1
|
Ádány R, Juhász A, Nagy C, Burkali B, Pikó P, McKee M, Oroszi B. Discrepancies between the Spatial Distribution of Cancer Incidence and Mortality as an Indicator of Unmet Needs in Cancer Prevention and/or Treatment in Hungary. Cancers (Basel) 2024; 16:2917. [PMID: 39199687 PMCID: PMC11353249 DOI: 10.3390/cancers16162917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/12/2024] [Accepted: 08/19/2024] [Indexed: 09/01/2024] Open
Abstract
There is a rich body of literature on the distribution of cancer incidence and mortality in socioeconomically different world regions, but none of the studies has compared the spatial distribution of mortality and incidence to see if they are consistent with each other. All malignant neoplasms combined and cervical, colorectal, breast, pancreatic, lung, and oral cancers separately were studied in the Hungarian population aged 25-64 years for 2007-2018 at the municipality level by sex. In each case, the spatial distribution of incidence and mortality were compared with each other and with the level of deprivation using disease mapping, spatial regression, risk analysis, and spatial scan statistics. A positive association between deprivation and mortality was found for each type of cancer, but there was no significant association for male colorectal cancer (relative risk (RR) 1.00; 95% credible interval (CI) 0.99-1.02), pancreatic cancer (RR: 1.01; 95%CI 0.98-1.04), and female colorectal cancer incidence (RR: 1.01; 95%CI 0.99-1.03), whereas a negative association for breast cancer (RR: 0.98; 95%CI 0.96-0.99) was found. Disease mapping analyses showed only partial overlap between areas of high incidence and mortality, often independent of deprivation. Our results highlight not only the diverse relationship between cancer burden and deprivation, but also the inconsistent relationship between cancer incidence and mortality, pointing to areas with populations that require special public health attention.
Collapse
Affiliation(s)
- Róza Ádány
- Epidemiology and Surveillance Centre, Semmelweis University, 25. Üllői Street, 1085 Budapest, Hungary; (A.J.); (C.N.); (B.B.); (P.P.); (B.O.)
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26. Kassai Street, 4028 Debrecen, Hungary
- HUN-REN Public Health Research Group, University of Debrecen, 26. Kassai Street, 4028 Debrecen, Hungary
- Department of Preventive Medicine and Public Health, Semmelweis University, 1085 Budapest, Hungary
| | - Attila Juhász
- Epidemiology and Surveillance Centre, Semmelweis University, 25. Üllői Street, 1085 Budapest, Hungary; (A.J.); (C.N.); (B.B.); (P.P.); (B.O.)
| | - Csilla Nagy
- Epidemiology and Surveillance Centre, Semmelweis University, 25. Üllői Street, 1085 Budapest, Hungary; (A.J.); (C.N.); (B.B.); (P.P.); (B.O.)
| | - Bernadett Burkali
- Epidemiology and Surveillance Centre, Semmelweis University, 25. Üllői Street, 1085 Budapest, Hungary; (A.J.); (C.N.); (B.B.); (P.P.); (B.O.)
- Department of Quality Management in Healthcare and Infection Control, Petz Aladár Teaching Hospital of Győr-Moson-Sopron County, 2-4. Vasvári Pál Street, 9024 Győr, Hungary
| | - Péter Pikó
- Epidemiology and Surveillance Centre, Semmelweis University, 25. Üllői Street, 1085 Budapest, Hungary; (A.J.); (C.N.); (B.B.); (P.P.); (B.O.)
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26. Kassai Street, 4028 Debrecen, Hungary
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Beatrix Oroszi
- Epidemiology and Surveillance Centre, Semmelweis University, 25. Üllői Street, 1085 Budapest, Hungary; (A.J.); (C.N.); (B.B.); (P.P.); (B.O.)
| |
Collapse
|
2
|
Kovacs N, Piko P, Juhasz A, Nagy C, Oroszi B, Ungvari Z, Adany R. Comparative analysis of health status and health service utilization patterns among rural and urban elderly populations in Hungary: a study on the challenges of unhealthy aging. GeroScience 2024; 46:2017-2031. [PMID: 37798385 PMCID: PMC10828334 DOI: 10.1007/s11357-023-00926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/27/2023] [Indexed: 10/07/2023] Open
Abstract
The demographic transition poses a significant challenge for health systems, especially in Central and Eastern European (CEE) countries, where the healthcare needs of aging populations are on the rise. This study aimed to describe and compare the health status and utilization of health services among the elderly residing in urban and rural areas of the most deprived region in Hungary. A comprehensive health survey was conducted in 2022, involving a randomly selected sample of 443 older adults (≥ 65 years) in Northeast Hungary. Multivariable logistic regression models adjusting for age, sex, education, financial status, chronic diseases, and activity limitations were used to investigate the association between type of residence and health service use. Among the study participants, 62.3% were female, 38.3% attained primary education, 12.5% reported a bad or very bad financial situation and 52.6% lived in urban areas. Overall, 24% of the elderly rated their health as very good or good (27.8% in urban and 19.7% in rural areas), while 57.8% (52.6% and 63.5% in urban and rural areas) reported limitations in daily activities. Compared to urban residents, rural residents reported lower rates of dentist visits (p = 0.006), specialist visits (p = 0.028), faecal occult blood testing (p < 0.001), colorectal cancer screening with colonoscopy (p = 0.014), and breast cancer screening (p = 0.035), and a higher rate of blood pressure measurement (p = 0.042). Multivariable models indicated that urban residence was positively associated with faecal occult blood testing (OR = 2.32, p = 0.014), but negatively associated with blood pressure (OR = 0.42, p = 0.017) and blood glucose measurements (OR = 0.48, p = 0.009). These findings highlight the influence of residence on health service utilization among older adults in Hungary. Further comprehensive studies are needed to better understand the health needs of the elderly population and to develop policies aimed at promoting healthy aging in CEE countries.
Collapse
Affiliation(s)
- Nora Kovacs
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Peter Piko
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Center for Epidemiology and Surveillance, National Laboratory for Health Security, Semmelweis University, Budapest, Hungary
| | - Attila Juhasz
- Center for Epidemiology and Surveillance, National Laboratory for Health Security, Semmelweis University, Budapest, Hungary
| | - Csilla Nagy
- Center for Epidemiology and Surveillance, National Laboratory for Health Security, Semmelweis University, Budapest, Hungary
| | - Beatrix Oroszi
- Center for Epidemiology and Surveillance, National Laboratory for Health Security, Semmelweis University, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine, Departments of Public Health and Translational Medicine, Semmelweis University, Budapest, Hungary
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Roza Adany
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
- Center for Epidemiology and Surveillance, National Laboratory for Health Security, Semmelweis University, Budapest, Hungary.
- Department of Public Health, Semmelweis University, Budapest, Hungary.
| |
Collapse
|
3
|
Cordiano R, Papa V, Cicero N, Spatari G, Allegra A, Gangemi S. Effects of Benzene: Hematological and Hypersensitivity Manifestations in Resident Living in Oil Refinery Areas. TOXICS 2022; 10:678. [PMID: 36355969 PMCID: PMC9697938 DOI: 10.3390/toxics10110678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Literature is teeming with publications on industrial pollution. Over the decades, the main industrial pollutants and their effects on human health have been widely framed. Among the various compounds involved, benzene plays a leading role in the onset of specific diseases. Two systems are mainly affected by the adverse health effects of benzene exposure, both acute and chronic: the respiratory and hematopoietic systems. The most suitable population targets for a proper damage assessment on these systems are oil refinery workers and residents near refining plants. Our work fits into this area of interest with the aim of reviewing the most relevant cases published in the literature related to the impairment of the aforementioned systems following benzene exposure. We perform an initial debate between the two clinical branches that see a high epidemiological expression in this slice of the population examined: residents near petroleum refinery areas worldwide. In addition, the discussion expands on highlighting the main immunological implications of benzene exposure, finding a common pathophysiological denominator in inflammation, oxidative stress, and DNA damage, thus helping to set the basis for an increasingly detailed characterization aimed at identifying common molecular patterns between the two clinical fields discussed.
