Spatial autocorrelation analysis of health care hotspots in Taiwan in 2006

Background  

Spatial analytical techniques and models are often used in epidemiology to identify spatial anomalies (hotspots) in disease regions. These analytical approaches can be used to not only identify the location of such hotspots, but also their spatial patterns.     

Neighborhood size and local geographic variation of health and social determinants

Background  

Spatial filtering using a geographic information system (GIS) is often used to smooth health and ecological data. Smoothing disease data can help us understand local (neighborhood) geographic variation and ecological risk of diseases. Analyses that use small neighborhood sizes yield individualistic patterns and large sizes reveal the global structure of data where local variation is obscured. Therefore, choosing an optimal neighborhood size is important for understanding ecological associations with diseases. This paper uses Hartley's test of homogeneity of variance (F_max) as a methodological solution for selecting optimal neighborhood sizes. The data from a study area in Vietnam are used to test the suitability of this method.     

Using Weighted Hospital Service Area Networks to Explore Variation in Preventable Hospitalization

Objective

To demonstrate the use of multiple‐membership multilevel models, which analytically structure patients in a weighted network of hospitals, for exploring between‐hospital variation in preventable hospitalizations.

Data Sources

Cohort of 267,014 people aged over 45 in NSW, Australia.

Study Design

Patterns of patient flow were used to create weighted hospital service area networks (weighted‐HSANs) to 79 large public hospitals of admission. Multiple‐membership multilevel models on rates of preventable hospitalization, modeling participants structured within weighted‐HSANs, were contrasted with models clustering on 72 hospital service areas (HSAs) that assigned participants to a discrete geographic region.

Data Collection/Extraction Methods

Linked survey and hospital admission data.

Principal Findings

Between‐hospital variation in rates of preventable hospitalization was more than two times greater when modeled using weighted‐HSANs rather than HSAs. Use of weighted‐HSANs permitted identification of small hospitals with particularly high rates of admission and influenced performance ranking of hospitals, particularly those with a broadly distributed patient base. There was no significant association with hospital bed occupancy.

Conclusion

Multiple‐membership multilevel models can analytically capture information lost on patient attribution when creating discrete health care catchments. Weighted‐HSANs have broad potential application in health services research and can be used across methods for creating patient catchments.     

The relationship between social capital and self-rated health in a Japanese population: a multilevel analysis

Objective  

The aim of this study was to use a multilevel analysis to examine whether cognitive and structural dimensions of regional social capital were associated with individual health outcomes after adjusting for compositional factors.     

Regional inequalities in under-5 mortality in Nigeria: a population-based analysis of individual- and community-level determinants

Background  

Regions with geographically diverse ecology and socioeconomic circumstances may have different disease exposures and child health outcomes. This study assessed variations in the risks of death in children under age 5 across regions of Nigeria and determined characteristics at the individual and community levels that explain possible variations among regions.     

Application of a theoretical model to evaluate COPD disease management

Background  

Disease management programmes are heterogeneous in nature and often lack a theoretical basis. An evaluation model has been developed in which theoretically driven inquiries link disease management interventions to outcomes. The aim of this study is to methodically evaluate the impact of a disease management programme for patients with chronic obstructive pulmonary disease (COPD) on process, intermediate and final outcomes of care in a general practice setting.     

Social inequalities in vaccination uptake among children aged 0–59 months living in Madagascar: An analysis of Demographic and Health Survey data from 2008 to 2009

Background

Socioeconomic inequalities in vaccination can reduce the ability and efficiency of global efforts to reduce the burden of disease. Vaccination is particularly critical because the poorest children are often at the greatest risk of contracting preventable infectious diseases, and unvaccinated children may be clustered geographically, jeopardizing herd immunity. Without herd immunity, these children are at even greater risk of contracting disease and social inequalities in associated morbidity and mortality are amplified.

Methods

Data on vaccination for children under five came from the most recent Demographic and Health Survey in Madagascar (2008–2009). Vaccination status was available for diptheria, pertussis, tetanus, hepatitis B, measles, tuberculosis, poliomyelitis, and H. influenza type-B. Multilevel logistic regression was used to analyze childhood vaccination by parental socioeconomic status while accounting for shared district, cluster, and household variation. Maps were created to serve as a roadmap for efforts to increase vaccination.

