part 1: developing medix and medclass
DESCRIPTION
Part 1: Developing MEDIx and MEDClass. Richard Mitchell (PI), Niamh Shortt, Jamie Pearce, Elizabeth Richardson, Terry Dawson. Funding. NERC Environment and Human Health programme Supported by:. NERC EA Defra MOD MRC. The Wellcome Trust ESRC BBSRC EPSRC HPA. - PowerPoint PPT PresentationTRANSCRIPT
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Part 1: Developing MEDIx and MEDClass
Richard Mitchell (PI), Niamh Shortt, Jamie Pearce, Elizabeth Richardson, Terry Dawson
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Funding
• NERC Environment and Human Health programme
• Supported by:• NERC• EA• Defra• MOD• MRC
• The Wellcome Trust• ESRC• BBSRC• EPSRC• HPA
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Exploratory award: Multiple environmental classification of areas for researching health inequality
Objectives:
1) To develop a measure of health-related multiple physical environmental deprivation for the UK (small-area level)
1) To determine its utility in researching spatial inequalities in health
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Outline
• Objective 1:To develop a measure of health-related multiple physical environmental deprivation for the UK (small-area level)
• WHY?
• HOW?• Over-arching principles• Identification of health-relevant dimensions of
environmental deprivation• Dataset acquisition and processing• Construction of the summary measures:
• Index• Classification
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Why?
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Spatial health inequalities
• Widening spatial inequalities in health
Why?
Legend
UK_PARLCONS
SMR_allmort
0.693513 - 0.842089
0.842090 - 0.894062
0.894063 - 0.936554
0.936555 - 0.976199
0.976200 - 1.015046
1.015047 - 1.065584
1.065585 - 1.125754
1.125755 - 1.198214
1.198215 - 1.312202
1.312203 - 1.478902
Standardised mortality rate 1999-2003
150
70
100
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74
75
76
77
78
79
80
81
1 2 3 4 5 6 7 8 9 10
Poverty group
Spatial health inequalities
• Socioeconomic deprivation ‘explains’ much:
• But, significant proportion remains unexplained…
• … role of the physical environment?• How would we investigate this?
• How would we measure ‘the physical environment’?
Increasing affluenceIn
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Why?
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Measures of Multiple Socioeconomic Deprivation:• Carstairs score• Indices of Multiple Deprivation
Socioeconomic deprivation
• Socioeconomic deprivation:• Multi-dimensional, e.g.:
• Poverty• Housing conditions• Material possessions• Employment
Why?
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Measures of Multiple Physical Environmental Deprivation?
Environmental deprivation
• Physical environmental deprivation:• Multi-dimensional, e.g.:
• Air pollution• Climate• Radiation• Greenspace
Why?
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How?
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Over-arching principles
•Health-relevant•Scientifically credible•User-friendly and useful•Repeatable
(Briggs, 2000; Corvalán et al., 2000; Nardo et al., 2008; Sol et al., 1995)
How
?
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Development stages
1. Identify health-relevant dimensions of physical environmental deprivation
2. Identify and acquire datasets
3. Render to same geography
5. Test for associations with health outcomes
4. Develop summary measures
How
?
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Identify dimensions of environmental deprivation
1. Scoping review• Grey literature• Reference databases
Long list
2. Systematic literature search• Appraisal of health-relevance:
• Methodological rigour• Strength of association with health• Prevalence of health outcome• > 10% UK population exposure
‘Wish list’
How
?
Air pollutants Climate (temperature) Solar UV radiation Greenspace Industrial facilities Drinking water quality Noise ELF radiation (power lines) RF radiation (transmitters) Radon Individual industrial
pollutants Nuclear facilities Contaminated land Food environment Accidents
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Evidence for wish-listed factorsH
ow
?
Wish list dimensions Detrimental? Beneficial? Air pollutants Climate (temperature) Solar UV radiation Greenspace Certain industrial facilities Drinking water quality Noise
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Dataset acquisition and processingH
ow
?
UVB index (1991-2000)
6.7 - 9.2
9.3 - 10.2
10.3 - 11.2
11.3 - 12.1
12.2 - 13.2
Wish list dimensions Air pollutants
National Atmospheric Emissions Inventory (NAEI) 1 km grids
Climate (temperature)Met Office, 5 km grids
Solar UV radiationUVB Index (Mo & Green, 1974) calculated from Met Office cloud cover data & latitude
GreenspaceGeneralised Land Use Database (GLUD) CORINE Land Cover Data (modelled %)
Industrial facilitiesEuropean Pollutant Emission Register (EPER);facility type and grid ref
Drinking water quality Noise
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Industrial facilities (2001 and 2002)# Waste management sites
!( Metal processing/production plants
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Summary of environmental dataH
ow
?