Collapse
Affiliation(s)
- Raffaele Cordiano
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Vincenzo Papa
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Nicola Cicero
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98168 Messina, Italy
| | - Giovanna Spatari
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98168 Messina, Italy
| | - Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, 98125 Messina, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| |
Collapse
|
4
|
Oroszi B, Juhász A, Nagy C, Horváth JK, Komlós KE, Túri G, McKee M, Ádány R. Characteristics of the Third COVID-19 Pandemic Wave with Special Focus on Socioeconomic Inequalities in Morbidity, Mortality and the Uptake of COVID-19 Vaccination in Hungary. J Pers Med 2022; 12:388. [PMID: 35330387 PMCID: PMC8954719 DOI: 10.3390/jpm12030388] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023] Open
Abstract
Governments are increasingly looking to vaccination to provide a path out of the COVID-19 pandemic. Hungary offers an example to investigate whether social inequalities compromise what a successful vaccine program can achieve. COVID-19 morbidity, mortality, and vaccination coverage were characterized by calculation of indirectly standardized ratios in the Hungarian population during the third pandemic wave at the level of municipalities, classified into deprivation quintiles. Then, their association with socioeconomic deprivation was assessed using ecological regression. Compared to the national average, people living in the most deprived municipalities had a 15-24% lower relative incidence of confirmed COVID-19 cases, but a 17-37% higher relative mortality and a 38% lower vaccination coverage. At an ecological level, COVID-19 mortality showed a strong positive association with deprivation and an inverse association with vaccination coverage (RRVaccination = 0.86 (0.75-0.98)), but the latter became non-significant after adjustment for deprivation (RRVaccination = 0.95 (0.84-1.09), RRDeprivation = 1.10 (1.07-1.14)). Even what is widely viewed as one of the more successful vaccine roll outs was unable to close the gap in COVID-19 mortality during the third pandemic wave in Hungary. This is likely to be due to the challenges of reaching those living in the most deprived municipalities who experienced the highest mortality rates during the third wave.
Collapse
Affiliation(s)
- Beatrix Oroszi
- Epidemiology and Surveillance Centre, Semmelweis University, 25. Üllői Street, 1085 Budapest, Hungary; (B.O.); (J.K.H.); (K.E.K.); (G.T.)
| | - Attila Juhász
- Department of Public Health, Government Office of Capital City Budapest, 174. Váci Avenue, 1138 Budapest, Hungary; (A.J.); (C.N.)
| | - Csilla Nagy
- Department of Public Health, Government Office of Capital City Budapest, 174. Váci Avenue, 1138 Budapest, Hungary; (A.J.); (C.N.)
| | - Judit Krisztina Horváth
- Epidemiology and Surveillance Centre, Semmelweis University, 25. Üllői Street, 1085 Budapest, Hungary; (B.O.); (J.K.H.); (K.E.K.); (G.T.)
| | - Krisztina Eszter Komlós
- Epidemiology and Surveillance Centre, Semmelweis University, 25. Üllői Street, 1085 Budapest, Hungary; (B.O.); (J.K.H.); (K.E.K.); (G.T.)
| | - Gergő Túri
- Epidemiology and Surveillance Centre, Semmelweis University, 25. Üllői Street, 1085 Budapest, Hungary; (B.O.); (J.K.H.); (K.E.K.); (G.T.)
| | - Martin McKee
- European Centre on Health of Societies in Transition (ECOHOST), London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Róza Ádány
- MTA-DE-Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26. Kassai Street, 4028 Debrecen, Hungary
- Department of Public Health, Faculty of Medicine, Semmelweis University, 25. Üllői Street, 1085 Budapest, Hungary
| |
Collapse
|
5
|
Chen J, Zhou Z, Lin X, Liao J, Zhang Y, Xie B, Huang Y, Peng L. Environmental Cadmium Exposure Promotes the Development, Progression and Chemoradioresistance of Esophageal Squamous Cell Carcinoma. Front Cell Dev Biol 2022; 10:792933. [PMID: 35252173 PMCID: PMC8894704 DOI: 10.3389/fcell.2022.792933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/24/2022] [Indexed: 02/05/2023] Open
Abstract
Cadmium (Cd) exposure has been implicated in the etiology of esophageal squamous cell carcinoma (ESCC), albeit with inconsistent results from epidemiologic studies and without causal evidence. In this study, we explore the relationship of Cd exposure and the development, progression and therapeutic resistance of ESCC. A total of 150 ESCC patients and 177 matched controls from a coastal region with a high incidence of ESCC in China were included in the study. It was found that the median blood Cd level (BCL) was significantly higher in ESCC patients than that in the controls. Odds ratios for ESCC risk were 3.12 (95% CI 1.54-6.30) and 3.71 (95% CI 1.84-7.48) in the third and fourth quartiles of Cd distribution, respectively. Notably, BCL above 4.71 μg/L was strongly associated with shorter progression-free survival time compared to that below 1.60 μg/L (p < 0.001). The chronic Cd-treated ESCC cells (CCT-ESCC) CCT-EC109 and CCT-EC9706 exhibited increased cell proliferation and tumorigenesis, enhanced migration and invasion, and upregulated EMT biomarkers following 12 weeks of exposure to 5 μM cadmium chloride. Furthermore, Cd treatment attenuated the efficacy of 5-fluorouracil, cisplatin and irradiation treatment in CCT-ESCC cells both in vitro and in vivo. Moreover, we revealed that Cd stimulated the cancer cell stemness and Wnt/β-catenin signaling pathway in the CCT-ESCC cells. Additionally, 5-aza-2-deoxy-cytidine treatment resulted in suppression of the Wnt/β-catenin signaling pathway and rescue of the Cd-induced cell radioresistance. These results offer new insights into the role of environmental Cd exposure in the development, progression and chemoradioresistance of ESCC.
Collapse
Affiliation(s)
- Jiongyu Chen
- Central Laboratory, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Zhangzhu Zhou
- Central Laboratory, Cancer Hospital of Shantou University Medical College, Shantou, China
- Department of Laboratory, Jiangmen Central Hospital, Jiangmen, China
| | - Xueqiong Lin
- Department of Laboratory Medicine, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Jiahui Liao
- Central Laboratory, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Yujie Zhang
- Department of Chemical Engineering, Guangdong Technion-Israel Institute of Technology, Shantou, China
| | - Bingmeng Xie
- Central Laboratory, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Yiteng Huang
- Health Care Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lin Peng
- Central Laboratory, Cancer Hospital of Shantou University Medical College, Shantou, China
| |
Collapse
|
6
|
Oroszi B, Juhász A, Nagy C, Horváth JK, McKee M, Ádány R. Unequal burden of COVID-19 in Hungary: a geographical and socioeconomic analysis of the second wave of the pandemic. BMJ Glob Health 2021; 6:bmjgh-2021-006427. [PMID: 34518205 PMCID: PMC8438581 DOI: 10.1136/bmjgh-2021-006427] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/16/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction We describe COVID-19 morbidity, mortality, case fatality and excess death in a country-wide study of municipalities in Hungary, exploring the association with socioeconomic status. Methods The spatial distribution of morbidity, mortality and case fatality was mapped using hierarchical Bayesian smoothed indirectly standardised ratios. Indirectly standardised ratios were used to evaluate the association between deprivation and the outcome measures. We looked separately at morbidity and mortality in the 10 districts with the highest and 10 districts with the lowest share of Roma population. Results Compared with the national average, the relative incidence of cases was 30%–36% lower in the most deprived quintile but the relative mortality and case fatality were 27%–32% higher. Expressed as incidence ratios relative to the national average, the most deprived municipalities had a relative incidence ratio of 0.64 (CI: 0.62 to 0.65) and 0.70 (CI: 0.69 to 0.72) for males and females, respectively. The corresponding figures for mortality were 1.32 (CI: 1.20 to 1.44) for males and 1.27 (CI: 1.16 to 1.39) for females and for case fatality 1.27 (CI: 1.16 to 1.39) and 1.32 (CI: 1.20 to 1.44) for males and females, respectively. The excess death rate (per 100 000) increased with deprivation levels (least deprived: 114.12 (CI: 108.60 to 119.84) and most deprived: 158.07 (CI: 149.30 to 167.23)). The 10 districts where Roma formed the greatest share of the population had an excess mortality rate 17.46% higher than the average for the most deprived quintile. Conclusions Those living in more deprived municipalities had a lower risk of being identified as a confirmed COVID-19 case but had a higher risk of death. An inverse association between trends in morbidity and mortality by socioeconomic conditions should be a cause for concern and points to the need for responses, including those involving vaccination, to pay particular attention to inequalities and their causes.
Collapse
Affiliation(s)
- Beatrix Oroszi
- Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Attila Juhász
- Department of Public Health, Government Office of the Capital City Budapest, Budapest, Hungary
| | - Csilla Nagy
- Department of Public Health, Government Office of the Capital City Budapest, Budapest, Hungary
| | | | - Martin McKee
- European Centre on Health of Societies in Transition (ECOHOST), London School of Hygiene and Tropical Medicine, London, UK
| | - Róza Ádány
- MTA-DE-Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary .,Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| |
Collapse
|
7
|
Piel FB, Parkes B, Hambly P, Roca-Barceló A, McCallion M, Leonardi G, Strosnider H, Yip F, Elliott P, Hansell AL. Software application profile: the Rapid Inquiry Facility 4.0: an open access tool for environmental public health tracking. Int J Epidemiol 2021; 49 Suppl 1:i38-i48. [PMID: 32293011 PMCID: PMC7158065 DOI: 10.1093/ije/dyz094] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2019] [Indexed: 12/02/2022] Open
Abstract
The Rapid Inquiry Facility 4.0 (RIF) is a new user-friendly and open-access tool, developed by the UK Small Area Health Statistics Unit (SAHSU), to facilitate environment public health tracking (EPHT) or surveillance (EPHS). The RIF is designed to help public health professionals and academics to rapidly perform exploratory investigations of health and environmental data at the small-area level (e.g. postcode or detailed census areas) in order to identify unusual signals, such as disease clusters and potential environmental hazards, whether localized (e.g. industrial site) or widespread (e.g. air and noise pollution). The RIF allows the use of advanced disease mapping methods, including Bayesian small-area smoothing and complex risk analysis functionalities, while accounting for confounders. The RIF could be particularly useful to monitor spatio-temporal trends in mortality and morbidity associated with cardiovascular diseases, cancers, diabetes and chronic lung diseases, or to conduct local or national studies on air pollution, flooding, low-magnetic fields or nuclear power plants.
