Geospatial analyses to prioritize public health interventions: a case study of pedestrian and pedal cycle injuries in New South Wales, Australia

Objectives

Pedestrian and pedal cycle injuries are important causes of child morbidity and mortality. The combination of Bayesian methods and geographical distribution maps may assist public health practitioners to identify communities at high risk of injury.

Methods

Data were obtained on all hospitalizations of children from NSW (Australia), for pedestrian and pedal cycle injuries, from 2000?C2001 to 2004?C2005. Using Bayesian methods, posterior expected rate ratios (as an estimate of smoothed standardized hospitalization ratios for each injury mechanism) were mapped by local government area (LGA) across the state.

Results

There were over 7,000 hospitalizations for pedestrian and pedal cycle injuries. High risk LGAs accounted for more than one third of hospitalized pedestrian and pedal cycle injuries in NSW.

Conclusions

LGAs at high risk for pedestrian injury tended to be urbanized metropolitan areas with a high population density, while high risk LGAs for pedal cycle injury tended to be either in urban regional areas, or on the margin of urbanized metropolitan areas. Geospatial analyses can assist policymakers and practitioners to identify high risk communities for which public health interventions can be prioritized.     

Multiple Trigger Points for Quantifying Heat-Health Impacts: New Evidence from a Hot Climate

Background

Extreme heat is a public health challenge. The scarcity of directly comparable studies on the association of heat with morbidity and mortality and the inconsistent identification of threshold temperatures for severe impacts hampers the development of comprehensive strategies aimed at reducing adverse heat-health events.

Objectives

This quantitative study was designed to link temperature with mortality and morbidity events in Maricopa County, Arizona, USA, with a focus on the summer season.

Methods

Using Poisson regression models that controlled for temporal confounders, we assessed daily temperature–health associations for a suite of mortality and morbidity events, diagnoses, and temperature metrics. Minimum risk temperatures, increasing risk temperatures, and excess risk temperatures were statistically identified to represent different “trigger points” at which heat-health intervention measures might be activated.

Results

We found significant and consistent associations of high environmental temperature with all-cause mortality, cardiovascular mortality, heat-related mortality, and mortality resulting from conditions that are consequences of heat and dehydration. Hospitalizations and emergency department visits due to heat-related conditions and conditions associated with consequences of heat and dehydration were also strongly associated with high temperatures, and there were several times more of those events than there were deaths. For each temperature metric, we observed large contrasts in trigger points (up to 22°C) across multiple health events and diagnoses.

Conclusion

Consideration of multiple health events and diagnoses together with a comprehensive approach to identifying threshold temperatures revealed large differences in trigger points for possible interventions related to heat. Providing an array of heat trigger points applicable for different end-users may improve the public health response to a problem that is projected to worsen in the coming decades.

Citation

Petitti DB, Hondula DM, Yang S, Harlan SL, Chowell G. 2016. Multiple trigger points for quantifying heat-health impacts: new evidence from a hot climate. Environ Health Perspect 124:176–183; http://dx.doi.org/10.1289/ehp.1409119     

The effects of heat stress and its effect modifiers on stroke hospitalizations in Allegheny County,Pennsylvania

Purpose

Heat has been known to increase the risk of many health endpoints. However, few studies have examined its effects on stroke. The objective of this case-crossover study is to investigate the effects of high heat and its effect modifiers on the risk of stroke hospitalization in Allegheny County, Pennsylvania.

Methods

We obtained data on first stroke hospitalizations among adults ages 65 and older and daily meteorological information during warm seasons (May–September) from 1994 to 2000 in Allegheny County, Pennsylvania. Using conditional multiple logistic regressions, the effects of heat days (any day with a temperature greater than the 95th percentile) and heat wave days (at least two continuous heat days) on the risk of stroke hospitalization were investigated. The potential interactions between high heat and age, type of stroke, and gender were also examined.

Results

Heat day and heat wave at lag-2 day were significantly associated with an increased risk for stroke hospitalization (OR 1.121, 95 % CI 1.013–1.242; OR 1.173, 95 % CI 1.047–1.315, respectively) after adjusting for important covariates. In addition, having two or more heat wave days within the 4 day window prior to the event was also significantly associated with an increased risk (OR 1.119, 95 % CI 1.004, 1.246) compared to having no heat wave days during the period. The effect of high heat on stroke was more significant for ischemic stroke, men, and subjects ages 80 years or older.