Geography = UK CAS wards:• n = 10,654 (in 2001)• Average population ~5,500
Detrimental factors:• Air pollutants• Proximity to industry• Cold climate
Beneficial factors:• Solar UV radiation• Greenspace availability
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Cold, Clean
and Green
Alternative summary measuresH
ow
?
1. An index• a scale or ranking• increasing value reflects
increasing environmental ‘burden’
2. A classification • a label or category• groups areas that share the
same specific types of environmentComplementary uses:
• Dose-response effect?• Health consequences of specific
combinations of environments?
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The IndexH
ow
?
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Constructing the index H
ow
?
• Aim:• To represent relative ‘level’ of health-related environmental deprivation• To reflect both detrimental and beneficial environments• Unambiguous and easy to interpret
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• How to identify better or worse environments?
• A range of options… simplicity guided our choice:
1. Identify wards exposed to each environmental factor at a ‘detrimental’ (or ‘beneficial’) level
2. Index = balance of number of detrimental to number of beneficial exposures experienced by each ward
Constructing the index H
ow
?
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Constructing the index H
ow
?
• Effect thresholds?• Arbitrary decision: ‘health-relevant’ level =
highest exposure quintile
(i.e., most exposed 20% of wards in the UK)
0.0
5.1
.15
.2D
ensi
ty
10 15 20 25(first) PW_pm10Increasing PM10
No.
of
ward
s
‘health-relevant’ exposure
1 2 3 4 5
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Calculation for each ward:
Detrimental exposures: Score Highest air pollution (any pollutant)? +1 or 0
Highest proximity to industry? +1 or 0
Coldest temperatures? +1 or 0
Beneficial exposures: Highest greenspace availability? -1 or 0
Highest UV levels? -1 or 0
Multiple Environmental Deprivation Index (MEDIx)
-2 to +3
Constructing the index H
ow
?
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Constructing the index III
e.g. Rotherhithe, East End of London:
Detrimental exposures: Score Highest air pollution? +1
Highest proximity to industry? +1
Coldest temperatures? 0
Beneficial exposures: Highest greenspace availability? 0
Highest UV levels? 0
MEDIx +2
How
?
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MEDIx score
-2
-1
0
+1
+2
+3
0 150 30075km
Multiple Environmental Deprivation Index (MEDIx)H
ow
?
MEDIx score -2 =
Least environmentally deprived wards (‘healthiest’ places, theoretically)
MEDIx score +3 =
Most environmentally deprived wards (‘unhealthiest’ places)
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The ClassificationH
ow
?
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Cold, Clean
and Green
Constructing the classification H
ow
?
• Aim:• Identify specific types of health-relevant
environment• Group wards that share these
environmental characteristics
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Constructing the classification H
ow
?
Environmental dimensions Air pollutants
Climate (temperature)
Solar UV radiation
Greenspace
Certain industrial facilities
Data reduction
(PCA)
Two-step classificatio
n
Evaluate solutions
Classification
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MEDClass cluster
1 London and London-esque
2 Industrial
3 Mediocre Green Sprawl
4 Fair-weather Conurbations
5 Cold, Cloudy Conurbations
6 Isolated, Cold and Green
7 Sunny, Clean and Green
0 150 30075km
Multiple Environmental Deprivation Classification (MEDClass)H
ow
?
Clusters = distinct ‘types’ of environment
Wards in cluster 7:• most greenspace• high UV levels• low air pollutant levels
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Conclusion
• Yes, it is possible to construct summary measures of multiple environmental deprivation.• Rigorous, well-documented process• Limitations, room for improvement…
• Arbitrary decisions• Data limitations
• Part 2: Testing the utility of MEDIx and MEDClass…
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Any questions?
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References
• Briggs D, 2000, "Methods for building environmental health indicators", in Decision-making in environmental health Eds C Corvalán, D Briggs, G Zielhuis (E & FN Spon, London) pp 57-76
• Corvalán C, Briggs D, Kjellström T, 2000, "The need for information: environmental health indicators", in Decision-making in environmental health Eds C Corvalán, D Briggs, G Zielhuis (E & FN Spon, London) pp 25-56
• Nardo M, Saisana M, Saltelli A, Tarantola S, Hoffman A, Giovannini E, 2008 Handbook on constructing composite indicators: Methodology and user guide. EC Joint Research Centre & OECD Statistics Directorate and the Directorate for Science, Technology and Industry (OECD Publishing, Paris)
• Mo T, Green AES: A climatology of solar erythema dose. Photochem Photobiol 1974, 20:483-496.
• Shaw M, Davey Smith G, Dorling D, 2005, "Health inequalities and New Labour: how the promises compare with real progress" BMJ 330 1016-1021
• Sol V M, Lammers P E M, Aiking H, de Boer J, Feenstra J F, 1995, "Integrated environmental index for application in land-use zoning" Environmental Management 19 457-467