and a Rosin-Based Amino Acid Surfactant. J Agric Food Chem 2020; 68:10056-10062. [PMID: 32816467 DOI: 10.1021/acs.jafc.0c03748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The rational combination of natural molecules is expected to provide new soft material building blocks. Herein, a rosin-based amino acid surfactant was synthesized using dehydroabietic acid and l-serine as the starting materials (denoted as R-6-Ser). Supramolecular hydrogels were formed when β-cyclodextrin (β-CD) was mixed with R-6-Ser at molar ratios of over 0.5:1 and above certain concentrations. The hydrogels were investigated using rheometry, small-angle X-ray scattering, CD spectroscopy, and cryo-transmission electron microscopy (cryo-TEM). The β-CD associated with the isopropyl benzyl group of the dehydroabietic acid unit in R-6-Ser and formed R-6-Ser@β-CD complexes. The complexes and R-6-Ser self-assembled to form elongated right-handed rigid fibers with a diameter of approximately 7-8 nm, which were responsible for the elasticity of the hydrogels. This work demonstrated the feasibility of preparing supramolecular hydrogels from a diterpenoid-based surfactant and β-CD and provides a new means of utilizing the secretions of pine trees.
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Affiliation(s)
- Danping Wang
- The Key Laboratory of Synthetic and Biological Colloids, Ministry of Education, School of Chemical and Material Engineering, Jiangnan University, Wuxi, Jiangsu 214122, P.R. China
| | - Hao Chen
- The Key Laboratory of Synthetic and Biological Colloids, Ministry of Education, School of Chemical and Material Engineering, Jiangnan University, Wuxi, Jiangsu 214122, P.R. China
| | - Binglei Song
- The Key Laboratory of Synthetic and Biological Colloids, Ministry of Education, School of Chemical and Material Engineering, Jiangnan University, Wuxi, Jiangsu 214122, P.R. China
| | - Tingting Yan
- The Key Laboratory of Synthetic and Biological Colloids, Ministry of Education, School of Chemical and Material Engineering, Jiangnan University, Wuxi, Jiangsu 214122, P.R. China
| | - Zhaolan Zhai
- Key Laboratory of Biomass Energy and Material, Jiangsu Province, Institute of Chemical Industry of Forest Products, CAF, Nanjing, Jiangsu 210042, P.R. China
| | - Xiaomei Pei
- The Key Laboratory of Synthetic and Biological Colloids, Ministry of Education, School of Chemical and Material Engineering, Jiangnan University, Wuxi, Jiangsu 214122, P.R. China
| | - Zhenggang Cui
- The Key Laboratory of Synthetic and Biological Colloids, Ministry of Education, School of Chemical and Material Engineering, Jiangnan University, Wuxi, Jiangsu 214122, P.R. China
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Grigoroglou C, Munford L, Webb R, Kapur N, Doran T, Ashcroft D, Kontopantelis E. Impact of a national primary care pay-for-performance scheme on ambulatory care sensitive hospital admissions: a small-area analysis in England. BMJ Open 2020; 10:e036046. [PMID: 32907897 PMCID: PMC7482460 DOI: 10.1136/bmjopen-2019-036046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We aimed to spatially describe hospital admissions for ambulatory care sensitive conditions (ACSC) in England at small-area geographical level and assess whether recorded practice performance under one of the world's largest primary care pay-for-performance schemes led to reductions in these potentially avoidable hospitalisations for chronic conditions incentivised in the scheme. SETTING We obtained numbers of ACSC hospital admissions from the Hospital Episode Statistics database and information on recorded practice performance from the Quality and Outcomes Framework (QOF) administrative dataset for 2015/2016. We fitted three sets of negative binomial models to examine ecological associations between incentivised ACSC admissions, general practice performance, deprivation, urbanity and other sociodemographic characteristics. RESULTS Hospital admissions for QOF incentivised ACSCs varied within and between regions, with clusters of high numbers of hospital admissions for incentivised ACSCs identified across England. Our models indicated a very small effect of the QOF on reducing admissions for incentivised ACSCs (0.993, 95% CI 0.990 to 0.995), however, other factors, such as deprivation (1.021, 95% CI 1.020 to 1.021) and urbanicity (0.875, 95% CI 0.862 to 0.887), were far more important in explaining variations in admissions for ACSCs. People in deprived areas had a higher risk of being admitted in hospital for an incentivised ACSC condition. CONCLUSION Spatial analysis based on routinely collected data can be used to identify areas with high rates of potentially avoidable hospital admissions, providing valuable information for targeting resources and evaluating public health interventions. Our findings suggest that the QOF had a very small effect on reducing avoidable hospitalisation for incentivised conditions. Material deprivation and urbanicity were the strongest predictors of the variation in ACSC rates for all QOF incentivised conditions across England.
