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Ganasegeran K, Abdul Manaf MR, Safian N, Waller LA, Mustapha FI, Abdul Maulud KN, Mohd Rizal MF. How Socio-economic Inequalities Cluster People with Diabetes in Malaysia: Geographic Evaluation of Area Disparities Using a Non-parameterized Unsupervised Learning Method. J Epidemiol Glob Health 2024; 14:169-183. [PMID: 38315406 PMCID: PMC11043261 DOI: 10.1007/s44197-023-00185-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/23/2023] [Indexed: 02/07/2024] Open
Abstract
Accurate assessments of epidemiological associations between health outcomes and routinely observed proximal and distal determinants of health are fundamental for the execution of effective public health interventions and policies. Methods to couple big public health data with modern statistical techniques offer greater granularity for describing and understanding data quality, disease distributions, and potential predictive connections between population-level indicators with areal-based health outcomes. This study applied clustering techniques to explore patterns of diabetes burden correlated with local socio-economic inequalities in Malaysia, with a goal of better understanding the factors influencing the collation of these clusters. Through multi-modal secondary data sources, district-wise diabetes crude rates from 271,553 individuals with diabetes sampled from 914 primary care clinics throughout Malaysia were computed. Unsupervised machine learning methods using hierarchical clustering to a set of 144 administrative districts was applied. Differences in characteristics of the areas were evaluated using multivariate non-parametric test statistics. Five statistically significant clusters were identified, each reflecting different levels of diabetes burden at the local level, each with contrasting patterns observed under the influence of population-level characteristics. The hierarchical clustering analysis that grouped local diabetes areas with varying socio-economic, demographic, and geographic characteristics offer opportunities to local public health to implement targeted interventions in an attempt to control the local diabetes burden.
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Affiliation(s)
- Kurubaran Ganasegeran
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
- Clinical Research Center, Seberang Jaya Hospital, Ministry of Health Malaysia, 13700, George Town, Penang, Malaysia.
| | - Mohd Rizal Abdul Manaf
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Nazarudin Safian
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Feisul Idzwan Mustapha
- Public Health Division, Perak State Health Department, Ministry of Health Malaysia, 30000, Ipoh, Perak, Malaysia
| | - Khairul Nizam Abdul Maulud
- Earth Observation Centre (EOC), Institute of Climate Change, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor Darul Ehsan, Malaysia
- Department of Civil Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor Darul Ehsan, Malaysia
| | - Muhammad Faid Mohd Rizal
- Earth Observation Centre (EOC), Institute of Climate Change, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor Darul Ehsan, Malaysia
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Cénat JM, Dromer É, Darius WP, Dalexis RD, Furyk SE, Poisson H, Mansoub Bekarkhanechi F, Shah M, Diao DG, Gedeon AP, Lebel S, Labelle PR. Incidence, factors, and disparities related to cancer among Black individuals in Canada: A scoping review. Cancer 2023; 129:335-355. [PMID: 36436148 DOI: 10.1002/cncr.34551] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Canada, two of five individuals will be diagnosed with cancer in their lifetime and one in four will die from this disease. Given the disparities observed in health research among Black individuals, we conducted a scoping review to analyze the state of cancer research in Canadian Black communities regarding prevalence, incidence, screening, mortality, and related factors to observe advances and identify gaps and disparities. METHODS A comprehensive search strategy was developed and executed in December 2021 across 10 databases (e.g., Embase). Of 3451 studies generated by the search, 19 were retained for extraction and included in this study. RESULTS Studies were focused on a variety of cancer types among Black individuals including anal, breast, cervical, colorectal, gastric, lung, and prostate cancers. They included data on incidence, stage of cancer at diagnosis, type of care received, diagnostic interval length, and screening. A few studies also demonstrated racial disparities among Black individuals. This research reveals disparities in screening, incidence, and quality of care among Black individuals in Canada. CONCLUSIONS Given the gaps observed in cancer studies among Black individuals, federal and provincial governments and universities should consider creating special funds to generate research on this important health issue. PLAIN LANGUAGE SUMMARY Important gaps were observed on research on cancer among Black communities in Canada. Studies included in the scoping review highlights disparities in screening, incidence, and quality of care among Black individuals in Canada.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.,Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada.,University of Ottawa Research Chair on Black Health, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Élisabeth Dromer
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Wina Paul Darius
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Hannah Poisson
