Assignment 1.1

[Chawarat Rotejanaprasert]

For assignment 1.1, please discuss the following questions:
1. What are possible reasons locations in epidemiological research have not been incorporated as much as other components in epidemiological research? How can spatial epidemiology be considered as an interdisciplinary science?
2. Explain why it is widely recognized that the place where an individual lives or works should be considered as a potential disease determinant and give some examples?

[Tippa Wongstitwilairoong]

Question 1: There are several possible reasons why locations have not been incorporated as much as other components in epidemiological research:
1. Data availability and quality pose challenges: Collecting location-specific data is often difficult and expensive. In many countries or regions, comprehensive databases or surveillance systems may not exist, leading to a lack of reliable location-specific information for researchers to utilize.
2. Privacy and confidentiality concerns arise: Location-based data typically involves geospatial information, raising privacy concerns. Researchers must ensure that individuals’ identities are protected when using such data, a complex process requiring careful handling.
3. Resource constraints hinder incorporation: Research at a geographical level demands additional resources, including specialized expertise, geographic information systems (GIS) tools, and funding. Many studies may lack the necessary resources to include location-specific analyses.
4. Methodological complexities present challenges: Analyzing data at a geographic level introduces complexities in study design and statistical analysis. Researchers must consider spatial autocorrelation, clustering, and other geographic-specific factors, deterring some from incorporating location in their research.
5. Lack of awareness limits adoption: Some researchers may not fully understand the potential benefits of incorporating spatial aspects into epidemiological research. They may be more comfortable with traditional epidemiological methods, unaware of how spatial information can enhance their studies.
Now, let’s discuss how spatial epidemiology can be considered an interdisciplinary science because it integrates various fields to understand disease patterns better and improve public health outcomes:
1. It involves geography, studying diseases in relation to geographic locations, population distributions, and environmental factors.
2. Collaboration with public health facilitates the implementation of targeted interventions and more efficient resource allocation.
3. Environmental sciences contribute valuable insights into how environmental exposures may contribute to disease patterns.
4. Computer science and statistics play a vital role in developing robust models and improving data analysis techniques.
5. Urban planning aids in identifying areas with higher disease burdens and designing healthier living environments.
In conclusion, spatial epidemiology represents an interdisciplinary approach, leveraging expertise from multiple fields to comprehend disease spatial patterns, identify risk factors, and design effective interventions for enhancing public health outcomes.

Question 2:It is widely recognized that the place where an individual lives or works should be considered as a potential disease determinant due to several reasons:
1. Environmental Exposures: Different geographic locations have distinct environmental characteristics, such as air quality, water sources, and exposure to pollutants or toxins. These environmental factors can directly influence health outcomes. For example, living in an area with high air pollution can increase the risk of respiratory diseases.
2. Socioeconomic Factors: Place of residence often correlates with socioeconomic status, which, in turn, affects access to healthcare, education, and economic opportunities. Socioeconomic disparities can contribute to differences in disease prevalence and outcomes. For instance, individuals living in impoverished neighborhoods may face higher rates of chronic diseases due to limited access to healthcare and healthy food options.
3. Vector-Borne Diseases: The geographical distribution of certain diseases is closely linked to the presence of disease-carrying vectors, such as mosquitoes and ticks. Geographic location plays a crucial role in determining the risk of diseases like malaria, dengue fever, and Lyme disease.
4. Climate and Weather: Climate and weather patterns can impact disease transmission and prevalence. For example, warmer temperatures and increased humidity can lead to the proliferation of certain pathogens, affecting disease patterns.
5. Access to Healthcare Facilities: The availability and proximity of healthcare facilities can significantly influence an individual’s access to medical services. Living in a remote or underserved area might result in delayed diagnosis and treatment, impacting health outcomes.
6. Social Networks and Behaviors: Geographic location can influence an individual’s social networks and behaviors, which, in turn, affect health. For example, living in an area with a high prevalence of smoking may increase the likelihood of individuals engaging in smoking behavior.
Considering the place where an individual lives or works as a potential disease determinant allows epidemiologists to identify spatial patterns, explore underlying factors contributing to disease disparities, and develop targeted interventions to improve public health in specific regions or communities.

[Boonyarat Kanjanapongporn]

Thank you for bringing many useful aspects toward the live or work places analysis.😊

[ABDILLAH FARKHAN]

I like that you raise a point about methodological complexity. Epidemiology in place variable, known as spatial epidemiology, contains a lot of complex statistical methods computed from either frequentism or Bayesianism (belief and probability) approach.

Spatial epidemiology allows us to display maps of disease risk that are leveraged for the decision-making process. These risk maps help identify areas with higher or lower disease risks, enabling policymakers to target interventions.

However, not all knowledge users, even decision-makers may fully realize and adopt the importance of statistical methods that work behind the map. When comparing different areas to find out high-risk distribution, people might use two or more common epidemiological measurements such as absolute numbers, rates, or proportions, then exhibit the number on a map to make assumption.