Findings

Geographic variation in vaccination rates was substantial. Districts that were less covered were near other districts with limited coverage. Most districts lacked herd immunity for diphtheria, pertussis, poliomyelitis and measles. Full herd immunity was reached in a small number of districts clustered near the capital. While within-district variation in coverage was substantial; parental education and wealth were independently associated with vaccination.

Interpretation

Socioeconomic inequalities in vaccination reduce herd immunity and perpetuate inequalities by allowing infectious diseases to disproportionately affect the most vulnerable populations. Findings indicated that most districts had low immunization coverage rates and unvaccinated children were geographically clustered. The result was inequalities in vaccination and reduced herd immunity. To further improve coverage, interventions must take a multilevel approach that focuses on both supply- and demand-side barriers to delivering vaccination to underserved regions, and to the poorest children in those regions.     

Three-dimensional visualization of cultural clusters in the 1878 yellow fever epidemic of New Orleans

Background  

An epidemic may exhibit different spatial patterns with a change in geographic scale, with each scale having different conduits and impediments to disease spread. Mapping disease at each of these scales often reveals different cluster patterns. This paper will consider this change of geographic scale in an analysis of yellow fever deaths for New Orleans in 1878. Global clustering for the whole city, will be followed by a focus on the French Quarter, then clusters of that area, and finally street-level patterns of a single cluster. The three-dimensional visualization capabilities of a GIS will be used as part of a cluster creation process that incorporates physical buildings in calculating mortality-to-mortality distance. Including nativity of the deceased will also capture cultural connection.     

The complexities of measuring access to parks and physical activity sites in New York City: a quantitative and qualitative approach

Background  

Proximity to parks and physical activity sites has been linked to an increase in active behaviors, and positive impacts on health outcomes such as lower rates of cardiovascular disease, diabetes, and obesity. Since populations with a low socio-economic status as well as racial and ethnic minorities tend to experience worse health outcomes in the USA, access to parks and physical activity sites may be an environmental justice issue. Geographic Information systems were used to conduct quantitative and qualitative analyses of park accessibility in New York City, which included kernel density estimation, ordinary least squares (global) regression, geographically weighted (local) regression, and longitudinal case studies, consisting of field work and archival research. Accessibility was measured by both density of park acreage and density of physical activity sites. Independent variables included percent non-Hispanic black, percent Hispanic, percent below poverty, percent of adults without high school diploma, percent with limited English-speaking ability, and population density.     

Volume et profil de consommation d’alcool des élèves et des camarades scolaires comme prédicteurs de l’agression et de la victimisation: une analyse multiniveaux auprès d’adolescents suisses

Volume and profile of alcohol consumption among students and classmates as predictors of aggression and victimization: a multilevel analysis among Swiss adolescents

Objective:  

To test the effects of the volume of alcohol consumption and drinking patterns on alcohol-related aggression and victimization, both at the individual and class levels.     

Patterns of health-related quality of life and patterns associated with health risks among Rhode Island adults

Background  

Health-related quality of life (HRQOL) has become an important consideration in assessing the impact of chronic disease on individuals as well as in populations. HRQOL is often assessed using multiple indicators. The authors sought to determine if multiple indicators of HRQOL could be used to characterize patterns of HRQOL in a population, and if so, to examine the association between such patterns and demographic, health risk and health condition covariates.     

Developing the atlas of cancer in Queensland: methodological issues

Background  

Achieving health equity has been identified as a major challenge, both internationally and within Australia. Inequalities in cancer outcomes are well documented, and must be quantified before they can be addressed. One method of portraying geographical variation in data uses maps. Recently we have produced thematic maps showing the geographical variation in cancer incidence and survival across Queensland, Australia. This article documents the decisions and rationale used in producing these maps, with the aim to assist others in producing chronic disease atlases.     

Attainment of clinical performance targets and improvement in clinical outcomes and resource use in hemodialysis care: a prospective cohort study

Background  

Clinical performance targets are intended to improve patient outcomes in chronic disease through quality improvement, but evidence of an association between multiple target attainment and patient outcomes in routine clinical practice is often lacking.     

