Improving longitudinal research in geospatial health: An agenda

Geospatial Health: achievements, innovations, priorities

An expert panel discussion on achievements, current areas of rapid scientific progress, prospects, and critical gaps in geospatial health was organized as part of the 16thsymposium of the global network of public health and earth scientists dedicated to the development of geospatial health (GnosisGIS), held at the Faculty of Geo-Information Science and Earth Observation (ITC) of the University of Twente in The Netherlands in November 2023. The symposium consisted of a three-day scientific event that brought together an interdisciplinary group of researchers and health professionals from across the globe. The aim of the panel session was threefold: firstly, to reflect on the main achievements of the scientific discipline of geospatial health in the past decade; secondly, to identify key innovation areas where rapid scientific progress is currently made and thirdly, to identify critical gaps and associated research and education priorities to move the discipline forward. [...].

Opportunities and shortcomings of AI for spatial epidemiology and health disparities research on aging and the life course

Established spatial and life course methods have helped epidemiologists and health and medical geographers study the impact of individual and area-level determinants on health disparities. While these methods are effective, the emergence of Geospatial Artificial Intelligence (GeoAI) offers new opportunities to leverage complex and multi-scalar data in spatial aging and life course research. The objective of this perspective is three-fold: (1) to review established methods in aging, life course, and spatial epidemiology research; (2) to highlight some of the opportunities offered by GeoAI for enhancing research on health disparities across life course and aging research; (3) to discuss the shortcomings of using GeoAI methods in aging and life course studies.

Residential history, the electronic health record, and clinical medicine: A descriptive study in a lung transplant cohort

Neighborhood level social determinants of health are commonly measured using a patient's most recent residential location. Not accounting for residential history, and therefore missing accumulated stressors from prior social vulnerabilities, could increase misclassification bias. We tested the hypothesis that the electronic health record could capture the residential history of lung transplant patients -a vulnerable population. After applying the Social Vulnerability Index (SVI) to individual residential histories, the most recent SVI equaled the first SVI in only 15.4% (58/374) of patients. There is a need for databases with residential histories to inform place-based determinants of health and applications to patient care.

Advancing geospatial preconception health research in primary care through medical informatics and artificial intelligence

Established life course approaches suggest that health status in adulthood can be influenced by events that occurred during the prenatal developmental period. Yet, interventions such as diet and lifestyle changes performed during pregnancy have had a small impact on both maternal and offspring health outcomes. Currently, there is a growing body of literature that highlights the importance of maternal health before conception (months or years before pregnancy occurs) for the future health of offspring. While some studies have explored factors such as maternal body composition, nutrition, and lifestyle in this area, location-based environmental and socioeconomic exposures before conception may also contribute to future offspring health. In this line, the study of a patient's geographic history presents a promising avenue. To foster research in this direction, the integration of geospatial health, medical informatics and artificial intelligence techniques offers great potential. Importantly, novel sources of big health data sets such as electronic health records registered at the primary care level provide a unique framework due to its inherent longitudinal nature. Nonetheless, a number of privacy, ethical, and technical challenges need to be overcome for this kind of longitudinal analysis to mature and succeed. In the long-term, we support the vision of incorporating a patient's geographic history into her clinical history to equip clinicians with useful contextual information to explore.

The impact of area-level socioeconomic status in childhood on mental health in adolescence and adulthood: A prospective birth cohort study in Aotearoa New Zealand

Mental health conditions pose a significant public health challenge, and low area-level socioeconomic status (SES) is a potentially important upstream determinant. Childhood exposure might have influences on later-life mental health. This study, utilises data from the Christchurch Health and Development Study birth cohort, examining the impact of area-level SES trajectories in childhood (from birth to age 16) on mental health at age 16 and from age 18-40 years. Findings revealed some associations between distinct SES trajectories and mental health. The study underscores the importance of using a spatial lifecourse epidemiology framework to understand long-term environmental impacts on later-life health.