Collapse
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.,MRC-PHE Centre for Environment & Health, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Brandon Parkes
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Peter Hambly
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Aina Roca-Barceló
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Martin McCallion
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Giovanni Leonardi
- Environmental Epidemiology Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK
| | - Heather Strosnider
- Environmental Public Health Tracking Program, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, US
| | - Fuyuen Yip
- Environmental Public Health Tracking Program, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, US
| | - Paul Elliott
- UK Small Area Health Statistics Unit (SAHSU), 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
| | - Anna L Hansell
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK.,Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| |
Collapse
|
8
|
Preventive Metformin Monotherapy Medication Prescription, Redemption and Socioeconomic Status in Hungary in 2018-2019: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052206. [PMID: 33668088 PMCID: PMC7956358 DOI: 10.3390/ijerph18052206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/07/2021] [Accepted: 02/20/2021] [Indexed: 12/14/2022]
Abstract
This study was designed to characterize the spatial distribution of metformin medication used as first-line monotherapy for prevention of T2DM in relationship with the socioeconomic status (level of deprivation) and T2DM mortality at district level in a nationwide cross-sectional ecological study for the first time in a European country, Hungary. Risk analysis was used to estimate the relationships between socioeconomic status, characterized by tertiles of deprivation index, and mortality caused by diabetes, and metformin medication (both prescription and redemption) for the years of 2018 and 2019 at the district level. The spatial distribution of districts with a higher relative frequency of metformin prescriptions and redemptions showed a positive correlation with socio-economic deprivation. Significant association between the relatively high T2DM mortality and the highest level of deprivation could also be detected, but less-deprived regions with high T2DM mortality and low metformin utilization could also be identified. Although the statistical associations detected in this ecological study do not indicate a causal relationship, it is reasonable to suppose that the underuse of metformin medication may contribute to the unfavourable T2DM mortality in certain regions. Our findings underline the need for more effective preventive services including metformin medication to decrease T2DM morbidity and mortality burden.
Collapse
|
9
|
Boonhat H, Lin RT. Association between leukemia incidence and mortality and residential petrochemical exposure: A systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2020; 145:106090. [PMID: 32932064 DOI: 10.1016/j.envint.2020.106090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/12/2020] [Accepted: 08/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The global burden of leukemia, which grew by 19% from 2007 to 2017, poses a threat to human development and global cancer control. Factors contributing to this growth include massive industrial pollution, especially from large-scale petrochemical industry complexes (PICs). Globally, around 700 PICs are continuously operating. Data on the impact of PICs on leukemia incidence and mortality in residents are sparse and inconsistent. OBJECTIVE To determine the association between residential exposure to PICs and leukemia incidence and mortality using systematic review and meta-analysis. METHODS The studies were identified through seven databases (Clinical Key, Cochrane Library, EBSCOhost, Embase, PubMed, ScienceDirect, and Web of Science). We screened the eligibility of studies using following criteria: (1) observational studies that focused on residential exposure to PICs; (2) exposure group that was defined as residents living close to PICs; (3) outcome that was defined as all leukemia incidence and mortality; and (4) available population data. We applied the Grading of Recommendations Assessment, Development, and Evaluation to assess the certainty of evidence. The random-effects model used to estimate the pooled effects in the meta-analysis. RESULTS We identified thirteen epidemiologic studies (including eleven for leukemia incidence, one for leukemia mortality, and one for both), covering 125,580 individuals from Croatia, Finland, Italy, Serbia, Spain, Sweden, Taiwan, the United Kingdom, and the United States. We found moderate certainty of evidence indicated the risk of leukemia incidence (relative risk [RR] = 1.18; 95% CI = 1.03-1.35) and mortality (RR = 1.26; 95% CI = 1.10-1.45) in residents living close to PICs. Our subgroup analysis found increased RRs for leukemia incidence in studies using distance-based exposure indicator (RR = 1.11; 95% CI = 1.00-1.23), and with longer follow-up periods (RR = 1.24; 95% CI = 1.06-1.45). CONCLUSION Our analysis provides low-certainty evidence of increased leukemia incidence and moderate-certainty evidence of increased leukemia mortality among residents living close to PICs. While the global petrochemicals sector is growing, our findings suggest the need to consider disease prevention and pollution control measures during the development of PICs.
Collapse
Affiliation(s)
- Hathaichon Boonhat
- Graduate Institute of Public Health, College of Public Health, China Medical University, Taichung 406, Taiwan
| | - Ro-Ting Lin
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung 406, Taiwan.
| |
Collapse
|
10
|
Bae HJ, Kang JE, Lim YR. Assessment of Relative Asthma Risk in Populations Living Near Incineration Facilities in Seoul, Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207448. [PMID: 33066152 PMCID: PMC7601977 DOI: 10.3390/ijerph17207448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 11/29/2022]
Abstract
While incineration is among the most commonly used technologies for waste disposal, there is ongoing public concern regarding the adverse health impact. The aim of this study is thus to use health statistics to assess the relative risk of asthma-related hospitalization for those living in close proximity to incineration facilities. We also examine differences in asthma risk related to age demographics. The spatial relationship between incineration facilities and asthma-related hospital admissions in Seoul is analyzed for the period of 2009–2011 using the Rapid Inquiry Facility (RIF) and SaTScan software. The relative risk of asthma-related hospitalization decreased with increasing distance from incinerators, but increased among those living within a 2-km radius. The relative risks of asthma-related hospitalization were 1.13 (95% confidence interval (CI): 1.10–1.17), 1.12 (95% CI: 1.08–1.17), and 1.18 (95% CI: 1.10–1.27) for all ages, those aged below 15 years, and those aged 65 years and older, respectively. This study is the first to observe an increased risk of asthma-related hospitalization in relation to a person’s distance from an incinerator in Seoul, Korea. It is clear that asthma should be considered an adverse health outcome during health impact assessments of incineration plants.
Collapse
Affiliation(s)
- Hyun-Joo Bae
- Climate, Air Quality and Safety Research Group, Korea Environment Institute, Bldg B, 370 Sicheong-daero, Sejongsi 30147, Korea;
| | - Jung Eun Kang
- Department of Urban Planning and Engineering, Pusan National University, 2 Busandaehak-ro63, Geumjeong-gu, Busan 46241, Korea
- Correspondence: ; Tel.: +82-51-510-2451
| | - Yu-Ra Lim
- Institute of Environmental Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea;
| |
Collapse
|
11
|
Tello MA. Conceptualizing social impact: A geographic perspective. JOURNAL OF BUSINESS RESEARCH 2020; 119:562-571. [DOI: 10.1016/j.jbusres.2020.07.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
12
|
Antithrombotic Preventive Medication Prescription Redemption and Socioeconomic Status in Hungary in 2016: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186855. [PMID: 32961765 PMCID: PMC7559548 DOI: 10.3390/ijerph17186855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 01/02/2023]
Abstract
This work was designed to investigate antithrombotic drug utilization and its link with the socioeconomic characteristics of specific population groups in Hungary by a comparative analysis of data for prescriptions by general practitioners and the redeemed prescriptions for antithrombotic drugs. Risk analysis capabilities were applied to estimate the relationships between socioeconomic status, which was characterized by quintiles of a multidimensional composite indicator (deprivation index), and mortality due to thromboembolic diseases as well as antithrombotic medications for the year 2016 at the district level in Hungary. According to our findings, although deprivation is a significant determinant of mortality due to thromboembolic diseases, clusters can be identified that represent exemptions to this rule: an eastern part of Hungary, consisting of two highly deprived counties, had significantly lower mortality than the country average; by contrast, the least-deprived northwestern part of the country, consisting of five counties, had significantly higher mortality than the country average. The fact that low socioeconomic status in general and poor adherence to antithrombotic drugs irrespective of socioeconomic status were associated with increased mortality indicates the importance of more efficient control of preventive medication and access to healthcare in all districts of the country to reduce mortality due to thromboembolic diseases.