Conclusions

Our study suggests that high heat may have adverse effects on stroke and that some subgroups may be particularly susceptible to heat.     

Pr?vention hitzebedingter Gesundheitsgef?hrdungen in der station?ren Altenpflege

Background

Against the background of demographic prognosis and the increasing risk of heat waves, the vulnerability of aged people in need of care for heat stress forces preventive efforts in nursing homes.

Objectives

In this review, current epidemiological and physiological evidence about risk reduction measures in cases of high indoor temperatures in nursing homes is reported. Preventive approaches are discussed in the context of general conditions in nursing homes.

Results

Constructional measures promise to be most effective. Depending on the thermal conditions of the building, there will be a need for timely action. Preventive measures include the reduction of exposure and measures that target reducing the susceptibility of the residents to heat, the latter requiring close collaboration between physicians and nurses.     

Mortality analysis by neighbourhood in a city with high levels of industrial air pollution

Objectives

Taranto, a city in south-eastern Italy, suffers serious environmental pollution from industrial sources. A previous cohort analysis found mortality excesses among neighbourhoods closest to industrial areas. Aim of this study was to investigate whether mortality also increased in other neighbourhoods compared to Apulia region.

Methods

Standardized mortality ratios were computed. Number of deaths and of person-years at risk by neighbourhood came from the previous cohort study for 1998–2008 period. Reference population was Apulia region excluding Taranto province. A meta-analysis was conducted across less close neighbourhoods computing summary SMR estimates and evaluating heterogeneity.

Results

For the entire city higher mortality values are confirmed for all causes, all malignant neoplasms and several specific sites, neurological, cardiac, respiratory and digestive diseases. High mortality values are not confined to neighbourhoods closest to industrial areas for lung cancer, cardiac, respiratory and digestive diseases, in both sexes, and among women for all malignant neoplasms and pancreatic cancer.

Conclusions

Increased mortality risks can also be observed in Taranto neighbourhoods not directly adjacent to industrial areas. Spatial trend, impact of socio-economic factors and duration of residence should be further explored.     

Predictors of 3-year mortality in subjects over 95 years of age. The nonasantfeliu study

Objectives

To examine the survival rates of subjects aged 95 or over after a follow-up period of 3 years, and to determine predictive factors for mortality risk.

Design

A prospective cohort study.

Setting

A community-based study.

Participants

Forty-eight subjects aged 95 or over.

Measurements

Sociodemographic data, Barthel Index, Lawton-Brody Index, Spanish version of the Mini-Mental State Examination, short version of the Mini Nutritional Assessment, comorbidity (Charlson Index), and prevalent chronic diseases were evaluated. Patients who died were compared with the rest.

Results

Thirty-six deaths (75%) were recorded during follow-up. The Cox multivariate analysis showed that lower Barthel Index scores and a history of heart failure were independently associated with long-term mortality.

Conclusions

In subjects aged 95 or over, poor functional status and history of heart failure were the two independent risk factors for 3-year mortality.     

A simple method for estimating excess mortality due to heat waves, as applied to the 2006 California heat wave

Objectives

To characterize excess mortality during a major heat wave in California and its regions; to assess the validity of a simple method.

Methods

We calculated mortality rate ratios for the heat-wave period, using a reference period of the same number of days from the same summer. We conducted alternative analyses and compared our results with those from a time-series model.

Results

We estimated 655 excess deaths, a 6% increase (95% confidence interval, 3–9%), impacting varied geographic/climate regions. Alternate analyses supported model validity.

Conclusions

California experienced excess heat-wave related mortality not restricted to high heat regions. As climate change is anticipated to increase heat events, public health efforts to monitor effects assume greater importance.     

A retrospective cohort study of shift work and risk of cancer-specific mortality in German male chemical workers

Objectives

Human evidence of carcinogenicity concerning shift work is inconsistent. In a previous study, we observed no elevated risk of total mortality in shift workers followed up until the end of 2006. The present study aimed to investigate cancer-specific mortality, relative to shift work.