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Affiliation(s)
- Christos Grigoroglou
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Luke Munford
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Health Organisation, Policy and Economics, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Roger Webb
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Centre for Mental Health and Safety, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Navneet Kapur
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Centre for Suicide Prevention, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health Trust, Manchester, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| | - Darren Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Faculty of Biology, Medicine & Health, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, Greater Manchester, UK
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Wairoto KG, Joseph NK, Macharia PM, Okiro EA. Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in Kenya. BMC Health Serv Res 2020; 20:665. [PMID: 32682421 PMCID: PMC7368739 DOI: 10.1186/s12913-020-05531-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The spatial variation in antenatal care (ANC) utilisation is likely associated with disparities observed in maternal and neonatal deaths. Most maternal deaths are preventable through services offered during ANC; however, estimates of ANC coverage at lower decision-making units (sub-county) is mostly lacking. In this study, we aimed to estimate the coverage of at least four ANC (ANC4) visits at the sub-county level using the 2014 Kenya Demographic and Health Survey (KDHS 2014) and identify factors associated with ANC utilisation in Kenya. METHODS Data from the KDHS 2014 was used to compute sub-county estimates of ANC4 using small area estimation (SAE) techniques which relied on spatial relatedness to yield precise and reliable estimates at each of the 295 sub-counties. Hierarchical mixed-effect logistic regression was used to identify factors influencing ANC4 utilisation. Sub-county estimates of factors significantly associated with ANC utilisation were produced using SAE techniques and mapped to visualise disparities. RESULTS The coverage of ANC4 across sub-counties was heterogeneous, ranging from a low of 17% in Mandera West sub-county to over 77% in Nakuru Town West and Ruiru sub-counties. Thirty-one per cent of the 295 sub-counties had coverage of less than 50%. Maternal education, household wealth, place of delivery, marital status, age at first marriage, and birth order were all associated with ANC utilisation. The areas with low ANC4 utilisation rates corresponded to areas of low socioeconomic status, fewer educated women and a small number of health facility deliveries. CONCLUSION Suboptimal coverage of ANC4 and its heterogeneity at sub-county level calls for urgent, focused and localised approaches to improve access to antenatal care services. Policy formulation and resources allocation should rely on data-driven strategies to guide national and county governments achieve equity in access and utilisation of health interventions.
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Affiliation(s)
- Kefa G. Wairoto
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K. Joseph
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Emelda A. Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LJ UK
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Norwood TA, Encisa C, Wang X, Seliske L, Cunningham J, De P. A Bayesian shared components modeling approach to develop small area indicators of social determinants of health with measures of uncertainty. Can J Public Health 2020; 111:342-357. [PMID: 32500336 PMCID: PMC7352027 DOI: 10.17269/s41997-020-00321-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Existing Canadian social determinants of health (SDOH) indicators do not quantify uncertainty to identify priority areas. The objectives of this methodologic study were: (1) to estimate and map small area (dissemination area) shared and variable-specific SDOH indicators with measures of uncertainty using a Bayesian model that accounts for spatial dependence; (2) to quantify geographic variation in the SDOH indicators and their contribution to a shared indicator; and (3) to assess the SDOH indicators' associations with behavioural risk factors and their consistency with the Ontario Marginalization Index (ON-Marg). METHODS Lower education-, income-, unemployment-, living alone- and visible minority-related variables used in existing Canadian SDOH indices were fit as dependent variables to a Bayesian model to produce area-based SDOH indicators that were mapped with measures of uncertainty in two study areas. The fractions of spatial variation explained by the model components were computed. Bayesian analysis of variance was used to examine the SDOH indicator associations with behavioural risk factors and their consistency with ON-Marg examined using Pearson's correlation coefficient. RESULTS The shared component was strongly associated with material deprivation (i.e., income) in each study area; however, variable-specific SDOH indicators were important too. The SDOH indicators were associated with behavioural risk factors for chronic disease, particularly alcohol consumption and smoking, and the shared component estimates were consistent with the ON-Marg material deprivation. CONCLUSIONS The Bayesian approach to produce SDOH indicators met the three study objectives and as such provides a new approach to prioritize areas that may experience health inequalities.
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Affiliation(s)
- Todd A Norwood
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Clarissa Encisa
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Xiaotian Wang
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Laura Seliske
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Jessie Cunningham
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Prithwish De
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada
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Flórez KC, Corberán-Vallet A, Iftimi A, Bermúdez JD. A Bayesian unified framework for risk estimation and cluster identification in small area health data analysis. PLoS One 2020; 15:e0231935. [PMID: 32379767 PMCID: PMC7205265 DOI: 10.1371/journal.pone.0231935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 04/03/2020] [Indexed: 11/20/2022] Open
Abstract
Many statistical models have been proposed to analyse small area disease data with the aim of describing spatial variation in disease risk. In this paper, we propose a Bayesian hierarchical model that simultaneously allows for risk estimation and cluster identification. Our model formulation assumes that there is an unknown number of risk classes and small areas are assigned to a risk class by means of independent allocation variables. Therefore, areas within each cluster are assumed to share a common risk but they may be geographically separated. The posterior distribution of the parameter representing the number of risk classes is estimated using a novel procedure that combines its prior distribution with an efficient estimate of the marginal likelihood of the data given this parameter. An extension of the model incorporating covariates is also shown. These covariates may incorporate additional information on the problem or they may account for spatial correlation in the data. We illustrate the performance of the proposed model through both a simulation study and a case study of reported cases of varicella in the city of Valencia, Spain.