Collapse
|
13
|
Jephcote C, Brown D, Verbeek T, Mah A. A systematic review and meta-analysis of haematological malignancies in residents living near petrochemical facilities. Environ Health 2020; 19:53. [PMID: 32430062 PMCID: PMC7236944 DOI: 10.1186/s12940-020-00582-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/20/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND The petrochemical industry is a major source of hazardous and toxic air pollutants that are recognised to have mutagenic and carcinogenic properties. A wealth of occupational epidemiology literature exists around the petrochemical industry, with adverse haematological effects identified in employees exposed to 'low' concentrations of aromatic hydrocarbons (benzene, toluene, ethylbenzene, and xylene). Releases from the petrochemical industry are also thought to increase the risk of cancer incidence in fenceline communities. However, this emerging and at times inconclusive evidence base remains fragmented. The present study's aim was to conduct a systematic review and meta-analysis of epidemiological studies investigating the association between incidences of haematological malignancy and residential exposure to the petrochemical industry. METHODS Epidemiological studies reporting the risk of haematological malignancies (Leukaemia, Hodgkin's lymphoma, Non-Hodgkin's lymphoma, and Multiple myeloma) were included where the following criteria were met: (i) Cancer incidence is diagnosed by a medical professional and coded in accordance to the International Classification of Diseases; (ii) A clear definition of fenceline communities is provided, indicating the proximity between exposed residents and petrochemical activities; and (iii) Exposure is representative of normal operating conditions, not emergency events. Two investigators independently extracted information on study characteristics and outcomes in accordance with PRISMA and MOOSE guidelines. Relative risks and their 95% confidence intervals were pooled across studies for the four categories of haematological malignancy, using a random effects meta-analysis. RESULTS The systematic review identified 16 unique studies, which collectively record the incidence of haematological malignancies across 187,585 residents living close to a petrochemical operation. Residents from fenceline communities, less than 5 km from a petrochemical facility (refinery or manufacturer of commercial chemicals), had a 30% higher risk of developing Leukaemia than residents from communities with no petrochemical activity. Meanwhile, the association between exposure and rarer forms of haematological malignancy remains uncertain, with further research required. CONCLUSIONS The risk of developing Leukaemia appears higher in individuals living near a petrochemical facility. This highlights the need for further policy to regulate the release of carcinogens by industry.
Collapse
Affiliation(s)
- Calvin Jephcote
- Department of Sociology, University of Warwick, Coventry, CV4 7AL UK
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, LE1 7HA UK
| | - David Brown
- Department of Sociology, University of Warwick, Coventry, CV4 7AL UK
| | - Thomas Verbeek
- Department of Sociology, University of Warwick, Coventry, CV4 7AL UK
| | - Alice Mah
- Department of Sociology, University of Warwick, Coventry, CV4 7AL UK
| |
Collapse
|
14
|
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] [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.
Collapse
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
| |
Collapse
|
15
|
Papp M, Kőrösi L, Sándor J, Nagy C, Juhász A, Ádány R. Workforce crisis in primary healthcare worldwide: Hungarian example in a longitudinal follow-up study. BMJ Open 2019; 9:e024957. [PMID: 31340955 PMCID: PMC6661691 DOI: 10.1136/bmjopen-2018-024957] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The study was designed to explore the development of the general practitioner (GP) shortage in primary care and its characteristics in Hungary. DESIGN Longitudinal follow-up study over the decade 2007-2016. METHODS Analyses were performed on changes in number, age and sex of GPs by practice type (adult, paediatric and mixed), as well as on their geographical distribution and migration between areas characterised by deprivation index (DI) at municipality level. The association between deprivation and vacancy for GPs was studied by risk analysis. The number of population underserved was defined by DI quintile. SETTING AND SUBJECTS The study involved all general practices and GPs in the period examined. MAIN OUTCOME MEASURE It is showed that the number of general practices with unfilled GP posts was increasing exponentially, mainly in the most deprived areas of the country. RESULTS A decrease in the number of GPs in all types of practices, especially in mixed (by 7.7%; p<0.001) and paediatric (by 6.5%; p<0.001) ones, was shown; the number of adult practices with unfilled GP posts doubled, while the number of paediatric practices with a vacancy for a paediatrician more than tripled. The average age of GPs was increased by 3.7 years (p<0.001) in adult, by 5.4 years (p<0.001) in paediatric and by 4.2 years (p<0.001) in mixed practices. In 2007, 52.27% (95% CI 51.03 to 53.5) of the GPs were women, and this rate increased to 56.19% (95% CI 54.93 to 57.44) by the end of the decade. An exponential association between relative vacancy rate and deprivation was confirmed. As a result of the migration of GPs, in the most deprived areas, the number of GPs decreased by 8.43% (95% CI 5.86 to 10.99). CONCLUSIONS The workforce crisis in Hungarian primary care is progressively deepening and resulting in more severe inequity in access to healthcare.
Collapse
Affiliation(s)
- Magor Papp
- National Public Health Institute, Budapest, Hungary
| | - László Kőrösi
- National Institute of Health Insurance Fund Management, Budapest, Hungary
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Csilla Nagy
- Public Health Administration Service of Government Office of Capital City Budapest, Budapest, Hungary
| | - Attila Juhász
- Public Health Administration Service of Government Office of Capital City Budapest, Budapest, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- MTA-DE Public Health Research Group of the Hungarian Academy of Sciences, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
16
|
Boruzs K, Juhász A, Nagy C, Szabó Z, Jakovljevic M, Bíró K, Ádány R. High Inequalities Associated With Socioeconomic Deprivation in Cardiovascular Disease Burden and Antihypertensive Medication in Hungary. Front Pharmacol 2018; 9:839. [PMID: 30123128 PMCID: PMC6085562 DOI: 10.3389/fphar.2018.00839] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/11/2018] [Indexed: 11/13/2022] Open
Abstract
The wide life expectancy gap between the old and new member states of the European Union is most strongly related to the high rate of premature mortality caused by cardiovascular diseases (CVDs). To learn more about the background of this gap, the relationship of socioeconomic status (SES) with CVD mortality, morbidity and the utilization of antihypertensive drugs was studied in Hungary, a Central-Eastern European country with an extremely high relative risk of premature CVD mortality. Risk analysis capabilities were used to estimate the relationships between SES, which was characterized by tertiles of a multidimensional composite indicator (the deprivation index) and CVD burden (mortality and morbidity) as well as the antihypertensive medications at the district level in Hungary. The excess risks caused by premature mortality from CVDs showed a strong correlation with deprivation using the Rapid Inquiry Facility. The distribution of prevalence values related to these diseases was found to be similar, but in the areas of highest deprivation, where the prevalence of chronic ischaemic heart diseases and cerebrovascular diseases was found to be higher than the national average by 30 and 20%, the prevalence of hypertension exceeded the national average by only 4%. A linear association between the relative frequency of prescriptions/redemptions and deprivation for most antihypertensive drugs, except angiotensinogen receptor blockers, was shown. More intense screening for hypertension is proposed to improve the control of CVDs in countries affected by high disease burden.
Collapse
Affiliation(s)
- Klára Boruzs
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Attila Juhász
- Department of Public Health, Government Office of Capital City Budapest, Budapest, Hungary
| | - Csilla Nagy
- Department of Public Health, Government Office of Capital City Budapest, Budapest, Hungary
| | - Zoltán Szabó
- Department of Emergency Medicine, Medical Center, University of Debrecen, Debrecen, Hungary
| | - Mihajlo Jakovljevic
- Department of Global Health, Economics & Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Klára Bíró
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- MTA-DE Public Health Research Group of the Hungarian Academy of Sciences, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
17
|
Benedetti M, De Santis M, Manno V, Minerba S, Mincuzzi A, Morabito A, Panocchia N, Soggiu ME, Tanzarella A, Pastore T, Bossola M, Giua R, Leogrande S, Nocioni A, Conti S, Comba P. Spatial distribution of kidney disease in the contaminated site of Taranto (Italy). Am J Ind Med 2017; 60:1088-1099. [PMID: 29027241 DOI: 10.1002/ajim.22781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Exposure to heavy metals has been associated with kidney disease. We investigated the spatial distribution of kidney disease in the industrially contaminated site of Taranto. METHODS Cases were subjects with a first hospital discharge diagnosis of kidney disease. Cases affected by specific comorbidities were excluded. Standardized Hospitalization Ratios (SHRs) were computed for low/high exposure area and for modeled spatial distribution of cadmium and fine particulate matter. RESULT Using the high/low exposure approach, in subjects aged 20-59 years residing in the high exposure area a significant excess of hospitalization was observed in males and a non-significant excess in females. No excesses were observed in subjects aged 60 years and over. The analysis by the modeling approach did not show a significant association with the greatest pollution impact area. CONCLUSION Due to the excesses of hospitalization observed in the high/low exposure approach, a continuing epidemiological surveillance of residents and occupational groups is warranted.
