Mapping For Wellness: Then and Now - American College of ... · 10/30/2017 2 Objectives •...

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Mapping For Wellness: Then and Now

John Ritter, Ph.D.Geomatics Dept.

Oregon Institute of TechnologyKlamath Falls, OR 97601

[email protected]

Sponsors

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Objectives

• Understand how medical mapping can inform our study of disease incidence and progression.

• See how 2-dimensional regression analysis can be used to model disease incidence

• See how spatial analyses (i.e. GIS) can be used to help direct resources needed to address current health issues

Mapping Wellness: Then and Now

Downtown Salem, OR: A Mapping Example

Log in from the ArcGIS Maps ribbon to Unlock Map.


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Then

Plague: Bari, Naples 1690-1692

Mapping Wellness: Then and Now Source: Koch, Tom.

(2005); Scasciamacchia, et al. (2012)

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New York City: 1795 Yellow Fever Outbreak (Seaman, 1798)

Mapping Wellness: Then and Now Source: Altonen, Brian.

Sanitary Map for Leeds (Chadwick, 1842)

Mapping Wellness: Then and Now Credit: Wellcome Library, London

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London: 1849 Cholera Density (Grainger, 1850)

Mapping Wellness: Then and Now Source: Koch, T and Denike, K. (2007)

Soho’s Saint James ParishThe Broad Street Pump Analysis

(Snow, 1854)

Mapping Wellness: Then and Now Source: Koch, T.

and K Denike (2010); Wired.com

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Now

Risk Factors for Childhood Trauma

• Poverty

• Poor Housing / Poor Nutrition

• Unstable Families

• Foster Care

• Domestic Violence

• Substance Abuse

• Behavioral Health

• Unsafe Neighborhoods

Mapping Wellness: Then and Now Credit: John A. Kitzhaber, M.D., Apr., 2017

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Foster Care Episodes by CCO

Mapping Wellness: Then and Now Credit: John A. Kitzhaber, M.D., Apr., 2017

• Mapping Disease Incidents in Klamath Falls, OR

- Working in tandem with personnel from SLMC and SLWC, approximately 60,000 (de-identified) patient records for 2012 were obtained for the following disease categories:

- Diabetes (DM)

- Hypertension (Htn)

- Obesity (OB)

- Cholesterol (HL)

- Stroke (ST)

- Heart Disease (HD)

- Smoking (SM)

- Data were also obtained on the

total cost of care


Klamath Falls Wellness Mapping Initiative

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Klamath Falls, ORWalkability vs Disease Incident Density (#/sq-km)

Obesity

Ordinary Least Squares (OLS)

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Results• Heart Disease (HD)

- Variable significance

- HL, Walk, AvgHHInc – passed

- Spatial Autocorrelation – passed

- Normally Distributed in value – passed

- VIF – passed

- Adjusted R-Sq: 0.43

- Map of locally varying R-sq


Hot Spot AnalysisGetis-Ord Gi*

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Hot Spot Analysis: Definitions


Study Area with Neighborhood

& Feature Neighborhood

&Feature

Feature

Klamath Falls, ORHot Spot Analysis for Disease Incidence Density


Obesity

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Cluster & Outlier AnalysisAnselin Local Morans I

Cluster & Outlier Analysis: Definitions


Study Area with Neighborhood

& Feature Neighborhood

With FeatureOmitted

Feature

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There are four possible outcomes.

• Clusters:

- HH – the disease incidence in the feature area is higher than that within its neighborhood and the disease incidence of its neighborhood is higher than that of other neighborhoods in the study area

- LL – the disease incidence in the feature area is lower than that within its neighborhood and the disease incidence of its neighborhood is lower than that of other neighborhoods in the study area



Outliers:

- HL – the disease incidence in the feature area is higher than that within its neighborhood and the disease incidence of its neighborhood is lower than that of other neighborhoods in the study area.

- LH - the disease incidence in the feature area is lower than that within its neighborhood and the disease incidence of its neighborhood is higher than that of other neighborhoods in the study area.

Note that this analysis can’t be done in any other way other than in a spatial context. Even though one could sort the data in a tabular construct to find the ‘high’ or ‘low’ values, these would be the ‘global’ high/low values. This process enables one to find the ‘local’ high/low value, i.e. outliers.

The areas that show HL or LH results are almost always the most interesting.


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Klamath Falls, ORCluster & Outlier Analysis for Disease Incidence

Density


Obesity

Incident Density Hot Spot Analysis Cluster & Outlier Analysis

Obesity

Diabetes

Heart

Disease

LinkLinkLink

LinkLinkLink

LinkLinkLink

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Grouping Analysis

Results• Obesity, Diabetes, Heart

Disease


• Green areas

• highest in OB; lowest in HD

• Red areas

• highest in DM and HD

• Blue areas

• uniformly low in OB, DM, and HD

The values for each variable, for each census block group, were placed into one of three groups such that values for features within a group were most similar to each other.

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Klamath Falls Wellness Mapping: Conclusions

• The results of this analysis show that remediation efforts should be specifically directed towards the extended downtown and south-central suburbs

• Grouping analysis shows OB, DM, Htn, and HL to be ‘high’ in the extended downtown area and DM, Htn, OB, HL, and HD to be ‘high’ in the south-central area

• Based on these results a protected bike lane has been proposed that would pass through the extended downtown area


Klamath County Tobacco Retail Licensing Program

• In April 2016, Klamath County Public Health received a

grant to propose a tobacco retail licensing ordinance

throughout the county. Tobacco retail licensing (TRL),

similar to an alcohol or marijuana license, requires

retailers to obtain a license in exchange for the privilege of

selling tobacco products.

• Currently, Oregon is one of only 10 states without a TRL

ordinance.

• The following link shows the distribution of average household income across the county superimposed upon the tobacco retailer-school proximity display.

Swipe map of Schools-Tobacco Retailers/Ave HH Income


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Blue Zones Initiative - Healthy Klamath


References

• Koch, Tom. (2005). Mapping the Miasma: Air, Health, and Place in Early Medical Mapping. Cartographic Perspectives. 4-27. 10.14714/CP52.376.

• Koch, Tom and Kenneth Denike. (2007). Aaron's Solution, Instructor's Problem: Teaching Surface Analysis Using GIS. Journal of Geography. 106. 69-77. 10.1080/00221340701487608.

• Koch, Tom and Kenneth Denike: Essential, Illustrative, or … Just Propaganda? Rethinking John Snow’s Broad Street Map. Cartographica, 45(1): 19-31 (2010).

• Scasciamacchia, S., Serrecchia, L., Giangrossi, L., Garofolo, G., Balestrucci, A., Sammartino, G....Fasanella, A. (2012). Plague Epidemic in the Kingdom of Naples, 1656–1658. Emerging Infectious Diseases, 18(1), 186-188. https://dx.doi.org/10.3201/eid1801.110597.


Mapping For Wellness: Then and Now - American College of ... · 10/30/2017 2 Objectives •...

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