Linda Beale

Methodologic issues and approaches to spatial epidemiology.

Spatial epidemiology is increasingly being used to assess health risks associated with environmental hazards. Risk patterns tend to have both a temporal and a spatial component; thus, spatial epidemiology must combine methods from epidemiology, statistics, and geographic information science. Recent statistical advances in spatial epidemiology include the use of smoothing in risk maps to create an interpretable risk surface, the extension of spatial models to incorporate the time dimension, and the combination of individual- and area-level information. Advances in geographic information systems and the growing availability of modeling packages have led to an improvement in exposure assessment. Techniques drawn from geographic information science are being developed to enable the visualization of uncertainty and ensure more meaningful inferences are made from data. When public health concerns related to the environment arise, it is essential to address such anxieties appropriately and in a timely manner. Tools designed to facilitate the investigation process are being developed, although the availability of complete and clean health data, and appropriate exposure data often remain limiting factors.

Aircraft noise and cardiovascular disease near Heathrow airport in London: small area study

Objective To investigate the association of aircraft noise with risk of stroke, coronary heart disease, and cardiovascular disease in the general population. Design Small area study. Setting 12 London boroughs and nine districts west of London exposed to aircraft noise related to Heathrow airport in London. Population About 3.6 million residents living near Heathrow airport. Risks for hospital admissions were assessed in 12 110 census output areas (average population about 300 inhabitants) and risks for mortality in 2378 super output areas (about 1500 inhabitants). Main outcome measures Risk of hospital admissions for, and mortality from, stroke, coronary heart disease, and cardiovascular disease, 2001-05. Results Hospital admissions showed statistically significant linear trends (P<0.001 to P<0.05) of increasing risk with higher levels of both daytime (average A weighted equivalent noise 7 am to 11 pm, LAeq,16h) and night time (11 pm to 7 am, Lnight) aircraft noise. When areas experiencing the highest levels of daytime aircraft noise were compared with those experiencing the lowest levels (>63 dB v ≤51 dB), the relative risk of hospital admissions for stroke was 1.24 (95% confidence interval 1.08 to 1.43), for coronary heart disease was 1.21 (1.12 to 1.31), and for cardiovascular disease was 1.14 (1.08 to 1.20) adjusted for age, sex, ethnicity, deprivation, and a smoking proxy (lung cancer mortality) using a Poisson regression model including a random effect term to account for residual heterogeneity. Corresponding relative risks for mortality were of similar magnitude, although with wider confidence limits. Admissions for coronary heart disease and cardiovascular disease were particularly affected by adjustment for South Asian ethnicity, which needs to be considered in interpretation. All results were robust to adjustment for particulate matter (PM10) air pollution, and road traffic noise, possible for London boroughs (population about 2.6 million). We could not distinguish between the effects of daytime or night time noise as these measures were highly correlated. Conclusion High levels of aircraft noise were associated with increased risks of stroke, coronary heart disease, and cardiovascular disease for both hospital admissions and mortality in areas near Heathrow airport in London. As well as the possibility of causal associations, alternative explanations such as residual confounding and potential for ecological bias should be considered.

Mapping for Wheelchair Users: Route Navigation in Urban Spaces

Abstract Navigation around urban areas is often constraining for the mobility-impaired due to the fabric of the urban landscape, and there is a need to provide maps tailored to individual abilities. Barriers to effective navigation, such as slope, surface type and dropped kerbs, differ for able-bodied pedestrians and wheelchair users. This study identifies and quantifies such differences, and develops a Geographical Information Systems (GIS) network model for the creation of accessibility maps for wheelchair users. The measurement of barriers uses Digital Elevation Models, calculation of rolling resistance, and surveys in the field using hand-held GIS. A spatial database has been constructed which contains the pedestrian route network and barriers to navigation. A GIS application runs the model, providing a user-friendly interface to define and calculate routes through the pedestrian route network that take account of impedances to accessibility. The model, application and interface has been tested with wheelchair users and the route selection provides a good correspondence with patterns of route finding already established through experience. The interface and individually tailored maps generated, provide a tool suitable to assist wheelchair users new to an area; to enable better navigation for existing users, and a means for planners to consider the way in which access is restricted for wheelchair users in their designs for more inclusive urban environments.

Mobile phone base stations and early childhood cancers: case-control study.