[Boonyarat Kanjanapongporn]

Availability of location data might be the main burden of implementing location in analysis. Healthcare unit locations would be available from the reimbursement system. However, individual historical location might not have been recorded which would not be enough in some investigations. For example, finding location of work related to lung cancer. The work location would not be simple to find in the health records and it also consumes resources when conducting the interviews. Even though, location of work is linked with social security systems, data accessibility and preciseness would have to be considered.
Secondly, data privacy would reduce the ability to use the specific location. Location might be able to specify group of people which possibly reveal their personal information. Therefore, location might have to be taken off, especially if the specifying causes the embarrassment and traumatization.

Location related health needs more than healthcare knowledge to identify common happening in that location, which possibly leads to the interesting situation. Accumulation of knowledge from interdisciplinary is necessary such as Economic to differentiate the rich and poor areas, Chemical science to explain the chemical waste from the factory which might effect to neighboring health and Zoology to identify the animal health and behavior which is plausible to disease pathogens.

Locations related to regular exposure are beneficially recorded to link with plausible cause of diseases. People are having most of their regular routine at home and work places. Therefore, environment and other people who they regularly contact with might be the factors activating diseases both contagious and chronic. For example, people who have locations of work near to electrical pylons for long periods, are more likely to develop cancer than the ones who aren’t. Living under the same house with scabies infested people might increase the chance of receiving the mite.

[Chawarat Rotejanaprasert]

Thank you all for your contributions to this fruitful discussion! While communicable diseases are widely recognized for their spatial dimension, I also would like to emphasize that place can also serve as a proxy for non-communicable diseases, which we will further explore in this course. Understanding the geographic context and environmental factors of individuals’ living and working areas offers crucial insights to study spatial patterns and identify potential risk factors associated with specific areas. This knowledge is instrumental in designing effective public health interventions and shaping policies for both communicable and non-communicable diseases. 😀

Please feel free to share any further comments or engage in more discussions! Cheers!

[chanapong]

1.One potential challenge in this situation is data availability. In Thailand, the location might receive from the 43 folders system via the reimbursement, which could not contain an actual residential area but a registered base location—leading to inaccuracy when investigating epidemiological studies. Additionally, using different approaches to obtain the location, rather than obtaining it from the registry, requires resources including budget, specialists, and technology.

Another issue is data confidentiality. Using a person’s address to pinpoint their position more precisely for epidemiologic research might reveal the owner’s sensitive information.

It is reasonable to regard spatial epidemiology as an interdisciplinary science. With the use of advanced spatial, location-based, and technologies, such as GIS and GPS, in conjunction with demographic and health data, spatial epidemiology integrates a number of scientific fields, including epidemiology and spatial science.

2.The location in which a person lives or works should be taken into account as a possible disease factor. Different regional traditional foods are linked with particular diseases. Lower incidences of hypertension can be found in Mediterranean countries with Mediterranean diets. The liver fluke, Opisthorchis viverrini, which is present in traditional uncooked freshwater fish meals, is also accountable for the higher prevalence of cholangiocarcinoma in Northeastern Thailand.

Additionally, a medical condition may be related to a different latitude. Countries with latitudes further from the equator have higher multiple sclerosis prevalence rates due to lower sun exposure.

[Chawarat Rotejanaprasert]

Thank you, Chanapong, for your comment. I agree with you that spatial epidemiology’s interdisciplinary approach, which integrates advanced technologies and data from various scientific fields, allows us to gain valuable insights into disease patterns and their spatial context. Your point about considering the impact of location on disease factors is essential, as regional dietary habits and environmental factors can significantly influence disease prevalence. This emphasizes the importance of spatial analysis in understanding health disparities across different regions. In this course, we will explore various methods to model spatial health data, quantify uncertainty, and analyze disease clusters. Look forward to engaging in fruitful discussions with you all throughout the course. Cheers!!

[ABDILLAH FARKHAN]

The decision to explore the place-related variables must be undertaken carefully and considers multiple factors such as the feasibility of data collection, the feasibility of data analysis, and data confidentiality.
1. Though the place-related variables can explain the dynamic pattern of disease transmission, this is often challenging to be included in the research milestones as it requires larger and more complex data rather than people and time variables.
2. Analysis of place-related variables requires specific skills and knowledge in geography and spatial analysis techniques. Spatial epidemiological research requires greater resources, especially in terms of technology and statistical expertise.
3. The issue of data confidentiality is also a consideration for researchers because the risk of disclosing an ‘area of concern’ can trigger public concern and has the potential to be a violation of data confidentiality.

Spatial epidemiology is an interdisciplinary science because it covers various disciplines (public health, geography, statistics, and information systems) where there are intensive interactions between these sciences during the integration of concepts, methods, analysis, and knowledge synthesis.

It is true to recognize that place where people live is one of the determinants of diseases. The place variable can be a representation of environmental factors (which account for 40% of the health status) and healthcare facilities (which account for 10% of the health status), as described in the theory mentioned by Henrik L. Blum. The easiest example is the transmission of Dengue Haemorrhagic Fever, a vector-borne disease that occurs in urban areas, slum spots, and dense residential areas with high population density due to the impact of urbanization and human mobilization. People’s dependence on artificial clean water consumption may become a risk, particularly when their water management method risks becoming a breeding ground for mosquitoes.

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