Collapse
Affiliation(s)
- Marta Benedetti
- Department of Environment and Health (DAMSA); Istituto Superiore di Sanità; Rome Italy
| | - Marco De Santis
- Department of Environment and Health (DAMSA); Istituto Superiore di Sanità; Rome Italy
| | - Valerio Manno
- Unit of Statistics; Istituto Superiore di Sanità; Rome Italy
| | - Sante Minerba
- Epidemiological and Statistical Unit; Azienda Sanitaria Locale Taranto; Taranto Italy
| | - Antonella Mincuzzi
- Epidemiological and Statistical Unit; Azienda Sanitaria Locale Taranto; Taranto Italy
| | - Angela Morabito
- Apulia Region Environmental Protection Agency (ARPA PUGLIA); Bari Italy
| | - Nicola Panocchia
- Haemodialysis Service; Department of Surgery; Università Cattoloca del Sacro Cuore; Rome Italy
| | - Maria Eleonora Soggiu
- Department of Environment and Health (DAMSA); Istituto Superiore di Sanità; Rome Italy
| | | | - Tiziano Pastore
- Apulia Region Environmental Protection Agency (ARPA PUGLIA); Bari Italy
| | - Maurizio Bossola
- Haemodialysis Service; Department of Surgery; Università Cattoloca del Sacro Cuore; Rome Italy
| | - Roberto Giua
- Apulia Region Environmental Protection Agency (ARPA PUGLIA); Bari Italy
| | - Simona Leogrande
- Epidemiological and Statistical Unit; Azienda Sanitaria Locale Taranto; Taranto Italy
| | | | - Susanna Conti
- Unit of Statistics; Istituto Superiore di Sanità; Rome Italy
| | - Pietro Comba
- Department of Environment and Health (DAMSA); Istituto Superiore di Sanità; Rome Italy
| |
Collapse
|
18
|
Mayne DJ, Morgan GG, Jalaludin BB, Bauman AE. The contribution of area-level walkability to geographic variation in physical activity: a spatial analysis of 95,837 participants from the 45 and Up Study living in Sydney, Australia. Popul Health Metr 2017; 15:38. [PMID: 28974226 PMCID: PMC5627488 DOI: 10.1186/s12963-017-0149-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 08/25/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Individual-level studies support a positive relation between walkable built environments and participation in moderate-intensity walking. However, the utility of this evidence for population-level planning is less clear as it is derived at much finer spatial scales than those used for regional programming. The aims of this study were to: evaluate if individual-level relations between walkability and walking to improve health manifest at population-level spatial scales; assess the specificity of area-level walkability for walking relative to other moderate and vigorous physical activity (MVPA); describe geographic variation in walking and other MVPA; and quantify the contribution of walkability to this variation. METHODS Data on sufficient walking, sufficient MVPA, and high MVPA to improve health were analyzed for 95,837 Sydney respondents to the baseline survey of the 45 and Up Study between January 2006 and April 2010. We used conditional autoregressive models to create smoothed MVPA "disease maps" and assess relations between sufficient MVPA to improve health and area-level walkability adjusted for individual-level demographic, socioeconomic, and health factors, and area-level relative socioeconomic disadvantage. RESULTS Within-cohort prevalence of meeting recommendations for sufficient walking, sufficient MVPA, and high MVPA were 31.7 (95% CI 31.4-32.0), 69.4 (95% CI 69.1-69.7), and 56.1 (95% CI 55.8-56.4) percent. Prevalence of sufficient walking was increased by 1.20 (95% CrI 1.12-1.29) and 1.07 (95% CrI 1.01-1.13) for high and medium-high versus low walkability postal areas, and for sufficient MVPA by 1.05 (95% CrI 1.01-1.08) for high versus low walkability postal areas. Walkability was not related to high MVPA. Postal area walkability explained 65.8 and 47.4 percent of residual geographic variation in sufficient walking and sufficient MVPA not attributable to individual-level factors. CONCLUSIONS Walkability is associated with area-level prevalence and geographic variation in sufficient walking and sufficient MVPA to improve health in Sydney, Australia. Our study supports the use of walkability indexes at multiple spatial scales for informing population-level action to increase physical activity and the utility of spatial analysis for walkability research and planning.
Collapse
Affiliation(s)
- Darren J. Mayne
- Sydney School of Public Health, The University of Sydney, Camperdown, 2006 NSW Australia
- Public Health Unit, Illawarra Shoalhaven Local Health District, Warrawong, 2502 NSW Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, 2500 NSW Australia
- Illawarra Health and Medical Research Institute, Wollongong, 2500 NSW Australia
| | - Geoffrey G. Morgan
- University Centre for Rural Health - North Coast, School of Public Health, The University of Sydney, Camperdown, 2006 NSW Australia
| | - Bin B. Jalaludin
- Ingham Institute, University of New South Wales, Sydney, 2052 NSW Australia
- Epidemiology, Healthy People and Places Unit, Population Health, South Western Sydney Local Health District, Liverpool, 1871 NSW Australia
| | - Adrian E. Bauman
- Sydney School of Public Health, The University of Sydney, Camperdown, 2006 NSW Australia
| |
Collapse
|
19
|
Boruzs K, Juhász A, Nagy C, Ádány R, Bíró K. Relationship between Statin Utilization and Socioeconomic Deprivation in Hungary. Front Pharmacol 2016; 7:66. [PMID: 27047381 PMCID: PMC4806228 DOI: 10.3389/fphar.2016.00066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/07/2016] [Indexed: 11/24/2022] Open
Abstract
The risk of premature mortality caused by cardiovascular diseases (CVDs) is approximately three times higher in the Central Eastern European region than in high income European countries, which suggests a lack and/or ineffectiveness of preventive interventions against CVDs. The aim of the present study was to provide data on the relationship between premature CVD mortality, statin utilization as a preventive medication and socioeconomic deprivation at the district level in Hungary. As a conceptually new approach, the prescription of statins, the prescription redemption and the ratio between redemption and prescription rates were also investigated. The number of prescriptions for statins and the number of redeemed statin prescriptions were obtained from the National Health Insurance Fund Administration of Hungary for each primary healthcare practice for the entire year of 2012. The data were aggregated at the district level. To define the frequency of prescription and of redemption, the denominator was the number of the 40+-year-old population adjusted by the rates of 60+-year-old population of the district. The standardized mortality rates, frequency of statin prescriptions, redeemed statin prescriptions, and ratios for compliance in relation to the national average were mapped using the “disease mapping” option, and their association with deprivation (tertile of deprivation index as a district-based categorical covariate) was defined using the risk analysis capabilities within the Rapid Inquiry Facility. The risk analysis showed a significant positive association between deprivation and the relative risk of premature cardiovascular mortality, and a reverse J-shaped association between the relative frequency of statin prescriptions and deprivation. Districts with the highest deprivation showed a low relative frequency of statin prescriptions; however, significantly higher primary compliance (redemption) was observed in districts with the highest deprivation. Our data clearly indicate that insufficient statin utilization is strongly linked to the so-called physician-factor, i.e., a statin prescription. Consequently, statin treatment is poor and represents a significant barrier to reducing mortality, particularly among people living in highly deprived areas of the country.
Collapse
Affiliation(s)
- Klára Boruzs
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen Debrecen, Hungary
| | - Attila Juhász
- Public Health Administration Service of Government Office of Capital City Budapest Budapest, Hungary
| | - Csilla Nagy
- Public Health Administration Service of Government Office of Capital City Budapest Budapest, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of DebrecenDebrecen, Hungary; MTA-DE Public Health Research Group of the Hungarian Academy of Sciences, University of DebrecenDebrecen, Hungary
| | - Klára Bíró
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen Debrecen, Hungary
| |
Collapse
|
20
|
Abstract
The uptake and acceptance of Geographic Information Systems (GIS) technology has increased since the early 1990s and public health applications are rapidly expanding. In this paper, we summarize the common uses of GIS technology in the public health sector, emphasizing applications related to mapping and understanding of parasitic diseases. We also present some of the success stories, and discuss the challenges that still prevent a full scope application of GIS technology in the public health context. Geographical analysis has allowed researchers to interlink health, population and environmental data, thus enabling them to evaluate and quantify relationships between health-related variables and environmental risk factors at different geographical scales. The ability to access, share and utilize satellite and remote-sensing data has made possible even wider understanding of disease processes and of their links to the environment, an important consideration in the study of parasitic diseases. For example, disease prevention and control strategies resulting from investigations conducted in a GIS environment have been applied in many areas, particularly in Africa. However, there remain several challenges to a more widespread use of GIS technology, such as: limited access to GIS infrastructure, inadequate technical and analytical skills, and uneven data availability. Opportunities exist for international collaboration to address these limitations through knowledge sharing and governance.