Aging in climate change: Unpacking residential mobility and changes of social determinants of health in southern United States

The southern coastal states of the United States are susceptible to extreme weather and climate events. With growing move-in and -out older populations in the region, health implications of their residential mobility lack sufficient knowledge. Using 126,352 person-level records from 2012 to 2021, we examined geospatial and temporal patterns of older populations' residential mobility, considering the changing social determinants of health and disparities. We found the moves of older populations with socioeconomic or health disadvantages were related to increased exposure to environmental hazards and reduced access to health resources. The findings inform targeted strategies for climate adaptation that address the needs of vulnerable aging populations.

Linking sequences of exposure to residential (dis)advantage, individual socioeconomic status, and health

Life course theories suggest that the relationship between residential (dis)advantage and health is best understood by examining the ordering and duration of cumulative exposures across the life course. This study employs sequence and cluster analysis on two decades of residential histories linked to the Survey of the Health of Wisconsin to define typologies of exposure to residential (dis)advantage and use these typologies to predict self-rated fair/poor health. Exposure to residential (dis)advantage is mostly stable across the adult life course and greater disadvantage predicts fair/poor health. Longitudinal exposures to residential (dis)advantage shape health independently of and in tandem with individual-level resources.

Higher air pollution exposure in early life is associated with worse health among older adults: A 72-year follow-up study from Scotland

Air pollution increases the risk of mortality and morbidity. However, limited evidence exists on the very long-term associations between early life air pollution exposure and health, as well as on potential pathways. This study explored the relationship between fine particle (PM2.5) exposure at age 3 and limiting long-term illness (LLTI) at ages 55, 65 and 75 using data from the Scottish Longitudinal Study Birth Cohort 1936, a representative administrative cohort study. We found that early life PM2.5 exposure was associated with higher odds of LLTI in mid-to-late adulthood (OR = 1.10, 95% CI: 1.06, 1.14 per 10 μg m-3 increment) among the 2085 participants, with stronger associations among those growing up in disadvantaged families. Path analyses suggested that 15-21% of the association between early life PM2.5 concentrations and LLTI at age 65 (n = 1406) was mediated through childhood cognitive ability, educational qualifications, and adult social position. Future research should capitalise on linked administrative and health data, and explore causal mechanisms between environment and specific health conditions across the life course.

Association between air temperature and unintentional drowning risk in the United Kingdom 2012-2019: A nationwide case-crossover study

OBJECTIVE

Drowning is a leading cause of death. The World Health Organization (WHO) and United Nations (UN) emphasise the need for population-level data-driven approaches to examine risk factors to improve water safety policies. Weather conditions, have the potential to influence drowning risk behaviours as people are more likely to spend time around water and/or undertake risky activities in aquatic spaces as a behavioural thermoregulatory response (e.g., seeking coolth).

METHODS

A case-crossover approach assessed associations between changes in daily maximum air temperature (data from the nearest weather station to each drowning event) and unintentional drowning risk using anonymous data from the validated UK Water Incident Database 2012-2019 (1945 unintentional deaths, 82% male). Control days were selected using a unidirectional time-stratified approach, whereby seven and 14 days before the hazard day were used as the controls.

RESULTS

Mean maximum air temperature on case and control days was 15.36 °C and 14.80 °C, respectively. A 1 °C increase in air temperature was associated with a 7.2% increase in unintentional drowning risk. This relationship existed for males only. Drowning risk was elevated on days where air temperature reached 15-19.9 °C (Odds Ratio; OR: 1.75), 20-24.9 °C (OR: 1.87), and ≥ 25 °C (OR: 4.67), compared with days <10 °C. The greatest elevations in risk appeared to be amongst males and when alcohol intoxication was suspected. Precipitation showed no significant association with unintentional drowning risk.

CONCLUSIONS

Identifying such relationships highlights the value of considering weather conditions when evaluating environmental risk factors for drowning, and may inform water safety policy and allocating resources to prevention and rescue.

Childhood neighborhoods and cause-specific adult mortality in Sweden 1939-2015

The socioeconomic health gradient has widened in recent decades. We study how childhood socioeconomic neighborhood conditions influence gender- and cause-specific adult mortality. Using uniquely detailed geocoded longitudinal microdata for a Swedish town (1939-1967), with a follow-up in national registers (1968-2015), we apply Cox proportional hazards models and estimate individual neighborhoods at the address-level. We find that childhood neighborhood social class has a lasting influence on male adult mortality (ages 40-69), even when adjusting for class position, class origin, neighborhood physical attributes and school districts. This impact was particularly pronounced for preventable causes of death, pointing to lifestyle and behavioral factors as important mechanisms.

