Spatial Epidemiology: GIS and Geostatistical Applications for Public Health
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1 Spatial Epidemiology: GIS and Geostatistical Applications for Public Health Thomas J. Stopka, PhD, MHS Maternal, Child and Adolescent Health, CDPH, University of California, Davis Sacramento Area GIS Users Group Symposium Sacramento, CA November 27, 2012
2 Overview Epidemiology / Public Health **Spatial epidemiology** **GIS applications** for public health Infant nutrition in Africa: Social mapping Pharmacy availability: Hot-spot analysis Crime and HIV prevention: Areal interpolation HIV prevention and pharmacy use: Spatial analysis Women, Infants and Children (WIC): Hot-spot clusters Interactive online maps and future directions
3 ??? Public Health? Epidemiology?
4 Do you speak Greek? Epidemiology: "the study of what is upon the people epi = upon, among demos = people, district logos = study, word, discourse
5 What is epidemiology? Epidemiology: The study of how diseases (health related states) are distributed in populations and the factors that influence or determine this distribution Source: Gordis, 3rd Edition
6 What is spatial epidemiology?
7 Example 1: Social Mapping** and Infant Feeding What foods are given to infants and when? Nyeri, Kenya
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11 Example 2: Pharmacy Availability What factors are associated with the presence of pharmacies? - Los Angeles
12 Background In the United States 56,000 people are newly diagnosed with HIV/year More than 14,000 people with die with AIDS/year In California >3,000 people are diagnosed with AIDS/year Pharmacy syringe sales can help to decrease HIV risk among injection drug users (IDUs)
13 Pharmacies and OTC Syringe-Selling Pharmacies in LA County, 2008
14 Results: Cluster Analyses Low No. of Pharmacies Young Population (Percent<18 Years) = Hot Spot (p<0.05) = Cold Spot (p<0.05) Poor Population (Percent Received Public Assistance)
15 Results: Pharmacy Availability Pharmacy availability associated with population size, age, and sociodemographic characteristics **Cluster analyses** identified Regions with high and low pharmacy availability Clusters of pharmacies that were distant from clusters of younger and poorer populations
16 Example 3: Pharmacy Syringe Sales and Crime Is crime associated with OTC syringe-selling pharmacies? -Los Angeles
17 LAPD Reporting Districts and OTC Syringe-Selling Pharmacies
18 Problem: Different Units of Analysis Crime and Pharmacies LAPD reporting district level Sociodemographic variables Census tract level Need data in same unit of analysis
19 Areal Interpolation: Spatial Kriging Percent Unemployed Census Tracts Percent Unemployed in LAPD RDs Prediction Surface LAPD RDs Overlaid
20 Crime Rates per 1,000 Crime Rates in Police Districts With OTC Syringe Sales (n=94) OTC Sales Began All Crime Rate Econ. Mot. Crime Rate Violent Crime Rate Nuisance Crime Rate Other Crime Rate 0 Jan-June, 2006 July-Dec, 2006 Jan-June, 2007 July-Dec, 2007 Jan-June, 2008 July-Dec, 2008 Semiannual Periods
21 Results: Syringe Sales and Crime Age, race, and percent unemployed were positively associated with overall crime rates OTC pharmacy syringe sales were NOT associated with increases in crime in LAPD reporting districts **GIS and areal interpolation / spatial Kriging** allowed us to do this study!
22 Example 4: Pharmacy use and HIV prevention Who uses OTC syringe-selling pharmacies? - San Francisco
23 Results: Syringe source during past 6 months (n=563) Syringe Source Percentage Pharmacy 33% Needle Exchange 84% Unauthorized Source 65% Secondary Syringe Exchange 52%
24 Adjusted Prevalence Ratio (95% CI) Factors Associated with OTC Pharmacy Syringe Purchase African American IDUs Older IDUs Meth IDUs IDUs with Unsafe Syringe Sources
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26 South of Market Bayview
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28 Results: Pharmacy use and HIV Prevention OTC pharmacy syringe purchase among IDUs was associated with race, drug of choice, and use of unsafe syringe sources **Spatial analyses** highlighted neighborhoods that need improved access to safe syringes and HIV prevention
29 Example 5: Targeting Women Infant and Children (WIC) Nutrition Services Where are clusters of WIC eligible nonparticipants (ENPs)? California
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31 Hot-Spot Clusters: Density of ENPs 2010
32 Local Hot-Spots
33 Results The 5 geoprocessing steps for **hot-spot analyses** provided a systematic, rigorous, and objective approach State level hot-spot analyses helped locate statistically significant clusters of WIC eligible women in key CA counties County level hot-spot analyses allowed us to locate clusters of highest WIC need on the local neighborhood level Findings helped inform WIC program and funding decisions on the state and local level
34 Interactive Maps and Future Directions Can we put helpful GIS and spatial analysis tools in the hands of stakeholders? California
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37 2-Mile WIC Center Buffers
38 Distance
39 Interactive Maps on Smartphones and Tablets
40 Review Epidemiology / Public Health **Spatial epidemiology** **GIS applications** for public health Infant nutrition in Africa: Social mapping Pharmacy availability: Hot-spot analysis Crime and HIV prevention: Areal interpolation HIV prevention and pharmacy use: Spatial analysis Women, Infants, and Children: Hot-spot clusters Interactive online maps and future directions
41 Public Health Impact Will science inform policy?
42 Public Health Impact Will science inform policy? Potential interventions Work with public health officials Target locations for new services Inform community members & policymakers Use spatial analysis tools for surveillance Health service access (pharmacies, WIC centers) Assess risky behavior, disease spread across populations Assess spatial relationships for health outcomes
43 Thank you! Questions? Thomas J. Stopka, PhD, MHS Maternal, Child and Adolescent Health, CDPH, University of California, Davis Sacramento Area GIS Users Group Symposium Sacramento, CA November 27, 2012
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