Methods

The cohort consisted of male production workers (14,038 shift work and 17,105 day work), employed at BASF Ludwigshafen for at least 1 year between 1995 and 2005. Vital status was followed from 2000 to 2009. Cause-specific mortality was obtained from death certificates. Exposure to shift work was measured both as a dichotomous and continuous variable. While lifetime job history was not available, job duration in the company was derived from personal data, which was then categorized at the quartiles. Cox proportional hazard model was used to adjust for potential confounders, in which job duration was treated as a time-dependent covariate.

Results

Between 2000 and 2009, there were 513 and 549 deaths among rotating shift and day work employees, respectively. Risks of total and cancer-specific mortalities were marginally lower among shift workers when taking age at entry and job level into consideration and were statistically significantly lower when cigarette smoking, alcohol intake, job duration, and chronic disease prevalence at entry to follow-up were included as explanatory factors. With respect to mortality risks in relation to exposure duration, no increased risks were found in any of the exposure groups after full adjustment and there was no apparent trend suggesting an exposure–response relation with duration of shift work.

Conclusions

The present analysis extends and confirms our previous finding of no excess risk of mortality associated with work in the shift system employed at BASF Ludwigshafen. More specifically, there is also no indication of an increased risk of mortality due to cancer.     

Malnutrition in Turkish nursing homes: A correlate of short term mortality

Objective

Elderly nursing home residents are under high risk of malnutrition. Early interventions to prevent malnutrition may play a critical role in malnutrition-mortality correlation. This study aimed to obtain insight into the prevalence of malnutrition in nursing homes in the capital city of Turkey and the role of malnutrition in predicting the risk for short-term mortality.

Design

This study was conducted in seven different residential care facilities in Ankara.

Measurements

Nutritional status was evaluated by Mini Nutritional Assessment-Short Form.

Results

The mean age of the 534 participants was 79.46±7.22 years. Nutritional assessment revealed that 15.9% of all older adults suffered from malnutrition and another 53.6% were at risk of malnutrition. The mortality rate for all subjects was 118 (22.1%) over 18 months, which was significantly higher in participants with malnutrition.

Conclusions

We noted a high prevalence of malnutrition and a strong correlation of increased mortality with malnutrition in nursing home residents. Given the negative impact of malnutrition on mortality and morbidity, an emphasis should be placed on an effective nutritional policy in nursing homes.     

Changes in population susceptibility to heat and cold over time: assessing adaptation to climate change

Background

In the context of a warming climate and increasing urbanisation (with the associated urban heat island effect), interest in understanding temperature related health effects is growing. Previous reviews have examined how the temperature-mortality relationship varies by geographical location. There have been no reviews examining the empirical evidence for changes in population susceptibility to the effects of heat and/or cold over time. The objective of this paper is to review studies which have specifically examined variations in temperature related mortality risks over the 20^th and 21^st centuries and determine whether population adaptation to heat and/or cold has occurred.

Methods

We searched five electronic databases combining search terms for three main concepts: temperature, health outcomes and changes in vulnerability or adaptation. Studies included were those which quantified the risk of heat related mortality with changing ambient temperature in a specific location over time, or those which compared mortality outcomes between two different extreme temperature events (heatwaves) in one location.

Results

The electronic searches returned 9183 titles and abstracts, of which eleven studies examining the effects of ambient temperature over time were included and six studies comparing the effect of different heatwaves at discrete time points were included. Of the eleven papers that quantified the risk of, or absolute heat related mortality over time, ten found a decrease in susceptibility over time of which five found the decrease to be significant. The magnitude of the decrease varied by location. Only two studies attempted to quantitatively attribute changes in susceptibility to specific adaptive measures and found no significant association between the risk of heat related mortality and air conditioning prevalence within or between cities over time. Four of the six papers examining effects of heatwaves found a decrease in expected mortality in later years. Five studies examined the risk of cold. In contrast to the changes in heat related mortality observed, only one found a significant decrease in cold related mortality in later time periods.