Outcomes associated with matching patients' treatment preferences to physicians' recommendations: study methodology

Background  

Patients often express strong preferences for the forms of treatment available for their disease. Incorporating these preferences into the process of treatment decision-making might improve patients' adherence to treatment, contributing to better outcomes. We describe the methodology used in a study aiming to assess treatment outcomes when patients' preferences for treatment are closely matched to recommended treatments.     

Applying multilevel model to the relationship of dietary patterns and colorectal cancer: an ongoing case–control study in Córdoba, Argentina

Purposes

Scientific literature has consistently shown the effects of certain diets on health but regional variations of dietary habits, and their relationship colorectal cancer (CRC) has been poorly studied in Argentina. Our aims were to identify dietary patterns and estimate their effect on CRC occurrence and to quantify the association between family history of CRC and CRC occurrence by applying multilevel models to estimate and interpret measures of variation.

Methods

Principal components factor analysis was performed to identify dietary patterns that were then used in a multilevel logistic regression applied to an ongoing case–control data about dietary exposure and CRC occurrence taking into account familiar clustering.

Results

Three dietary patterns were identified: “Southern Cone pattern” (red meat, wine, and starchy vegetables), “High-sugar drinks pattern”, and “Prudent pattern”. The study considered 41 cases and 95 controls. There was a significant promoting effects on CRC of “Southern Cone” (OR 1.5, 95%CI 1.0–2.2) and “High-sugar drinks” (OR 3.8, 95%CI 2.0–7.1) patterns, whereas “Prudent pattern” (OR 0.3, 95%CI 0.2–0.4) showed a significant protective effect at third tertile level. BMI, use of NSAIDs, and to have medical insurance showed significant effects. Variance of the random effect of family history of CRC was highly significant.

Conclusions

This novel approach for Argentina showed that Southern Cone and High-sugar drinks patterns were associated with a higher risk of CRC, whereas the Prudent pattern showed a protective effect. There was a significant clustering effect of family history of CRC.     

Subjective assessments of comorbidity correlate with quality of life health outcomes: Initial validation of a comorbidity assessment instrument

Background  

Interventions to improve care for persons with chronic medical conditions often use quality of life (QOL) outcomes. These outcomes may be affected by coexisting (comorbid) chronic conditions as well as the index condition of interest. A subjective measure of comorbidity that incorporates an assessment of disease severity may be particularly useful for assessing comorbidity for these investigations.     

A multilevel non-hierarchical study of birth weight and socioeconomic status

Background  

It is unclear whether the socioeconomic status (SES) of the community of residence has a substantial association with infant birth weight. We used multilevel models to examine associations of birth weight with family- and community-level SES in the Cape Cod Family Health Study. Data were collected retrospectively on births to women between 1969 and 1983 living on Cape Cod, Massachusetts. The sample included siblings born in different residences with differing community-level SES.     

Sampling in population-based cancer caregivers research

Background  

Awareness that cancer impacts not only the person with the disease but also the family has increased, yet existing data provide limited information, primarily because of reliance on small geographically restricted samples. The current study used population-based sampling to develop a formula to compute the probability of survivors completing a survivor survey and nominating their family caregivers.     

Social capital and health: a review of prospective multilevel studies

Background

This article presents an overview of the concept of social capital, reviews prospective multilevel analytic studies of the association between social capital and health, and discusses intervention strategies that enhance social capital.

Methods

We conducted a systematic search of published peer-reviewed literature on the PubMed database and categorized studies according to health outcome.

Results

We identified 13 articles that satisfied the inclusion criteria for the review. In general, both individual social capital and area/workplace social capital had positive effects on health outcomes, regardless of study design, setting, follow-up period, or type of health outcome. Prospective studies that used a multilevel approach were mainly conducted in Western countries. Although we identified some cross-sectional multilevel studies that were conducted in Asian countries, including Japan, no prospective studies have been conducted in Asia.

Conclusions

Prospective evidence from multilevel analytic studies of the effect of social capital on health is very limited at present. If epidemiologic findings on the association between social capital and health are to be put to practical use, we must gather additional evidence and explore the feasibility of interventions that build social capital as a means of promoting health.Key words: health, literature review, multilevel analysis, prospective study, social capital