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Affiliation(s)
- K. C. Flórez
- Department of Statistics and Operations Research, University of Valencia, Valencia, Spain
| | - A. Corberán-Vallet
- Department of Statistics and Operations Research, University of Valencia, Valencia, Spain
- * E-mail:
| | - A. Iftimi
- Department of Statistics and Operations Research, University of Valencia, Valencia, Spain
| | - J. D. Bermúdez
- Department of Statistics and Operations Research, University of Valencia, Valencia, Spain
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Dwane N, Wabiri N, Manda S. Small-area variation of cardiovascular diseases and select risk factors and their association to household and area poverty in South Africa: Capturing emerging trends in South Africa to better target local level interventions. PLoS One 2020; 15:e0230564. [PMID: 32320425 PMCID: PMC7176123 DOI: 10.1371/journal.pone.0230564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 03/03/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Of the total 56 million deaths worldwide during 2012, 38 million (68%) were due to noncommunicable diseases (NCDs), particularly cardiovascular diseases (17.5 million deaths) cancers (8.2 million) which represents46.2% and 21.7% of NCD deaths, respectively). Nearly 80 percent of the global CVD deaths occur in low- and middle-income countries. Some of the major CVDs such as ischemic heart disease (IHD) and stroke and CVD risk conditions, namely, hypertension and dyslipidaemia share common modifiable risk factors including smoking, unhealthy diets, harmful use of alcohol and physical inactivity. The CVDs are now putting a heavy strain of the health systems at both national and local levels, which have previously largely focused on infectious diseases and appalling maternal and child health. We set out to estimate district-level co-occurrence of two cardiovascular diseases (CVDs), namely, ischemic heart disease (IHD) and stroke; and two major risk conditions for CVD, namely, hypertension and dyslipidaemia in South Africa. METHOD The analyses were based on adults health collected as part of the 2012 South African National Health and Nutrition Examination Survey (SANHANES). We used joint disease mapping models to estimate and map the spatial distributions of risks of hypertension, self-report of ischaemic heart disease (IHD), stroke and dyslipidaemia at the district level in South Africa. The analyses were adjusted for known individual social demographic and lifestyle factors, household and district level poverty measurements using binary spatial models. RESULTS The estimated prevalence of IHD, stroke, hypertension and dyslipidaemia revealed high inequality at the district level (median value (range): 5.4 (0-17.8%); 1.7 (0-18.2%); 32.0 (12.5-48.2%) and 52.2 (0-71.7%), respectively). The adjusted risks of stroke, hypertension and IHD were mostly high in districts in the South-Eastern parts of the country, while that of dyslipidaemia, was high in Central and top North-Eastern corridor of the country. CONCLUSIONS The study has confirmed common modifiable risk factors of two cardiovascular diseases (CVDs), namely, ischemic heart disease (IHD) and stroke; and two major risk conditions for CVD, namely, hypertension and dyslipidaemia. Accordingly, an integrated intervention approach addressing cardiovascular diseases and associated risk factors and conditions would be more cost effective and provide stronger impacts than individual tailored interventions only. Findings of excess district-level variations in the CVDs and their risk factor profiles might be useful for developing effective public health policies and interventions aimed at reducing behavioural risk factors including harmful use of alcohol, physical inactivity and high salt intake.
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Affiliation(s)
- Ntabozuko Dwane
- Empilweni Services Research Unit, Department of Paediatrics and Child Health, University of Witwatersrand, Johannesburg, South Africa
| | - Njeri Wabiri
- Human Sciences Research Council, Pretoria, South Africa
| | - Samuel Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Statistics, University of Pretoria, Pretoria, South Africa
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Piel FB, Cockings S. Using large and complex datasets for small-area environment-health studies: from theory to practice. Int J Epidemiol 2020; 49 Suppl 1:i1-i3. [PMID: 32293010 PMCID: PMC7158051 DOI: 10.1093/ije/dyaa018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/14/2020] [Accepted: 02/11/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Frédéric B Piel
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, Imperial College London, UK
| | - Samantha Cockings
- Department of Geography and Environmental Science, University of Southampton, Southampton, UK
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Fecht D, Cockings S, Hodgson S, Piel FB, Martin D, Waller LA. Advances in mapping population and demographic characteristics at small-area levels. Int J Epidemiol 2020; 49 Suppl 1:i15-i25. [PMID: 32293009 PMCID: PMC7158058 DOI: 10.1093/ije/dyz179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/09/2019] [Indexed: 11/30/2022] Open
Abstract
Temporally and spatially highly resolved information on population characteristics, including demographic profile (e.g. age and sex), ethnicity and socio-economic status (e.g. income, occupation, education), are essential for observational health studies at the small-area level. Time-relevant population data are critical as denominators for health statistics, analytics and epidemiology, to calculate rates or risks of disease. Demographic and socio-economic characteristics are key determinants of health and important confounders in the relationship between environmental contaminants and health. In many countries, census data have long been the source of small-area population denominators and confounder information. A strength of the traditional census model has been its careful design and high level of population coverage, allowing high-quality detailed data to be released for small areas periodically, e.g. every 10 years. The timeliness of data, however, becomes a challenge when temporally and spatially highly accurate annual (or even more frequent) data at high spatial resolution are needed, for example, for health surveillance and epidemiological studies. Additionally, the approach to collecting demographic population information is changing in the era of open and big data and may eventually evolve to using combinations of administrative and other data, supplemented by surveys. We discuss different approaches to address these challenges including (i) the US American Community Survey, a rolling sample of the US population census, (ii) the use of spatial analysis techniques to compile temporally and spatially high-resolution demographic data and (iii) the use of administrative and big data sources as proxies for demographic characteristics.
