Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of...

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Spatial Perspectives on Health and Social Issues Sara McLafferty University of Illinois SPACE Workshop, Ohio State University, July 13, 2005

Transcript of Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of...

Page 1: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Spatial Perspectives on Health and Social Issues

Sara McLaffertyUniversity of Illinois

SPACE Workshop, Ohio State University, July 13, 2005

Page 2: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

What is a ‘spatial perspective’?

Why does it matter for understanding health?

Page 3: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Biomedical perspective

• Health as an individual property• Risk factors and behaviors• Methodologies

– Case-control– Longitudinal

Page 4: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

But, this is changing

• ‘New’ public health• Health as socially constructed

– Contextual factors• Health inequalities

Page 5: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Spatial Concepts

• Uneven spatial distribution• Tobler’s first law

– Distance/proximity• Place• Scale

Page 6: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Three examples

• Health inequalities -- low birthweight• Environmental health• Access to health care• Sample spatial analysis lab

Page 7: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Health Inequalities

• Low Birthweight– Infants born weighing less than 2500g at

birth– Linked to infant mortality, health and

developmental problems after birth– A potent indicator of infant, maternal and

community health• Focus on Brooklyn, NY

Page 8: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Low birthweight infants, Brooklyn NY, 2000

Page 9: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Kernel Estimation

λ(s) = Σ 1/τ k ( di /τ)di<τ

Where:

λ(s) = est. density at grid point sdi = distance from point i to grid point sτ = bandwidthk( ) = kernel function

Page 10: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data
Page 11: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

LBW Density, 1.0 mile bandwidth

Page 12: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

LBW Density, 2.0 mile bandwidth

Page 13: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Births ‘constrain’ the spatial distribution of LBW

Page 14: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Smoothed LBW proportion, 2000, 1.5 mi bandwidth

Page 15: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Different groups have different residential locations: Density of Pakistani and Mexican mothers in Brooklyn, 2000

Page 16: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Residential density affects geographical access to prenatal clinics

Page 17: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Are there spatial clusters of high LBW?

Page 18: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Analyzing changes in health through space and time

• Change in low birthweight• Components of change:

– Compositional– Contextual

• Combine spatial and statistical methods– GEODA – freeware for exploratory spatial

analysis

Page 19: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Decompose sources of change in LBW into:

• Change in population composition –ethnicity, race, age, education

• Change in financial coverage –Medicaid

• Change in risk behaviors – smoking, drug use, alcohol consumption

Page 20: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Smoothed LBW, 1990

Page 21: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Smoothed LBW, 2000

Page 22: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data
Page 23: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Compositional Change

Page 24: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data
Page 25: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Exploring the patterns (GEODA)

• Linking and brushing• Parallel coordinate plots

Page 26: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Spatial Brushing --GEODA

Page 27: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Spatial Analysis and Environmental Health

Page 28: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Using GIS to characterize neighborhood environments

Miranda et al (2002) Envir Health Perspectives

Page 29: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Hazardous Facilities in Urbana, IL

From: US EPA, Toxics Release Inventory

Page 30: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data
Page 31: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Measuring ‘exposure’ to environmental hazards/resources• Proximity measures

– Number/density– Distance

• Behavioral measures

Page 32: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Density measure: Store availability and diabetes (Horowitz et al, 2004)

18.942.2More undesirable stores than desirable stores

23.850.3At least 1 undesirable store

30.226.0At least 1 desirable store

Upper East Side (%)East Harlem (%)Census Block Store Availability

From: Horowitz et al (2004) Barriers to buying healthy foods for people with diabetes. AJPH, 94(9), 1549-54. Compared the availability of stores selling ‘desirable’ and ‘undesirable’ products between high diabetes and low diabetes neighborhoods in NYC.

Page 33: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data
Page 34: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data
Page 35: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Obesity and Neighborhood Characteristics

Burdette H, Whitaker R “Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children. Prev. Med, 2004, 38(1),57-63.

BMI>90% BMI<90%

Playground dist 0.37 0.41

Fast food dist 0.68 0.71

Page 36: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Human activity patterns underpin environmental exposures: Space-time prism

Page 37: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Human activity patterns underpin environmental exposures

From: Kai Elgethun, Richard A. Fenske, Michael G. Yost, and Gary J. PalciskoTime-Location Analysis for Exposure Assessment Studies of Children Using a Novel Global Positioning System InstrumentEnvir Health Perspec 111(1), 2003.