Conclusions

There is evidence that across a number of different settings, population susceptibility to heat and heatwaves has been decreasing. These changes in heat related susceptibility have important implications for health impact assessments of future heat related risk. A similar decrease in cold related mortality was not shown. Adaptation to heat has implications for future planning, particularly in urban areas, with anticipated increases in temperature due to climate change.

     

Studying relationships between environment and malaria incidence in Camopi (French Guiana) through the objective selection of buffer-based landscape characterisations

Background

Many sub-Saharan countries are confronted with persistently high levels of infant mortality because of the impact of a range of biological and social determinants. In particular, infant mortality has increased in sub-Saharan Africa in recent decades due to the HIV/AIDS epidemic. The geographic distribution of health problems and their relationship to potential risk factors can be invaluable for cost effective intervention planning. The objective of this paper is to determine and map the spatial nature of infant mortality in South Africa at a sub district level in order to inform policy intervention. In particular, the paper identifies and maps high risk clusters of infant mortality, as well as examines the impact of a range of determinants on infant mortality. A Bayesian approach is used to quantify the spatial risk of infant mortality, as well as significant associations (given spatial correlation between neighbouring areas) between infant mortality and a range of determinants. The most attributable determinants in each sub-district are calculated based on a combination of prevalence and model risk factor coefficient estimates. This integrated small area approach can be adapted and applied in other high burden settings to assist intervention planning and targeting.

Results

Infant mortality remains high in South Africa with seemingly little reduction since previous estimates in the early 2000's. Results showed marked geographical differences in infant mortality risk between provinces as well as within provinces as well as significantly higher risk in specific sub-districts and provinces. A number of determinants were found to have a significant adverse influence on infant mortality at the sub-district level. Following multivariable adjustment increasing maternal mortality, antenatal HIV prevalence, previous sibling mortality and male infant gender remained significantly associated with increased infant mortality risk. Of these antenatal HIV sero-prevalence, previous sibling mortality and maternal mortality were found to be the most attributable respectively.

Conclusions

This study demonstrates the usefulness of advanced spatial analysis to both quantify excess infant mortality risk at the lowest administrative unit, as well as the use of Bayesian modelling to quantify determinant significance given spatial correlation. The "novel" integration of determinant prevalence at the sub-district and coefficient estimates to estimate attributable fractions further elucidates the "high impact" factors in particular areas and has considerable potential to be applied in other locations. The usefulness of the paper, therefore, not only suggests where to intervene geographically, but also what specific interventions policy makers should prioritize in order to reduce the infant mortality burden in specific administration areas.     

The short-form mini-nutritional assessment is as effective as the full-mini nutritional assessment in predicting follow-up 4-year mortality in elderly Taiwanese

Objective

To compare the mortality-predictive ability of the full- and short-form (SF) Mini Nutritional Assessment (MNA).

Design

A prospective cohort study.

Setting

Population-representative sample.

Participants

2872 ≥65-year old men and women.

Measurements

The study analyzed 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging (TLSA). Subjects were graded for nutritional status with the full-MNA and MNA-SF of a Taiwanese-specific version (T2, containing calf circumference instead of BMI) at baseline (1999) and tracked their survival status for 4 years. Mortality-predictive abilities of the full-MNA and MNA-SF were compared using Cox regression analysis and Net Reclassification Improvement (NRI).

Results

The full-MNA and MNA-SF have comparable abilities in predicting follow-up 4-year mortality risk according to the hazard ratios (all p<0.001) and Akaike information criterion (AIC). It also showed a slight improvement (not significant) if the full-MNA in a predictive model was replaced by the MNA-SF (NRI=0.09%, p=0.956).

Conclusion

The MNA-SF has at least comparable or even slightly better ability in predicting follow-up 4-year mortality risk of elderly Taiwanese. Results suggest that MNA-SF with calf circumference may possess some basic characteristics of a comprehensive and universal geriatric screening scale.     

Mortality risk associated with temperature and prolonged temperature extremes in elderly populations in Taiwan

Background

This study investigated mortality risks from all causes, circulatory and respiratory diseases for the elderly associated with prolonged exposure to extreme temperatures in four major cities of Taiwan.