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Affiliation(s)
- Daniela Fecht
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, St Mary’s Campus, London, UK
| | - Samantha Cockings
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Susan Hodgson
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, St Mary’s Campus, London, UK
| | - Frédéric B Piel
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, St Mary’s Campus, London, UK
| | - David Martin
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Piel FB, Fecht D, Hodgson S, Blangiardo M, Toledano M, Hansell AL, Elliott P. Small-area methods for investigation of environment and health. Int J Epidemiol 2020; 49:686-699. [PMID: 32182344 PMCID: PMC7266556 DOI: 10.1093/ije/dyaa006] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/10/2020] [Indexed: 11/30/2022] Open
Abstract
Small-area studies offer a powerful epidemiological approach to study disease patterns at the population level and assess health risks posed by environmental pollutants. They involve a public health investigation on a geographical scale (e.g. neighbourhood) with overlay of health, environmental, demographic and potential confounder data. Recent methodological advances, including Bayesian approaches, combined with fast-growing computational capabilities, permit more informative analyses than previously possible, including the incorporation of data at different scales, from satellites to individual-level survey information. Better data availability has widened the scope and utility of small-area studies, but has also led to greater complexity, including choice of optimal study area size and extent, duration of study periods, range of covariates and confounders to be considered and dealing with uncertainty. The availability of data from large, well-phenotyped cohorts such as UK Biobank enables the use of mixed-level study designs and the triangulation of evidence on environmental risks from small-area and individual-level studies, therefore improving causal inference, including use of linked biomarker and -omics data. As a result, there are now improved opportunities to investigate the impacts of environmental risk factors on human health, particularly for the surveillance and prevention of non-communicable diseases.
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Affiliation(s)
- Frédéric B Piel
- UK Small Area Health Statistics Unit, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC-PHE Centre for Environment & Health, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, Imperial College London, UK
| | - Daniela Fecht
- UK Small Area Health Statistics Unit, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC-PHE Centre for Environment & Health, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Susan Hodgson
- UK Small Area Health Statistics Unit, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC-PHE Centre for Environment & Health, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Marta Blangiardo
- UK Small Area Health Statistics Unit, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC-PHE Centre for Environment & Health, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - M Toledano
- MRC-PHE Centre for Environment & Health, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - A L Hansell
- UK Small Area Health Statistics Unit, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
- Centre for Environmental Health and Sustainability, Medical School, University of Leicester, Leicester, UK
| | - Paul Elliott
- UK Small Area Health Statistics Unit, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC-PHE Centre for Environment & Health, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, Imperial College London, UK
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Hodgson S, Fecht D, Gulliver J, Iyathooray Daby H, Piel FB, Yip F, Strosnider H, Hansell A, Elliott P. Availability, access, analysis and dissemination of small-area data. Int J Epidemiol 2020; 49 Suppl 1:i4-i14. [PMID: 32293007 PMCID: PMC7158061 DOI: 10.1093/ije/dyz051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2019] [Indexed: 11/26/2022] Open
Abstract
In this era of 'big data', there is growing recognition of the value of environmental, health, social and demographic data for research. Open government data initiatives are growing in number and in terms of content. Remote sensing data are finding widespread use in environmental research, including in low- and middle-income settings. While our ability to study environment and health associations across countries and continents grows, data protection rules and greater patient control over the use of their data present new challenges to using health data in research. Innovative tools that circumvent the need for the physical sharing of data by supporting non-disclosive sharing of information, or that permit spatial analysis without researchers needing access to underlying patient data can be used to support analyses while protecting data confidentiality. User-friendly visualizations, allowing small-area data to be seen and understood by non-expert audiences, are revolutionizing public and researcher interactions with data. The UK Small Area Health Statistics Unit's Environment and Health Atlas for England and Wales, and the US National Environmental Public Health Tracking Network offer good examples. Open data facilitates user-generated outputs, and 'mash-ups', and user-generated inputs from social media, mobile devices and wearable tech are new data streams that will find utility in future studies, and bring novel dimensions with respect to ethical use of small-area data.