Collapse
|
21
|
Deng W, Long L, Tang XY, Huang TR, Li JL, Rong MH, Li KZ, Liu HZ. Anisotropic patterns of liver cancer prevalence in Guangxi in Southwest China: is local climate a contributing factor? Asian Pac J Cancer Prev 2016; 16:3579-86. [PMID: 25921181 DOI: 10.7314/apjcp.2015.16.8.3579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Geographic information system (GIS) technology has useful applications for epidemiology, enabling the detection of spatial patterns of disease dispersion and locating geographic areas at increased risk. In this study, we applied GIS technology to characterize the spatial pattern of mortality due to liver cancer in the autonomous region of Guangxi Zhuang in southwest China. A database with liver cancer mortality data for 1971-1973, 1990-1992, and 2004-2005, including geographic locations and climate conditions, was constructed, and the appropriate associations were investigated. It was found that the regions with the highest mortality rates were central Guangxi with Guigang City at the center, and southwest Guangxi centered in Fusui County. Regions with the lowest mortality rates were eastern Guangxi with Pingnan County at the center, and northern Guangxi centered in Sanjiang and Rongshui counties. Regarding climate conditions, in the 1990s the mortality rate of liver cancer positively correlated with average temperature and average minimum temperature, and negatively correlated with average precipitation. In 2004 through 2005, mortality due to liver cancer positively correlated with the average minimum temperature. Regions of high mortality had lower average humidity and higher average barometric pressure than did regions of low mortality. Our results provide information to benefit development of a regional liver cancer prevention program in Guangxi, and provide important information and a reference for exploring causes of liver cancer.
Collapse
Affiliation(s)
- Wei Deng
- Department of Epidemiology, Guangxi Cancer Institute, Nanning, Guangxi, China E-mail :
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Wesseling C, van Wendel de Joode B, Crowe J, Rittner R, Sanati NA, Hogstedt C, Jakobsson K. Mesoamerican nephropathy: geographical distribution and time trends of chronic kidney disease mortality between 1970 and 2012 in Costa Rica. Occup Environ Med 2015. [PMID: 26199395 DOI: 10.1136/oemed-2014-102799] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Mesoamerican nephropathy is an epidemic of chronic kidney disease (CKD) unrelated to traditional causes, mostly observed in sugarcane workers. We analysed CKD mortality in Costa Rica to explore when and where the epidemic emerged, sex and age patterns, and relationship with altitude, climate and sugarcane production. METHODS SMRs for CKD deaths (1970-2012) among population aged ≥20 were computed for 7 provinces and 81 counties over 4 time periods. Time trends were assessed with age-standardised mortality rates. We qualitatively examined relations between mortality and data on altitude, climate and sugarcane production. RESULTS During 1970-2012, age-adjusted mortality rates in the Guanacaste province increased among men from 4.4 to 38.5 per 100,000 vs. 3.6-8.4 in the rest of Costa Rica, and among women from 2.3 to 10.7 per 100,000 vs. 2.6-5.0 in the rest of Costa Rica. A significant moderate excess mortality was observed among men in Guanacaste already in the mid-1970s, steeply increasing thereafter; a similar female excess mortality appeared a decade later, remaining stable. Male age-specific rates were high in Guanacaste for age categories ≥30, and since the late 1990s also for age range 20-29. The male spatiotemporal patterns roughly followed sugarcane expansion in hot, dry lowlands with manual harvesting. CONCLUSIONS Excess CKD mortality occurs primarily in Guanacaste lowlands and was already present 4 decades ago. The increasing rates among Guanacaste men in hot, dry lowland counties with sugarcane are consistent with an occupational component. Stable moderate increases among women, and among men in counties without sugarcane, suggest coexisting environmental risk factors.
Collapse
Affiliation(s)
- Catharina Wesseling
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Berna van Wendel de Joode
- Program on Work, Environment and Health in Central America (SALTRA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Jennifer Crowe
- Program on Work, Environment and Health in Central America (SALTRA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Ralf Rittner
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Negin A Sanati
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Christer Hogstedt
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Jakobsson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| |
Collapse
|
23
|
Ghosh RE, Close R, McCann LJ, Crabbe H, Garwood K, Hansell AL, Leonardi G. Analysis of hospital admissions due to accidental non-fire-related carbon monoxide poisoning in England, between 2001 and 2010. J Public Health (Oxf) 2015; 38:76-83. [PMID: 25755248 PMCID: PMC4750524 DOI: 10.1093/pubmed/fdv026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Accidental non-fire-related (ANFR) carbon monoxide (CO) poisoning is a cause of fatalities and hospital admissions. This is the first study that describes the characteristics of ANFR CO hospital admissions in England. Methods Hospital Episode Statistics (HES) inpatient data for England between 2001 and 2010 were used. ANFR CO poisoning admissions were defined as any mention of ICD-10 code T58: toxic effect of CO and X47: accidental poisoning by gases or vapours, excluding ICD-10 codes potentially related to fires (X00-X09, T20-T32 and Y26). Results There were 2463 ANFR CO admissions over the 10-year period (annual rate: 0.49/100 000); these comprised just under half (48.7%) of all non-fire-related (accidental and non-accidental) CO admissions. There was seasonal variability, with more admissions in colder winter months. Higher admission rates were observed in the north of England. Just over half (53%) of ANFR admissions were male, and the highest rates of ANFR admissions were in those aged >80 years. Conclusion The burden of ANFR CO poisoning is preventable. The results of this study suggest an appreciable burden of CO and highlight differences that may aid targeting of public health interventions.
Collapse
Affiliation(s)
- Rebecca E Ghosh
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Rebecca Close
- Department of Epidemiology, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, Oxon OX11 0RQ, UK
| | - Lucy J McCann
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, Oxon OX11 0RQ, UK
| | - Helen Crabbe
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, Oxon OX11 0RQ, UK
| | - Kevin Garwood
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Anna L Hansell
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Giovanni Leonardi
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, Oxon OX11 0RQ, UK London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| |
Collapse
|
24
|
Kearney GD, Namulanda G, Qualters JR, Talbott EO. A decade of environmental public health tracking (2002-2012): progress and challenges. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 21 Suppl 2:S23-35. [PMID: 25621442 PMCID: PMC5667361 DOI: 10.1097/phh.0000000000000181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The creation of the Centers for Disease Control and Prevention Environmental Public Health Tracking Program spawned an invigorating and challenging approach toward implementing the nation's first population-based, environmental disease tracking surveillance system. More than 10 years have passed since its creation and an abundance of peer-reviewed articles have been published spanning a broad variety of public health topics related primarily to the goal of reducing diseases of environmental origin. OBJECTIVE To evaluate peer-reviewed literature related to Environmental Public Health Tracking during 2002-2012, recognize major milestones and challenges, and offer recommendations. DESIGN A narrative overview was conducted using titles and abstracts of peer-reviewed articles, key word searches, and science-based search engine databases. MAIN OUTCOMES Eighty published articles related to "health tracking" were identified and categorized according to 4 crossed-central themes. The Science and Research theme accounted for the majority of published articles, followed by Policy and Practice, Collaborations Among Health and Environmental Programs, and Network Development. CONCLUSIONS Overall, progress was reported in the areas of data linkage, data sharing, surveillance methods, and network development. Ongoing challenges included formulating better ways to establish the connections between health and the environment, such as using biomonitoring, public water systems, and private well water data. Recommendations for future efforts include use of data to inform policy and practice and use of electronic health records data for environmental health surveillance.
Collapse
Affiliation(s)
- Gregory D Kearney
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville North Carolina (Dr Kearney); Division of Environmental Hazards & Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Namulanda and Dr Qualters); and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Talbott)
| | | | | | | |
Collapse
|
25
|
Porter TR, Kent ST, Su W, Beck HM, Gohlke JM. Spatiotemporal association between birth outcomes and coke production and steel making facilities in Alabama, USA: a cross-sectional study. Environ Health 2014; 13:85. [PMID: 25342170 PMCID: PMC4223752 DOI: 10.1186/1476-069x-13-85] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/15/2014] [Indexed: 05/10/2023]
Abstract
BACKGROUND Previous research has shown exposure to air pollution increases the risk of adverse birth outcomes, although the effects of residential proximity to significant industrial point sources are less defined. The objective of the current study was to determine whether yearly reported releases from major industrial point sources are associated with adverse birth outcomes. METHODS Maternal residence from geocoded Alabama birth records between 1991 and 2010 were used to calculate distances from coke and steel production industries reporting emissions to the U.S. Environmental Protection Agency. Logistic regression models were built to determine associations between distance or yearly fugitive emissions (volatile organic compounds, polycyclic aromatic compounds, and metals) from reporting facilities and preterm birth or low birth weight, adjusting for covariates including maternal age, race, payment method, education level, year and parity. RESULTS A small but significant association between preterm birth and residential proximity (≤5.0 km) to coke and steel production facilities remained after adjustment for covariates (OR 1.05 95% CI: 1.01,1.09). Above average emissions from these facilities of volatile organic compounds during the year of birth were associated with low birth weight (OR 1.17 95% CI: 1.06, 1.29), whereas metals emissions were associated with preterm birth (OR 1.07 95% CI: 1.01, 1.14). CONCLUSIONS The present investigation suggests fugitive emissions from industrial point sources may increase the risk of adverse birth outcomes in surrounding neighborhoods. Further research teasing apart the relationship between exposure to emissions and area-level deprivation in neighborhoods surrounding industrial facilities and their combined effects on birth outcomes is needed.