Methods

Daily average temperatures at the high 99th, 97th, and 95th percentiles were defined as extreme heat, and those at the low 10th, 5th, and 1st percentiles were defined as extreme cold for each city in 1994–2007. Distributed lag non-linear model was used to estimate the relative risk (RR) of mortality associated with 30-day lag temperature, and heat and cold extremes lasting for 3–5, 6–8, and >8 days. The random-effects meta-analysis summarized the risks of temperature and extreme temperatures events.

Results

The lowest overall mortality among the elderly was when the temperature was 26 °C on average. Low temperatures caused greater adverse effects than high temperatures, particularly for mortality from circulatory diseases. After accounting for the cumulative 30-day temperature effects, meta-analysis showed that mortality risk slightly increased with strengthened and prolonged heat extremes (≥99th and >3 days; ≥97th and >8 days; and ≥ 95th and >8 days) that RRs ranged from 1.04–1.05, 1.01–1.05, and 1.05–1.13 for mortality from all causes and from circulatory and respiratory diseases, respectively. The corresponding RRs ranged from 0.98–1.01, 0.92–1.06, and 0.97–1.03, respectively, for shorter duration of heat extremes. This study did not identify significant effect for stronger or prolonged cold extremes.

Conclusions

Extreme temperatures and their duration cause varied mortality associations in the elderly. Short-term extremely low temperatures exhibit the greatest effect on mortality, and intensified and longer periods of heat extremes also exert a slightly increased effect on mortality.     

Analyzing spatial aggregation error in statistical models of late-stage cancer risk: a Monte Carlo simulation approach

Purpose

This paper examines the effect of spatial aggregation error on statistical estimates of the association between spatial access to health care and late-stage cancer.

Methods

Monte Carlo simulation was used to disaggregate cancer cases for two Illinois counties from zip code to census block in proportion to the age-race composition of the block population. After the disaggregation, a hierarchical logistic model was estimated examining the relationship between late-stage breast cancer and risk factors including travel distance to mammography, at both the zip code and census block levels. Model coefficients were compared between the two levels to assess the impact of spatial aggregation error.

Results

We found that spatial aggregation error influences the coefficients of regression-type models at the zip code level, and this impact is highly dependent on the study area. In one study area (Kane County), block-level coefficients were very similar to those estimated on the basis of zip code data; whereas in the other study area (Peoria County), the two sets of coefficients differed substantially raising the possibility of drawing inaccurate inferences about the association between distance to mammography and late-stage cancer risk.

Conclusions

Spatial aggregation error can significantly affect the coefficient values and inferences drawn from statistical models of the association between cancer outcomes and spatial and non-spatial variables. Relying on data at the zip code level may lead to inaccurate findings on health risk factors.     

Moderate alcohol consumption predicts long-term mortality in elderly subjects with chronic heart failure

Objective

Moderate alcohol consumption is related to a reduction of mortality. However, this phenomenon is not well established in the elderly, especially in the presence of chronic heart failure (CHF). The aim of the study was to verify the effect of moderate alcohol consumption on 12-year mortality in elderly community-dwelling with and without CHF.

Settings

community-dwelling from 5 regions of Italy.

Participants

A cohort of 1332 subjects aged 65 and older.

Measurement

Mortality after 12-year follow-up in elderly subjects (≥65 years old) with and without CHF was studied. Moderate alcohol consumption was considered ≤250 ml/day (drinkers).

Results

In the absence of CHF (n=947), mortality was 42.2% in drinkers vs. 53.7% in non-drinker elderly subjects (p=0.021). In contrast, in the presence of CHF (n=117), mortality was 86.5% in drinkers vs. 69.7% in non-drinker elderly subjects (p=0.004). Accordingly, Cox regression analysis shows that a moderate alcohol consumption is protective of mortality in the absence (HR=0.79; CI 95% 0.66–0.95; p<0.01) but it is predictive of mortality in the presence of CHF (HR=1.29; CI 95% 1.05–1.97; p<0.05).

Conclusions

Our data demonstrates that moderate alcohol consumption is associated with an increased long-term mortality risk in the elderly in the presence of CHF.     

Anpassungsma?nahmen zur Reduktion von klimawandelinduzierten Gesundheitsrisiken in ?sterreich

Background

Climate change is also a challenge to public health.