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Affiliation(s)
- Susan Hodgson
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Daniela Fecht
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - John Gulliver
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Hima Iyathooray Daby
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Frédéric B Piel
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Fuyuen Yip
- Environmental Health Tracking Section, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Heather Strosnider
- Environmental Health Tracking Section, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Anna Hansell
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
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Pryce R, Angus C, Holmes J, Gillespie D, Buykx P, Meier P, Hickman M, de Vocht F, Brennan A. Reweighting national survey data for small area behaviour estimates: modelling alcohol consumption in Local Authorities in England. Popul Health Metr 2020; 18:1. [PMID: 31898545 PMCID: PMC6941256 DOI: 10.1186/s12963-019-0201-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are likely to be differences in alcohol consumption levels and patterns across local areas within a country, yet survey data is often collected at the national or sub-national/regional level and is not representative for small geographic areas. METHODS This paper presents a method for reweighting national survey data-the Health Survey for England-by combining survey and routine data to produce simulated locally representative survey data and provide statistics of alcohol consumption for each Local Authority in England. RESULTS We find a 2-fold difference in estimated mean alcohol consumption between the lightest and heaviest drinking Local Authorities, a 4.5-fold difference in abstention rates, and a 3.5-fold difference in harmful drinking. The method compares well to direct estimates from the data at regional level. CONCLUSIONS The results have important policy implications in itself, but the reweighted data can also be used to model local policy effects. This method can also be used for other public health small area estimation where locally representative data are not available.
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Affiliation(s)
- Robert Pryce
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA UK
| | - Duncan Gillespie
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA UK
| | - Penny Buykx
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA UK
- School of Humanities and Social Science, Newcastle University, Newcastle, New South Wales Australia
| | - Petra Meier
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA UK
| | - Matt Hickman
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Frank de Vocht
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA UK
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Salm M, Wübker A. Sources of regional variation in healthcare utilization in Germany. J Health Econ 2020; 69:102271. [PMID: 31874377 DOI: 10.1016/j.jhealeco.2019.102271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/24/2019] [Accepted: 11/28/2019] [Indexed: 06/10/2023]
Abstract
We examine sources of regional variation in ambulatory care utilization in Germany. We exploit patient migration to examine which share of regional variation in ambulatory care utilization can be attributed to demand factors and to supply factors, respectively. Based on administrative claim-level data we find that regional variation can be overwhelmingly explained by patient characteristics. Our results contrast with previous results for other countries, and they suggest that institutional rules in Germany successfully constrain supply-side variation in ambulatory care use between German regions for most patients. Furthermore, we find that both demographics and other patient characteristics substantially contribute to regional variation and that causes of regional variation vary when comparing different regions within Germany.
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Affiliation(s)
- Martin Salm
- Tilburg University, Department of Econometrics and Operations Research, the Netherlands.
| | - Ansgar Wübker
- RWI Essen, Leibniz Science Campus Ruhr, and Ruhr-Universität Bochum, Germany.
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Torok M, Shand F, Phillips M, Meteoro N, Martin D, Larsen M. Data-informed targets for suicide prevention: a small-area analysis of high-risk suicide regions in Australia. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1209-1218. [PMID: 31041467 DOI: 10.1007/s00127-019-01716-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 04/25/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate small-area variation in risks associated with suicide deaths across four regional communities in New South Wales, Australia, and to determine whether these areas have unique demographic and socioeconomic risk profiles that could inform targeted means restriction suicide prevention efforts. METHODS Archival data on suicide mortality for all deaths in New South Wales, Australia, over the period 2006-2015 were geospatially attributed to four high-risk priority regions. Deaths in the four regions were compared to each other, and to NSW, on demographic factors, indicators of economic deprivation, and suicide means. RESULTS Priority means restriction targets were identified for all sites. In Murrumbidgee, suicide deaths were significantly more likely to involve firearms and older males (p < 0.001). The Central Coast had a greater proportion of overdose deaths (p < 0.001), which were associated with being female and unemployed. Suicide deaths in Newcastle were associated with being younger (p = 0.001) and involving 'jumping from a height' (p < 0.001), while economic deprivation was a major risk for suicide death in Illawarra Shoalhaven (p < 0.001). CONCLUSIONS Local regions were significantly differentiated from each other, and from the State, in terms of priority populations and means of suicide, demonstrating the need for locally based, targeted interventions. There were, however, also some risk constancies across all sites (males, hanging, economic deprivation), suggesting that prevention initiatives should, optimally, be delivered within multilevel models that target risk commonalities and provide tailored initiatives that address risk specific to a region.