Objective To investigate the risk of early childhood cancers associated with the mother’s exposure to radiofrequency from and proximity to macrocell mobile phone base stations (masts) during pregnancy. Design Case-control study. Setting Cancer registry and national birth register data in Great Britain. Participants 1397 cases of cancer in children aged 0-4 from national cancer registry 1999-2001 and 5588 birth controls from national birth register, individually matched by sex and date of birth (four controls per case). Main outcome measures Incidence of cancers of the brain and central nervous system, leukaemia, and non-Hodgkin’s lymphomas, and all cancers combined, adjusted for small area measures of education level, socioeconomic deprivation, population density, and population mixing. Results Mean distance of registered address at birth from a macrocell base station, based on a national database of 76 890 base station antennas in 1996-2001, was similar for cases and controls (1107 (SD 1131) m v 1073 (SD 1130) m, P=0.31), as was total power output of base stations within 700 m of the address (2.89 (SD 5.9) kW v 3.00 (SD 6.0) kW, P=0.54) and modelled power density (−30.3 (SD 21.7) dBm v −29.7 (SD 21.5) dBm, P=0.41). For modelled power density at the address at birth, compared with the lowest exposure category the adjusted odds ratios were 1.01 (95% confidence interval 0.87 to 1.18) in the intermediate and 1.02 (0.88 to 1.20) in the highest exposure category for all cancers (P=0.79 for trend), 0.97 (0.69 to 1.37) and 0.76 (0.51 to 1.12), respectively, for brain and central nervous system cancers (P=0.33 for trend), and 1.16 (0.90 to 1.48) and 1.03 (0.79 to 1.34) for leukaemia and non-Hodgkin’s lymphoma (P=0.51 for trend). Conclusions There is no association between risk of early childhood cancers and estimates of the mother’s exposure to mobile phone base stations during pregnancy.

Modelling Access with GIS in Urban Systems (MAGUS): capturing the experiences of wheelchair users

Access and mobility are important dimensions of quality of life. For wheelchair users, everyday trips are often fraught with problems, with many barriers imperceptible to the able-bodied, hindering or totally restricting movement. This paper describes a project undertaken with wheelchair users, which has developed, tested and applied a Geographic Information System model. This model acts both as a navigational device for wheelchairs users 2013 enabling them to make informed route choices through urban places 2013 and as a decision support and planning tool for urban planners 2013 making visible the ways in which built environments are often distorted and hostile spaces for wheelchair users.

Feasibility and utility of mapping disease risk at the neighbourhood level within a Canadian public health unit: an ecological study

BackgroundWe conducted spatial analyses to determine the geographic variation of cancer at the neighbourhood level (dissemination areas or DAs) within the area of a single Ontario public health unit, Wellington-Dufferin-Guelph, covering a population of 238,326 inhabitants. Cancer incidence data between 1999 and 2003 were obtained from the Ontario Cancer Registry and were geocoded down to the level of DA using the enhanced Postal Code Conversion File. The 2001 Census of Canada provided information on the size and age-sex structure of the population at the DA level, in addition to information about selected census covariates, such as average neighbourhood income.ResultsAge standardized incidence ratios for cancer and the prevalence of census covariates were calculated for each of 331 dissemination areas in Wellington-Dufferin-Guelph. The standardized incidence ratios (SIR) for cancer varied dramatically across the dissemination areas. However, application of the Morans I statistic, a popular index of spatial autocorrelation, suggested significant spatial patterns for only two cancers, lung and prostate, both in males (p < 0.001 and p = 0.002, respectively). Employing Bayesian hierarchical models, areas in the urban core of the City of Guelph had significantly higher SIRs for male lung cancer than the remainder of Wellington-Dufferin-Guelph; and, neighbourhoods in the urban and surrounding rural areas of Orangeville exhibited significantly higher SIRs for prostate cancer. After adjustment for age and spatial dependence, average household income attenuated much of the spatial pattern of lung cancer, but not of prostate cancer.ConclusionThis paper demonstrates the feasibility and utility of a systematic approach to identifying neighbourhoods, within the area served by a public health unit, that have significantly higher risks of cancer. This exploratory, ecologic study suggests several hypotheses for these spatial patterns that warrant further investigations. To the best of our knowledge, this is the first Canadian study published in the peer-reviewed literature estimating the risk of relatively rare public health outcomes at a very small areal level, namely dissemination areas.

Evaluation of spatial relationships between health and the environment: the rapid inquiry facility.