Collapse
Affiliation(s)
- Travis R Porter
- />Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL 35294 USA
- />Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112 USA
| | - Shia T Kent
- />Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL 35294 USA
| | - Wei Su
- />Center for the Study of Community Health, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL 35294 USA
| | - Heidi M Beck
- />Center for the Study of Community Health, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL 35294 USA
| | - Julia M Gohlke
- />Department of Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL 35294 USA
| |
Collapse
|
26
|
Strosnider H, Zhou Y, Balluz L, Qualters J. Engaging academia to advance the science and practice of environmental public health tracking. ENVIRONMENTAL RESEARCH 2014; 134:474-81. [PMID: 25038624 PMCID: PMC4909327 DOI: 10.1016/j.envres.2014.04.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 04/25/2014] [Accepted: 04/29/2014] [Indexed: 05/27/2023]
Abstract
Public health agencies at the federal, state, and local level are responsible for implementing actions and policies that address health problems related to environmental hazards. These actions and policies can be informed by integrating or linking data on health, exposure, hazards, and population. The mission of the Centers for Disease Control and Prevention׳s National Environmental Public Health Tracking Program (Tracking Program) is to provide information from a nationwide network of integrated health, environmental hazard, and exposure data that drives actions to improve the health of communities. The Tracking Program and federal, state, and local partners collect, integrate, analyze, and disseminate data and information to inform environmental public health actions. However, many challenges exist regarding the availability and quality of data, the application of appropriate methods and tools to link data, and the state of the science needed to link and analyze health and environmental data. The Tracking Program has collaborated with academia to address key challenges in these areas. The collaboration has improved our understanding of the uses and limitations of available data and methods, expanded the use of existing data and methods, and increased our knowledge about the connections between health and environment. Valuable working relationships have been forged in this process, and together we have identified opportunities and improvements for future collaborations to further advance the science and practice of environmental public health tracking.
Collapse
Affiliation(s)
- Heather Strosnider
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Environmental Health Tracking Branch, 1600 Clifton Road, MS-F60, Atlanta, GA 30333, USA.
| | - Ying Zhou
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Environmental Health Tracking Branch, 1600 Clifton Road, MS-F60, Atlanta, GA 30333, USA.
| | - Lina Balluz
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Environmental Health Tracking Branch, 1600 Clifton Road, MS-F60, Atlanta, GA 30333, USA.
| | - Judith Qualters
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Office of the Director, 1600 Clifton Road, MS-F60, Atlanta, GA, 30333, USA.
| |
Collapse
|
27
|
Samarasundera E, Hansell A, Leibovici D, Horwell CJ, Anand S, Oppenheimer C. Geological hazards: from early warning systems to public health toolkits. Health Place 2014; 30:116-9. [PMID: 25255167 DOI: 10.1016/j.healthplace.2014.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 06/06/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
Abstract
Extreme geological events, such as earthquakes, are a significant global concern and sometimes their consequences can be devastating. Geographic information plays a critical role in health protection regarding hazards, and there are a range of initiatives using geographic information to communicate risk as well as to support early warning systems operated by geologists. Nevertheless we consider there to remain shortfalls in translating information on extreme geological events into health protection tools, and suggest that social scientists have an important role to play in aiding the development of a new generation of toolkits aimed at public health practitioners. This viewpoint piece reviews the state of the art in this domain and proposes potential contributions different stakeholder groups, including social scientists, could bring to the development of new toolkits.
Collapse
Affiliation(s)
- Edgar Samarasundera
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, St. Dunstan׳s Road, London W6 8RP, United Kingdom.
| | - Anna Hansell
- Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, St. Mary׳s Campus, W2 1PG, United Kingdom; Imperial College NHS Trust, The Bays, South Wharf Road, St Mary׳s Hospital, London W2 1NY, United Kingdom.
| | - Didier Leibovici
- Nottingham Geospatial Institute, University of Nottingham, Triumph Road, Nottingham NG7 2TU, United Kingdom.
| | - Claire J Horwell
- Institute of Hazard, Risk and Resilience, Department of Earth Sciences, Durham University, Durham DH1 3LE, United Kingdom.
| | - Suchith Anand
- Nottingham Geospatial Institute, University of Nottingham, Triumph Road, Nottingham NG7 2TU, United Kingdom.
| | - Clive Oppenheimer
- Department of Geography, University of Cambridge, Downing Place, Cambridge CB2 3EN, United Kingdom.
| |
Collapse
|
28
|
Lim YR, Bae HJ, Lim YH, Yu S, Kim GB, Cho YS. Spatial analysis of PM10 and cardiovascular mortality in the Seoul metropolitan area. ENVIRONMENTAL HEALTH AND TOXICOLOGY 2014; 29:e2014005. [PMID: 25116367 PMCID: PMC4152940 DOI: 10.5620/eht.2014.29.e2014005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 05/29/2014] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Numerous studies have revealed the adverse health effects of acute and chronic exposure to particulate matter less than 10 μm in aerodynamic diameter (PM10). The aim of the present study was to examine the spatial distribution of PM10 concentrations and cardiovascular mortality and to investigate the spatial correlation between PM10 and cardiovascular mortality using spatial scan statistic (SaTScan) and a regression model. METHODS From 2008 to 2010, the spatial distribution of PM10 in the Seoul metropolitan area was examined via kriging. In addition, a group of cardiovascular mortality cases was analyzed using SaTScan-based cluster exploration. Geographically weighted regression (GWR) was applied to investigate the correlation between PM10 concentrations and cardiovascular mortality. RESULTS An examination of the regional distribution of the cardiovascular mortality was higher in provincial districts (gu) belonging to Incheon and the northern part of Gyeonggido than in other regions. In a comparison of PM10 concentrations and mortality cluster (MC) regions, all those belonging to MC 1 and MC 2 were found to belong to particulate matter (PM) 1 and PM 2 with high concentrations of air pollutants. In addition, the GWR showed that PM10 has a statistically significant relation to cardiovascular mortality. CONCLUSIONS To investigate the relation between air pollution and health impact, spatial analyses can be utilized based on kriging, cluster exploration, and GWR for a more systematic and quantitative analysis. It has been proven that cardiovascular mortality is spatially related to the concentration of PM10.
Collapse
Affiliation(s)
- Yu-Ra Lim
- Korea Environment Institute, Seoul, Korea
| | | | - Youn-Hee Lim
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Seungdo Yu
- Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
| | - Geun-Bae Kim
- Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
| | - Yong-Sung Cho
- Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
| |
Collapse
|
29
|
Nagy C, Juhász A, Papp Z, Beale L. Hierarchical spatio-temporal mapping of premature mortality due to alcoholic liver disease in Hungary, 2005-2010. Eur J Public Health 2013; 24:827-33. [PMID: 24218047 DOI: 10.1093/eurpub/ckt169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Excess alcohol consumption is a major public health issue in Hungary, with high mortality rates from alcohol disease. In addition, excess alcohol consumption has been found to differ by socioeconomic and environmental factors. METHODS The spatial pattern of mortality from alcoholic liver disease across Hungary for the period 2005 and 2010, at municipality level, was investigated by sex using Bayesian modelling. The changes in mortality over this 6-year period were analysed using hierarchical spatio-temporal disease mapping. The association between the spatial distribution of mortality from alcoholic liver disease and cirrhosis and deprivation (by sex) was also assessed using a Hungarian-specific deprivation index. RESULTS A statistically significant association was found between mortality and deprivation status in males. Areas of significantly highest age-adjusted relative risks were found, for males, in the south-western part, and at the eastern border of the country. A number of areas showed area-specific trends that were significantly steeper than the national average mortality trend. CONCLUSION Using our findings, population groups with increasing mortality trends were identified, which may help decision makers fund effective health promotion programmes to reduce mortality rates in the working-age population.
Collapse
Affiliation(s)
- Csilla Nagy
- 1 Public Health Administration Service of Government Office of Capital City Budapest, Budapest, Hungary
| | - Attila Juhász
- 1 Public Health Administration Service of Government Office of Capital City Budapest, Budapest, Hungary
| | - Zoltán Papp
- 2 Public Health Administration Service of Government Office of Heves County, Eger, Hungary
| | - Linda Beale
- 3 Small Area Health Statistics Unit, MRC Centre for Environment and Health, Imperial College London, UK
| |
Collapse
|
30
|
|
31
|
Zöldi V, Juhász A, Nagy C, Papp Z, Egyed L. Tick-Borne Encephalitis and Lyme Disease in Hungary: The Epidemiological Situation Between 1998 and 2008. Vector Borne Zoonotic Dis 2013; 13:256-65. [DOI: 10.1089/vbz.2011.0905] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Viktor Zöldi
- Department for Vector and Public Health Pest Control, National Center for Epidemiology, Budapest, Hungary
| | - Attila Juhász
- Public Health Administration, Government Office of the Capital City Budapest, Budapest, Hungary
| | - Csilla Nagy
- Public Health Administration, Government Office of the Capital City Budapest, Budapest, Hungary
| | - Zoltán Papp
- Public Health Administration, Government Office of the Heves County, Eger, Hungary
| | - László Egyed
- Veterinary Medical Research Institute, Hungarian Academy of Sciences, Budapest, Hungary
| |
Collapse
|
32
|
Lam NSN. Geospatial Methods for Reducing Uncertainties in Environmental Health Risk Assessment: Challenges and Opportunities. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/00045608.2012.674900] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
33
|
Heinzl H, Waldhoer T. Relevance of the type III error in epidemiological maps. Int J Health Geogr 2012; 11:34. [PMID: 22900943 PMCID: PMC3492026 DOI: 10.1186/1476-072x-11-34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 07/02/2012] [Indexed: 11/10/2022] Open
Abstract
Background A type III error arises from a two-sided test, when one side is erroneously favoured although the true effect actually resides on the other side. The relevance of this grave error in decision-making is studied for epidemiological maps. Results Theoretical considerations confirm that a type III error may be large for regions with small numbers of expected cases even when no spatial smoothing has been performed. A simulation study based on infant mortality data in Austria reveals that spatial smoothing may additionally increase the risk of type III errors. Conclusions The occurrence of a type III error should be taken into account when interpreting results presented in epidemiological maps, particularly with regard to sparsely populated regions and spatial smoothing.