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Affiliation(s)
- Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, Australia.
| | - F Shand
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - M Phillips
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - N Meteoro
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - D Martin
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - M Larsen
- Black Dog Institute, University of New South Wales, Sydney, Australia
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Grigoroglou C, Munford L, Webb RT, Kapur N, Ashcroft DM, Kontopantelis E. Spatial distribution and temporal trends in social fragmentation in England, 2001-2011: a national study. BMJ Open 2019; 9:e025881. [PMID: 30679299 PMCID: PMC6347895 DOI: 10.1136/bmjopen-2018-025881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Social fragmentation is commonly examined in epidemiological studies of mental illness as high levels of social fragmentation are often found in areas with high prevalence of mental illness. In this study, we examine spatial and temporal patterns of social fragmentation and its underlying indicators in England over time. SETTING Data for social fragmentation and its underlying indicators were analysed over the decennial Censuses (2001-2011) at a small area geographical level (mean of 1500 people). Degrees of social fragmentation and temporal changes were spatially visualised for the whole of England and its 10 administrative regions. Spatial clustering was quantified using Moran's I; changes in correlations over time were quantified using Spearman's ranking correlation. RESULTS Between 2001 and 2011, we observed a strong persistence for social fragmentation nationally (Spearman's r=0.93). At the regional level, modest changes were observed over time, but marked increases were observed for two of the four social fragmentation underlying indicators, namely single people and those in private renting. Results supported our hypothesis of increasing spatial clustering over time. Moderate regional variability was observed in social fragmentation, its underlying indicators and their clustering over time. CONCLUSION Patterns of social fragmentation and its underlying indicators persisted in England which seem to be driven by the large increases in single people and those in private renting. Policies to improve social cohesion may have an impact on the lives of persons who experience mental illness. The spatial aspect of social fragmentation can inform the targeting of health and social care interventions, particularly in areas with strong social fragmentation clustering.
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Affiliation(s)
- Christos Grigoroglou
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
| | - Luke Munford
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
- Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Roger T Webb
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Nav Kapur
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Centre for Suicide Prevention, Division of Psychology and Mental Health, University of Manchester, Manchester, Greater Manchester, UK
- Greater Manchester Mental Health Trust, Manchester, UK
| | - Darren M Ashcroft
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
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van Os J. [An analysis of the degree of unexplained small-area variation in costs of mental health care: towards a model of evidence-based commissioning of care?]. Tijdschr Psychiatr 2019; 61:617-625. [PMID: 31560781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Part of the quality of a mental health service is the degree in which the service can demonstrate that its output is aligned with indicators of population need.<br/> AIM: To investigate to what degree small areas in the Netherlands (PC3-level, 798 areas) differ in the level of mental health care consumption; to what degree this is reducible to demographic and socioeconomic indicators representing known predictors of population mental health needs; and to what degree associations between indicators of need and mental health consumption vary across regions.<br/> METHOD: Analysis of public mental health cost data in the Netherlands over de period 2011-2017 for the age group 18-65 years.<br/> RESULTS: Mental health care costs displayed a pattern of small area variation that for 77% was reducible to socioeconomic and demographic factors at the regional level. Mental health care costs were associated independently with younger age, female sex and a range of socioeconomic factors including urbanicity, ethnic density and a socioeconomic index variable. However, the degree to which these indicators of mental health needs impacted mental health costs varied from region to region.<br/> CONCLUSION: Regional mental health care output in the Netherlands is partially aligned with population needs These analyses validate the notion that mental health care commissioning may be guided by benchmarked evidence of service output being proportional to the needs predicted by population socioeconomic indices.
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Broekman TG. [Reaction on 'An analysis of the degree of unexplained small-area variation in costs of mental health care: towards a model of evidence-based commissioning of care']. Tijdschr Psychiatr 2019; 61:910. [PMID: 31907906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Toivakka M, Pihlapuro A, Tykkyläinen M, Mehtätalo L, Laatikainen T. The usefulness of small-area-based socioeconomic characteristics in assessing the treatment outcomes of type 2 diabetes patients: a register-based mixed-effect study. BMC Public Health 2018; 18:1258. [PMID: 30428885 PMCID: PMC6236994 DOI: 10.1186/s12889-018-6165-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/30/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Assessment of the differences in the outcomes of care by socioeconomic status (SES) is beneficial for both the efficient targeting of health care services and to decrease health inequalities. This study compares the effects of three patient-based SES predictors (earned income, educational attainment, employment status) with three small-area-based SES predictors (median income, educational attainment, proportion of the unemployed) on the treatment outcomes of type 2 diabetes patients. METHODS Mixed-effect modeling was applied to analyse how SES factors affect the treatment outcomes of type 2 diabetes patients. The treatment outcomes were assessed by the patients' latest available glycated hemoglobin A1C (HbA1c) value. We used electronic health records of type 2 diabetes patients from the regional electronic patient database, the patients' individual register-based SES information from Statistics Finland, and the SES information about the population of the postal code area of the patients from Statistics Finland. RESULTS The effects of attained education on the treatment outcomes, both at the patient-level and the small-area-level are quite similar. Age and male gender were associated with higher HbA1c values and lower education indicated higher HbA1c values. Unemployment was not associated with HbA1c values at either the patient-level or the area-level. Income gave divergent results: high values of HbA1c were associated with low patient incomes but the median income of the postal code area did not predict the treatment outcomes of patients. CONCLUSIONS Our comparative study of three SES factors shows that the effects of attained education on the treatment outcomes are rather similar, regardless of whether patient-based or small-area-based predictors are used. Small-area-based SES variables can be a good way to overcome the absence of individual SES information, but further research is needed to find the valid small-area factors by disease. This possibility of using more small-area-based data would be valuable in health service research and first-hand planning of health care services.