Short-term exposure sequences and anxiety symptoms: a time series clustering of smartphone-based mobility trajectories

BACKGROUND

Short-term environmental exposures, including green space, air pollution, and noise, have been suggested to affect health. However, the evidence is limited to aggregated exposure estimates which do not allow the capture of daily spatiotemporal exposure sequences. We aimed to (1) determine individuals' sequential exposure patterns along their daily mobility paths and (2) examine whether and to what extent these exposure patterns were associated with anxiety symptoms.

METHODS

We cross-sectionally tracked 141 participants aged 18-65 using their global positioning system (GPS) enabled smartphones for up to 7 days in the Netherlands. We estimated their location-dependent exposures for green space, fine particulate matter, and noise along their moving trajectories at 10-min intervals. The resulting time-resolved exposure sequences were then partitioned using multivariate time series clustering with dynamic time warping as the similarity measure. Respondents' anxiety symptoms were assessed with the Generalized Anxiety Disorders-7 questionnaire. We fitted linear regressions to assess the associations between sequential exposure patterns and anxiety symptoms.

RESULTS

We found four distinctive daily sequential exposure patterns across the participants. Exposure patterns differed in terms of exposure levels and daily variations. Regression results revealed that participants with a "moderately health-threatening" exposure pattern were significantly associated with fewer anxiety symptoms than participants with a "strongly health-threatening" exposure pattern.

CONCLUSIONS

Our findings support that environmental exposures' daily sequence and short-term magnitudes may be associated with mental health. We urge more time-resolved mobility-based assessments in future analyses of environmental health effects in daily life.

Change in the food environment and measured adiposity in adulthood in the Christchurch Health and development birth cohort, Aotearoa, New Zealand: A birth cohort study

This study investigated associations between change in the food environment and change in measured body mass index (BMI) and waist circumference (WC) in the Christchurch Health and Development Study (CHDS) birth cohort. Our findings suggest that cohort members who experienced the greatest proportional change towards better access to fast food outlets had the slightly larger increases in BMI and WC. Contrastingly, cohort members who experienced the greatest proportional change towards shorter distance and better access to supermarkets had slightly smaller increases in BMI and WC. Our findings may help explain the changes in BMI and WC at a population level.

The environment a young person grows up in is associated with their mental health: A nationwide geospatial study using the integrated data infrastructure, New Zealand

BACKGROUND

Mental health conditions often arise during adolescence, are multifaceted in aetiology, and may be related to the type of environment in which young people reside. This study used nationwide population-level data to investigate whether the environment a young person grows up in is associated with their mental health.

METHOD

Data were extracted from the Integrated Data Infrastructure (IDI), a large nationwide research repository, for 917,211 young people (aged 10-24 years) including sociodemographic and mental health data (i.e. emotional, behavioural, substance problems, and self-harm). Environmental data were sourced from the nationwide area-based Healthy Location Index (HLI), which has comprehensive data on the location of several health-constraining (i.e. fast-food outlets) and health-promoting features (i.e. physical activity facilities). Environments were classified as: i) health-promoting, ii) health-constraining, or iii) neither. Associations between the HLI and mental health were investigated using multi-level mixed effects logistic regression modelling.

RESULTS

Overall, there was evidence of an association between the environment a young person resided in and their mental health. Young people residing in health-constraining environments had higher odds of any mental health condition (Adjusted Odds Ratio (AOR) = 1.020 [1.001, 1.040]) and any emotional condition (AOR = 1.037 [1.012, 1.062]). Young people residing in health-promoting environments had lower odds of substance problems (AOR = 0.950 [0.905, 0.997]). There were no significant effects of the environment on behavioural conditions.

CONCLUSION

Our study utilises a large national sample of almost one million young people to confirm the importance of environmental determinants for mental health. It is possible that leverage points for improving the mental health of young people, and reducing the burden to the health system of mental health, can be sought in upstream environmental based interventions.