Page 38: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Spatial analysis and health care access

Page 39: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Use of kernel estimation in exploring access to health care

• Density of health care facilities• Useful in urban context• Health care density can be linked to

population health data– Example – Brooklyn, prenatal clinics

Page 40: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data
Page 41: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data
Page 42: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

0.8411YesJam21

DensEducMedicaidEthnicityAge

Page 43: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Geographical Access to Clinics for Immigrant Mothers

31

84

94

61

% Medicaid

3.7

14.1

9.6

9.4

Late PNC %

.17.27Russia

.21.31Pakistan

.76.79Mexico

.97.92Jamaica

Median density

Average density

Country of Birth

Page 44: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data
Page 45: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Summary

• Space matters!• Health inequalities patterned over space• Exposures to disease agents and

environmental hazards and resources vary over space and relate to activity patterns

• Location and distance affect health care access and use

Page 46: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Thoughts on teaching

• Spatial concepts relevant in many social sciences

• Student backgrounds• Use local data and issues in labs

– many good data sources– data quality and access

• Critical perspective on methods

Page 47: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Sample lab assignment

• Use GEODA to explore spatial patterns of late-stage breast cancer in Illinois

• Late-stage cancer – not localized, regional spread

• Disease not detected early• May be associated with poor access to

screening and preventive health care

Page 48: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

• Data – percent late-stage breast cancer by county

• Spatial weights – ‘Rook’

Page 49: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Percent late-stage breast cancer

Identify highest and lowest rate counties

Record numbers of cases in each high/low rate county

Page 50: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Note that counties with highest and lowest rates tend to have small numbers of cases – rates are unstable due to small numbers

One way to deal with this is to compute spatially smoothed rates –rate for a ‘spatial window’ around each county

Discuss the spatial pattern

What are the advantages of smoothed vs. non-smoothed maps?

Page 51: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Are high late-stage counties more likely not to have hospital facilities?

The yellow, selected features are counties that lack hospitals.

This histogram suggests little association between high late-stage cancer and absence of hospital facilities

Page 52: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

References Albert D, Gesler W and Levergood B (eds) (2000) Spatial Analysis, GIS and Remote Sensing Applications in the Health Sciences. Chelsea MI: Ann Arbor Press.

Anselin L. (2003) GEODA 0.9 Users Guide. Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. https://geoda.uiuc.edu/.

Bailey T and Gatrell A (1996) Interactive Spatial Data Analysis. New York: John Wiley.

Cromley E (2003) GIS and Disease. Annual Review of Public Health, 24:7-24.

Cromley E. and McLafferty S. (2002) GIS and Public Health, New York: Guilford.

Dolinoy D, Miranda M (2004)GIS modeling of air toxics releases from TRI-reporting and non-TRI-reporting facilities: impacts for environmental justice.Environ Health Perspect. 2004 Dec;112(17):1717-24.

Kawachi I and Berkman L (2003) Neighborhoods and Health. New York NY: Oxford University Press.

Krieger N et al (2003) Geocoding and measurement of neighborhood socioeconomic position: a US perspective. In Kawachi and Berkman, pp. 147-178.

Page 53: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

References, cont.McLafferty S (2003) GIS and Health Care. Annual Reviews of Public Health, 24:25-42.

S. McLafferty and S. Grady (2005) Immigration and Geographical Access to Prenatal Clinics in Brooklyn, NY: A Geographic Information Systems Analysis,” American Journal of Public Health, 95(4), 638-640

Nuckolls JR, Ward MH, Jarup L (2004)Using geographic information systems for exposure assessment in environmental epidemiology studies.Environ Health Perspect. Jun;112(9):1007-15

Richards T, Croner C (1999) Special issues of the Journal of Public Health Management and Practice. Mar, Jul, 5(2) and 5(4).

Rushton G. (1998) GIS in public health, web site. http://www.uiowa.edu/~geog/health/index.html

Waller L, Gotway C (2004) Applied Spatial Statistics for Public Health Data. New York: Wiley.

Page 54: Spatial Perspectives on Health and Social Issues · Spatial Analysis Laboratory, University of Illinois, Urbana-Champaign IL. . Bailey T and Gatrell A (1996) Interactive Spatial Data

Selected health data web sites

• Federal– http://www.cdc.gov/reproductivehealth/GISAtlas/index.htm– http://www3.cancer.gov/atlasplus/index.html– http://www.cdc.gov/ncipc/wisqars/

• Illinois:– http://www.idph.state.il.us/about/epi/cancer.htm– http://www.idph.state.il.us/health/statshome.htm

• Ohio:– http://dwhouse.odh.ohio.gov/datawarehousev2.htm

• New York:– http://www.nyc.gov/html/doh/html/home/home.shtml– http://www.health.state.ny.us/statistics/

• Los Angeles– http://lapublichealth.org/dca/