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Affiliation(s)
- Maija Toivakka
- Department of Geographical and Historical Studies, University of Eastern Finland, P.O. Box 111, FI-80101 Joensuu, Finland
| | - Aki Pihlapuro
- Joint municipal authority for North Karelia social and health services (Siun sote), Tikkamäentie 16, FI-80210 Joensuu, Finland
| | - Markku Tykkyläinen
- Department of Geographical and Historical Studies, University of Eastern Finland, P.O. Box 111, FI-80101 Joensuu, Finland
| | - Lauri Mehtätalo
- School of Computing, University of Eastern Finland, P.O. Box 111, FI-80101 Joensuu, Finland
| | - Tiina Laatikainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Tikkamäentie 16, FI-80210 Joensuu, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
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Brehony C, Cullinan J, Cormican M, Morris D. Shiga toxigenic Escherichia coli incidence is related to small area variation in cattle density in a region in Ireland. Sci Total Environ 2018; 637-638:865-870. [PMID: 29763867 DOI: 10.1016/j.scitotenv.2018.05.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 06/08/2023]
Abstract
Shiga toxigenic Escherichia coli (STEC) are pathogenic E. coli that cause infectious diarrhoea. In some cases infection may be complicated by renal failure and death. The incidence of human infection with STEC in Ireland is the highest in Europe. The objective of the study was to examine the spatial incidence of human STEC infection in a region of Ireland with significantly higher rates of STEC incidence than the national average and to identify possible risk factors of STEC incidence at area level. Anonymised laboratory records (n = 379) from 2009 to 2015 were obtained from laboratories serving three counties in the West of Ireland. Data included location and sample date. Population and electoral division (ED) data were obtained from the Irish 2011 Census of Population. STEC incidence was calculated for each ED (n = 498) and used to map hotspots/coldspots using the Getis-Ord Gi* spatial statistic and significant spatial clustering using the Anselin's Local Moran's I statistic. Multivariable regression analysis was used to consider the importance of a number of potential predictors of STEC incidence. Incidence rates for the seven-year period ranged from 0 to 10.9 cases per 1000. A number of areas with significant local clustering of STEC incidence as well as variation in the spatial distribution of the two main serogroups associated with disease in the region i.e. O26 and O157 were identified. Cattle density was found to be a statistically significant predictor of STEC in the region. GIS analysis of routine data indicates that cattle density is associated STEC infection in this high incidence region. This finding points to the importance of agricultural practices for human health and the importance of a "one-health" approach to public policy in relation to agriculture, health and environment.
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Affiliation(s)
- C Brehony
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland.
| | - J Cullinan
- School of Business & Economics, National University of Ireland, Galway, Ireland
| | - M Cormican
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland; Department of Medical Microbiology, University Hospital Galway, Galway, Ireland
| | - D Morris
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland
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Arias E, Escobedo LA, Kennedy J, Fu C, Cisewki J. U.S. Small-area Life Expectancy Estimates Project: Methodology and Results Summary. Vital Health Stat 2 2018:1-40. [PMID: 30312153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Statistically reliable, abridged, period life tables were produced for 88.7% of U.S. census tracts (65,662). A battery of tests revealed that the census-tract life table functions followed expected patterns; their distribution about state and U.S. values showed no aberrations; and their weighted mean values compared well with state- and national-level estimates. The weighted mean life expectancy at birth for the 65,662 census tracts was 78.7 years compared with the official U.S. estimate of 78.8 years in midyear 2013. The results of this study concur with previous research showing that a minimum population size of 5,000 is acceptable, with the caveat that missing age-specific death counts cannot be ignored. The methodology developed for this study addressed the issues of small populations and zero deaths as robustly as possible, although it is not without error.
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Boz K, Denli HH. Spatial electromagnetic field intensity modelling of global system for mobile communication base stations in the Istanbul Technical University Ayazaga campus area. Geospat Health 2018; 13:527. [PMID: 29772874 DOI: 10.4081/gh.2018.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 07/07/2017] [Accepted: 06/30/2017] [Indexed: 06/08/2023]
Abstract
The rapid development of the global system for mobile communication services and the consequent increased electromagnetic field (EMF) exposure to the human body have generated debate on the potential danger with respect to human health. The many research studies focused on this subject have, however, not provided any certain evidence about harmful consequences due to mobile communication systems. On the other hand, there are still views suggesting such exposure might affect the human body in different ways. To reduce such effects to a minimum, the International Commission on Non-Ionizing Radiation Protection (ICNIRP) has declared boundary values for the energy released by the base stations, which are the main source of the electromagnetic fields. These values are accepted by many countries in various parts of the world. The aim of this study was to create EMF intensity maps for the area covered by Istanbul Technical University (ITU) and find areas of potential risk with regard to health considering the current situation and future trends. In this study, the field intensities of electromagnetic signals issued at the frequencies of 900 and 1800 MHz were measured in V/m at 29 pre-specified survey points using a spectrum analyzer (Spectran HF-6065). Geographic information systems and spatial interpolation techniques were used to produce EMF intensity maps. Three different spatial interpolation methods, minimum mean square error, Radial Basis and Empirical Bayesian Kriging, were compared. The results were geographically analyzed and the measurements expressed as heat maps covering the study area. Using these maps, the values measured were compared with the EMF intensity standards issued by ICNIRP. The results showed that the exposure levels to the EMF intensities were all within the ICNIRP limits at the ITU study area. However, since the EMF intensity level with respect to human health is not known, it is not possible to confirm if these levels are safe or not.