Collapse
Affiliation(s)
- Harald Heinzl
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
34
|
Wheeler DC, Ward MH, Waller LA. Spatial-temporal Analysis of Cancer Risk in Epidemiologic Studies with Residential Histories. ANNALS OF THE ASSOCIATION OF AMERICAN GEOGRAPHERS. ASSOCIATION OF AMERICAN GEOGRAPHERS 2012; 102:1049-1052. [PMID: 30956280 PMCID: PMC6450537 DOI: 10.1080/00045608.2012.671131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Exploring spatial-temporal patterns of disease incidence identifies areas of significantly elevated risk and can lead to discoveries of disease risk factors. One popular way to investigate patterns in risk over space and time is spatial-temporal cluster detection analysis. The identification of significant clusters may lead to etiological hypotheses to explain the pattern of elevated risk and to additional epidemiologic studies to explore these hypotheses. Several methodological issues and data challenges that arise in space-time cluster analysis of chronic diseases, such as cancer, include poor spatial precision of residence locations, long disease latencies, and adjustment for known risk factors. This paper reviews the key challenges faced when performing cluster analyses of chronic diseases and presents a spatial-temporal analysis of non-Hodgkin lymphoma (NHL) risk addressing these challenges. Residential histories, collected as part of a population-based case-control study of NHL (the National Cancer Institute [NCI]-Surveillance, Epidemiology, and End Results [SEER] NHL study) in four SEER centers (Detroit metropolitan area, Los Angeles, California, Seattle metropolitan area, and Iowa) were geocoded. In this analysis, we explored previously detected spatial-temporal clusters and adjusted for exposure to polychlorinated biphenyls (PCBs) and genetic polymorphisms in four genes, previously found to be associated with NHL, using a generalized additive model framework. We found that the genetic factors and PCB exposure did not fully explain previously detected areas of elevated risk.
Collapse
Affiliation(s)
- David C Wheeler
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Address: One Capitol Square, 7th Floor, Room 733; 830 East Main Street; P.O. Box 980032; Richmond, VA 23298-0032, ; Telephone: (804) 828-9827
| | - Mary H Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Address: 6120 Executive Boulevard; Executive Plaza South, Room 8006; Bethesda, MD 20892-7335, ; Telephone: (301) 435-4713
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Address: 1518 Clifton Road NE; Atlanta, GA 30322, ; Telephone: (404) 727-1057
| |
Collapse
|
35
|
Milewski I. Identifying at-risk communities for action on cancer prevention: a case study in new brunswick (Canada) communities. New Solut 2012; 22:79-107. [PMID: 22436208 DOI: 10.2190/ns.22.1.f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Health statistics reported by large geographic area such as province, state, county or health region offer little insight into disease conditions at the community level where people live and work, where occupational and environmental exposures occur, and where industrial emissions are often concentrated. This study investigated overall patterns of cancer incidence and socioeconomic status (SES) among 14 communities in the province of New Brunswick (Canada). A multivariate ordination technique, hierarchical clustering, and permutation procedures were used to identify and test significance of community clusters and whether the overall pattern of SES was correlated with patterns of cancer among communities. Communities with significantly high or significantly low overall rates of cancers were identified, patterns that were not related to SES. The potential influence of age, small populations, diagnostic screening, smoking and environmental risk factors contributing to locally elevated cancer rates are discussed. Cancer incidence reported at smaller spatial scales provides health officials and researchers with a basis for identifying communities potentially at-risk and aids in the development of appropriate community-based risk reduction actions and cancer prevention.
Collapse
Affiliation(s)
- Inka Milewski
- Conservation Council of New Brunswick, 180 St. John Street Fredericton, New Brunswick, E3B 4A9, Canada.
| |
Collapse
|
36
|
Mielke HW, Gonzales CR, Mielke PW. The continuing impact of lead dust on children's blood lead: comparison of public and private properties in New Orleans. ENVIRONMENTAL RESEARCH 2011; 111:1164-72. [PMID: 21764050 DOI: 10.1016/j.envres.2011.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 06/22/2011] [Accepted: 06/23/2011] [Indexed: 05/03/2023]
Abstract
BACKGROUND Compared with a maximum collective lead (Pb) estimate of ∼1811 metric tons (MT) in exterior paint on 86,000 New Orleans houses, Pb additives in gasoline were estimated at ∼12,000 MT in New Orleans, yielding ∼9100 MT Pb exhausted as aerosols from vehicles; ∼4850 MT were particles>10 μm and ∼4200 MT were particles <0.25 μm. OBJECTIVES To evaluate pre-Hurricane Katrina soil Pb and children's blood Pb at public housing and private residential properties in the inner-city compared with the outer city of New Orleans. METHODS This study includes 224 soil samples from 10 public housing properties and 363 soil samples from residential private properties within an 800 m radius of centroids of public housing census tracts. The Louisiana Childhood Lead Poisoning Prevention Program data from 2000 to 2005 (pre-Hurricane Katrina) was the source for 9807 children's blood Pb (μg/dL) results. Soil and blood Pb data were grouped by public housing census tracts and private residential properties. This study uses Multi-Response Permutation Procedures for statistical analysis. RESULTS Brick public properties in the city core had significantly more soil Pb contamination and higher prevalence of elevated children's blood Pb than same-aged brick public properties in the outer areas of the city. The pre-Hurricane Katrina New Orleans concentration of Pb dust in the inner-city soil displayed a median of 438 mg/kg or 3.7 times larger than Pb dust in outlying areas where the median soil Pb was 117 mg/kg (p-value=2.9×10(-15)). Also, the pre-Hurricane Katrina prevalence of children's blood Pb≥10 μg/dL was 22.9% within the inner-city compared with 9.1% in the outer areas of New Orleans (p-value=3.4×10(-74)). CONCLUSIONS Comparing the quantities of Pb dust from paint and Pb additives to gasoline, this study supports the later source as a more plausible explanation for the differences in soil Pb and children's blood Pb within public and private housing in the higher traffic congested inner-city core compared with the lower traffic congested outer areas of New Orleans. Similar patterns of environmental Pb dust contamination and childhood Pb exposure are expected in all cities.
Collapse
Affiliation(s)
- Howard W Mielke
- Department of Chemistry, Tulane University, New Orleans, LA 70118-5636, USA.
| | | | | |
Collapse
|
37
|
Nagy C, Juhász A, Beale L, Páldy A. Mortality amenable to health care and its relation to socio-economic status in Hungary, 2004-08. Eur J Public Health 2011; 22:620-4. [PMID: 21965543 DOI: 10.1093/eurpub/ckr143] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recently, research focus has returned to amenable mortality to health care, despite the decreasing trend, as it remains a significant contributor to social and economic loss due to premature death. This article assesses the trends of amenable mortality over time and, its spatial inequalities with respect to deprivation, in Hungary. METHODS An ecological analysis of mortality amenable to health care was carried out using smoothed indirectly standardized mortality ratios, calculated by full hierarchical Bayesian methods, at municipality level. The association between the spatial distribution of amenable mortality and deprivation was also assessed using a Hungarian specific deprivation index. RESULTS Trends of mortality amenable to health care were characterized by a decreasing pattern across the studied period, 1996-2008. Areas of significantly high risk of amenable mortality were identified in the North-eastern, Eastern and South-western parts of Hungary. A statistically significant association was found between amenable mortality and deprivation status in both genders. After correcting for bias due to socio-economic confounders, the patterns of areas with excess risks significantly changed. CONCLUSION Differences in deprivation alone cannot explain the spatial distribution of mortality amenable to health care. This study highlights the importance of exploring other factors (e.g. health-care system and individual life style) beyond socio-economic status, which affect health inequalities particularly for health policy makers, who are responsible for the mitigation of health disparities.
Collapse
Affiliation(s)
- Csilla Nagy
- Public Health Administration Service of Government Office of Capital City Budapest, Budapest, Hungary.
| | | | | | | |
Collapse
|