Methods

Commissioned by the Austrian Ministry for the Environment recommendations for public health actions within the framework of the national adaptation strategy were developed. This was done by an extensive survey conducted among leading national experts and by supporting workshops.

Results

Direct health effects of climate change with a high prognostic certainty were seen as the most pressing topics for adaptation measures. These effects include the acute impact of extreme temperatures, especially heat waves in urban areas, and heavy rainfalls with flooding, mud flows and landslides. High precipitation events can have long-term effects like post-traumatic stress syndrome, damage to infrastructure and buildings with impact on health, and migration which also should be in the focus of public health planning.     

Space-time clusters of Crohn’s disease in northern France

Abstract

Geographical variations in Crohn’s Disease incidence have been reported worldwide suggesting putative variations in the distribution of environmental risk factors. A spatial heterogeneity in standardized incidence ratios of Crohn’s Disease was previously detected in northern France.

Aims

The goals of this study were to highlight significant atypical clusters in terms of incidence using scan statistics methodology and to study the evolution of these clusters during the study period.

Subjects and methods

From 1990 to 2006, the EPIMAD Registry recorded 6,472 Crohn’s Disease cases distributed in 273 administrative areas of northern France. Detection of clusters used space-time scan statistics adjusted for gender and age of patients.

Results

Scan statistics provided identification of 18 significant clusters of two types: 14 time-constant clusters and 4 time-varying clusters. Among the fourteen time-constant clusters, 5 clusters of high incidence and 9 clusters of low incidence were detected. Among the four time-varying clusters, 3 clusters of high incidence and 1 cluster of low incidence were identified.

Conclusion

The existence of time-constant and time-varying clusters suggests that risk factors of Crohn’s Disease are still at work in our region.     

Regional deprivation in Bavaria, Germany: linking a new deprivation score with registry data for lung and colorectal cancer

Objective

This study aimed to examine the differences in cancer risk by regional deprivation in Bavaria, Germany.

Methods

Multilevel Poisson regression analysis was used to evaluate the association between lung and colorectal cancer risk and community deprivation level based on data from the Cancer Registry of Bavaria (2003–2006). The communities (n?=?1,408) were classified according to the Bavarian Index of Multiple Deprivation (BIMD), differentiated into quintiles ranging from lowest to highest deprivation.

Results

Increased lung cancer risk in men and colorectal cancer risk in both genders were associated with increasing BIMD. Comparing the most deprived with the least deprived communities, the relative risk for lung cancer incidence in men was 1.39 (95% CI 1.29–1.49), for mortality risk 1.54 (95% CI 1.41–1.68). The relative risk for colorectal cancer incidence in men was 1.30 (95% CI 1.22–1.38) and in women 1.19 (95% CI 1.11–1.27); for mortality risk we found 1.57 (95% CI 1.40–1.76) in men and 1.34 (95% CI 1.19–1.51) in women.

Conclusion

Area-based deprivation is significantly associated with cancer risk in Bavaria.     

Measuring the geographic coverage of methadone maintenance programme in Hong Kong by using geographic information system (GIS)

Background

Rural-urban disparities in health and healthcare are often attributed to differences in geographic access to care and health seeking behavior. Less is known about the differences between rural locations in health care seeking and outcomes. This study examines how commuting patterns in different rural areas are associated with perforated appendicitis.

Results

Controlling for age, sex, insurance type, comorbid conditions, socioeconomic status, appendectomy rates, hospital type, and hospital location, we found that patient residence in a rural ZIP code with significant levels of commuting to metropolitan areas was associated with higher risk of perforation compared to residence in rural areas with commuting to smaller urban clusters. The former group was more likely to seek care in an urbanized area, and was more likely to receive care in a Children's Hospital.

Conclusion

To our knowledge, this is the first study to differentiate rural dwellers with respect to outcomes associated with appendicitis as opposed to simply comparing "rural" to "urban". Risk of perforated appendicitis associated with commuting patterns is larger than that posed by several individual indicators including some age-sex cohort effects. Future studies linking the activity spaces of rural dwellers to individual patterns of seeking care will further our understanding of perforated appendicitis and ambulatory care sensitive conditions in general.