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Affiliation(s)
- Kubra Boz
- Institute of Geographic Information Technology, Ayazaga Campus, Sariyer/Istanbul.
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Kauhl B, Maier W, Schweikart J, Keste A, Moskwyn M. Exploring the small-scale spatial distribution of hypertension and its association to area deprivation based on health insurance claims in Northeastern Germany. BMC Public Health 2018; 18:121. [PMID: 29321032 PMCID: PMC5761146 DOI: 10.1186/s12889-017-5017-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 12/21/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hypertension is one of the most frequently diagnosed chronic conditions in Germany. Targeted prevention strategies and allocation of general practitioners where they are needed most are necessary to prevent severe complications arising from high blood pressure. However, data on chronic diseases in Germany are mostly available through survey data, which do not only underestimate the actual prevalence but are also only available on coarse spatial scales. The discussion of including area deprivation for planning of healthcare is still relatively young in Germany, although previous studies have shown that area deprivation is associated with adverse health outcomes, irrespective of individual characteristics. The aim of this study is therefore to analyze the spatial distribution of hypertension at very fine geographic scales and to assess location-specific associations between hypertension, socio-demographic population characteristics and area deprivation based on health insurance claims of the AOK Nordost. METHODS To visualize the spatial distribution of hypertension prevalence at very fine geographic scales, we used the conditional autoregressive Besag-York-Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific association of hypertension to area deprivation and further socio-demographic population characteristics. RESULTS The sex- and age-adjusted prevalence of hypertension was 33.1% in 2012 and varied widely across northeastern Germany. The main risk factors for hypertension were proportions of insurants aged 45-64, 65 and older, area deprivation and proportion of persons commuting to work outside their residential municipality. The GWR model revealed important regional variations in the strength of the examined associations. CONCLUSION Area deprivation has only a significant and therefore direct influence in large parts of Mecklenburg-West Pomerania. However, the spatially varying strength of the association between demographic variables and hypertension indicates that there also exists an indirect effect of area deprivation on the prevalence of hypertension. It can therefore be expected that persons ageing in deprived areas will be at greater risk of hypertension, irrespective of their individual characteristics. The future planning and allocation of primary healthcare in northeastern Germany would therefore greatly benefit from considering the effect of area deprivation.
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Affiliation(s)
- B. Kauhl
- AOK Nordost – Die Gesundheitskasse, Department of Medical Care, Berlin, Germany
- Beuth University of Applied Sciences, Department III, Civil Engineering and Geoinformatics, Berlin, Germany
| | - W. Maier
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - J. Schweikart
- Beuth University of Applied Sciences, Department III, Civil Engineering and Geoinformatics, Berlin, Germany
| | - A. Keste
- AOK Nordost – Die Gesundheitskasse, Department of Medical Care, Berlin, Germany
| | - M. Moskwyn
- AOK Nordost – Die Gesundheitskasse, Department of Medical Care, Berlin, Germany
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Conway R, Cournane S, Byrne D, O'Riordan D, Coveney S, Silke B. Interaction of Broadband Access and Education Levels in Determining the Rate of Emergency Medical Admissions. Ir Med J 2017; 110:636. [PMID: 29372951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Background We examined the effect of broadband access, educational status and their interaction on local population health. Methods We calculated the annual admission incidence rates for each small area population unit within our hospital catchment, relating quintiles of broadband access to two groups a) full time education to primary level (less than or equal to 15 years) and b) full time education to tertiary level (>18 years). Univariate and multivariable risk estimates were calculated, using truncated Poisson regression. Results 82,368 admissions in 44,628 patients were included. Broadband access was a linear predictor of the admission incidence rate with decreases from Q1 (least access) 50.8 (95%CI 30.2 to 71.4) to Q5 (highest access) 17.9 (95%CI 13.4 to 22.4). Areas with greater numbers educated only to primary level were more influenced by broadband access. Conclusion Broadband access is a predictor of the emergency medical admission rate; this effect is modulated by the baseline education level.
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Affiliation(s)
- R Conway
- Department of Internal Medicine, St James' Hospital, Dublin 8, Ireland
| | - S Cournane
- Medical Physics and Bioengineering Department, St James' Hospital
| | - D Byrne
- Department of Internal Medicine, St James' Hospital, Dublin 8, Ireland
| | - D O'Riordan
- Department of Internal Medicine, St James' Hospital, Dublin 8, Ireland
| | - S Coveney
- Envo-Geo Environmental Geoinformatics, Ireland
| | - B Silke
- Department of Internal Medicine, St James' Hospital, Dublin 8, Ireland
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