Background The initiation of environmental public health tracking systems in the United States and the United Kingdom provided an opportunity to advance techniques and tools available for spatial epidemiological analysis integrating both health and environmental data. Objective The Rapid Inquiry Facility (RIF) allows users to calculate adjusted and unadjusted standardized rates and risks. The RIF is embedded in ArcGIS so that further geographical information system (GIS) spatial functionality can be exploited or results can be exported to statistical packages for further tailored analyses where required. The RIF also links directly to several statistical packages and displays the results in the GIS. Methods The value of the RIF is illustrated here with two case studies: risk of leukemia in areas surrounding oil refineries in the State of Utah (USA) and an analysis of the geographical variation of risk of esophageal cancer in relation to zinc cadmium sulfide exposure in Norwich (United Kingdom). Results The risk analysis study in Utah did not suggest any evidence of increased relative risk of leukemia, multiple myeloma, or Hodgkin’s lymphoma in the populations around the five oil-refining facilities but did reveal an excess risk of non-Hodgkin’s lymphoma that might warrant further investigation. The disease-mapping study in Norwich did not reveal any areas with higher relative risks of esophageal cancer common to both males and females, suggesting that a common geographically determined exposure was unlikely to be influencing cancer risk in the area. Conclusion The RIF offers a tool that allows epidemiologists to quickly carry out ecological environmental epidemiological analysis such as risk assessment or disease mapping.

Development of a Deprivation Index and its relation to premature mortality due to diseases of the circulatory system in Hungary, 1998-2004.

An association between health and socio-economic status is well known. Based on international and national studies, the aims of this study were to develop a multi-dimensional index at the municipality level, to provide information about socio-economic deprivation in Hungary and to investigate the association between socio-economic status and the spatial distribution of premature mortality due to diseases of the circulatory system. Seven municipality level socio-economic indicators were used from the National Information System of Spatial Development (income, low qualification, unemployment, one-parent families, large families, density of housing and car ownership). After normalisation and standardisation, indicator weights were evaluated using factor analysis. A risk analysis study was conducted using the Rapid Inquiry Facility software to evaluate the association between deprivation and the spatial distribution of premature mortality due to diseases of the circulatory system for the years 1998-2004. Areas of significantly high deprivation were identified in the northeastern, eastern and southwestern parts of Hungary. A statistically significant association was found between premature cardiovascular mortality and deprivation status in both genders. The Deprivation Index is the first composite index at the municipality level in Hungary and includes key factors that affect socio-economic status. The identified association highlighted the fact that inequalities in socio-economic status may reflect the spatial distribution of health status in a population. The results can be used to inform prevention strategies and help plan local health promotion programs aimed at reducing health inequalities.

A GIS-based urban simulation model for environmental health analysis

Abstract This paper introduces an urban simulation model for environmental health analysis (SIENA). SIENA is a novel tool to explore urban interactions and processes with regard to exposure assessments. It is based on urban structures and relationships observed in real-world cities making it a realistic representation of a functioning city. The development of SIENA involved identifying and quantifying fundamental processes and similarities in urban areas in Great Britain and using those to guide the building of SIENA within a GIS. An internal validation confirmed SIENAs realism. Its generality, achieved through the pooling of information from different real-world cities, makes it particularly useful for developing and testing spatial epidemiological concepts and models; simulating processes and interactions relating to environmental exposure; and exploring theoretical and methodological problems in the spatial analysis of environmental health. SIENA ultimately provides a much needed tool in the form of a controlled, simplified urban simulation model.

A geographical model of radio-frequency power density around mobile phone masts

Public concern about possible health effects of EMF radiation from mobile phone masts has led to an increase of epidemiological studies and health risk assessments which, in turn, require adequate methods of exposure estimation. Difficulties in exposure modelling are exacerbated both by the complexity of the propagation processes, and the need to obtain estimates for large study populations in order to provide sufficient statistical power to detect or exclude the small relative risks that might exist. Use of geographical information system (GIS) techniques offers the means to make such computations efficiently. This paper describes the development and field validation of a GIS-based exposure model (Geomorf). The model uses a modified Gaussian formulation to represent spatial variations in power densities around mobile phone masts, on the basis of power output, antenna height, tilt and the surrounding propagation environment. Obstruction by topography is allowed for, through use of a visibility function. Model calibration was done using field data from 151 measurement sites (1510 antenna-specific measurements) around a group of masts in a rural location, and 50 measurement sites (658 antenna-specific measurements) in an urban area. Different parameter settings were found to be necessary in urban and rural areas to obtain optimum results. The calibrated models were then validated against independent sets of data gathered from measurement surveys in rural and urban areas, and model performance was compared with that of two commonly used path-loss models (the COST-231 adaptations of the Hata and Walfisch-Ikegami models). Model performance was found to vary somewhat between the rural and urban areas, and at different measurement levels (antenna-specific power density, total power density), but overall gave good estimates (R(2)=0.641 and 0.615, RMSE=10.7 and 6.7 dB m at the antenna and site-level respectively). Performance was considerably better than that of both path loss models.