- Faculty of Science, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Muhammad Shah
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Guangyu Diao
- Faculty of Arts and Science, McGill University, Montreal, Quebec, Canada
| | | | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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Zolitschka KA, Razum O, Sauzet O. Using agent-based modelling to test hypotheses on the role of neighbourhood social mechanisms in the development of small-area health inequalities. J Epidemiol Community Health 2022; 76:jech-2021-218310. [PMID: 35568396 DOI: 10.1136/jech-2021-218310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Small-area health inequalities may originate from differentials in the spatial distribution of environmental stressors on health. The role played by neighbourhood social mechanisms on small-area health inequalities is difficult to evaluate. We demonstrate that agent-based modelling (ABM) is a useful technique to overcome existing limitations. It allows testing hypotheses that social contagion has the potential to modify the effects of environmental stressors by reducing or increasing small-area health inequalities. METHODS Parameters defining the strength of the effect of social contagion on health behaviour were used together with a stochastic model to obtain for every year the health outcome of every agent based on health the previous year, environmental stressors and health behaviour. Unequal spatial distribution of stressors was operationalised with spatial correlation structure. We measured changes in health inequalities using parameters of the spatial correlation structure of health after 10 years. In a further round of simulations, social contagion depended on the environmental stressors. RESULTS A social contagion mechanism led to a reduction of small-area health inequalities together with an increase in the spatial reach of the effect of environmental stressors. An association between environmental stressor and social contagion mechanism led to a stronger localisation of the effect of environmental stressors. CONCLUSIONS Hypotheses about the role of neighbourhood social mechanisms can be tested using ABM. The respective models provide a better understanding of mechanisms in the causal chain between environmental stressors and health inequalities. This can pave the way to the development of a new type of neighbourhood-based intervention informed by social mechanisms.
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Affiliation(s)
- Kim Alexandra Zolitschka
- Epidemiology & International Public Health, Bielefeld University, Bielefeld School of Public Health (BiSPH), Bielefeld, Germany
| | - Oliver Razum
- Epidemiology & International Public Health, Bielefeld University, Bielefeld School of Public Health (BiSPH), Bielefeld, Germany
| | - Odile Sauzet
- Epidemiology & International Public Health, Bielefeld University, Bielefeld School of Public Health (BiSPH), Bielefeld, Germany
- Data Analysis Group, Department of Business Administration and Economics, Bielefeld University, Bielefeld, Germany
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Sauzet O, Breiding JH, Zolitschka KA, Breckenkamp J, Razum O. An ego-centred approach for the evaluation of spatial effects on health in urban areas based on parametric semi-variogram models: concept and validation. BMC Med Res Methodol 2021; 21:112. [PMID: 34074260 PMCID: PMC8170921 DOI: 10.1186/s12874-021-01300-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/28/2021] [Indexed: 12/01/2022] Open
Abstract
Background Neighbourhood is a complex structure but of high relevance for health. Its operationalisation remains however a challenge.The aim of this work is to present a new application of the use of semi-variograms as an approach for the evaluation of spatial effects on health. For this, we propose to estimate two parameters providing a measure of an average neighbourhood or spatial effect at city level without having to predefine any notion of physical neighbourhood. Methods We present the statistical method to estimate the parameters of this correlation neighbourhood by fitting an exponential model to the empirical semi-variogram at short distances. With a simulation study, we show for which sample size and sampling density the method performs well and illustrate how to use the method with data from a birth cohort using the outcome birthweight. Results For small sample sizes (500) the method provides reliable estimates if the density of observations is high. For larger sample sizes other parameters influencing the quality of estimates are the maximal distance at which the semi-variograms are estimated. Conclusions Given the complexity of spatial scales relative to neighbourhood spatial processes, our approach offers the possibility to incorporate existing approaches to the operationalisation of neighbourhood in quantitative analyses while providing a measure of the part of health inequalities which could be possibly due to unmeasured spatial exposure as well as a measure of their spatial scale.
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Affiliation(s)
- Odile Sauzet
- Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany. .,Centre for statistical consulting, Bielefeld University, Bielefeld, Germany.
| | - Janne H Breiding
- Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Kim A Zolitschka
- Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jürgen Breckenkamp
- Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
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