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?

[Ching To Chung]

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?

As mentioned in the paper, I think two of the major reasons is the availability of data and the appearance of easy-to-use GIS systems.

First, there is limited high-quality geographic data, which makes it difficult to conduct GIS analysis. I speak of this from personal experience since I have used GIS before, and when conducting analysis in rural areas or middle east countries, I often struggle to find shapefiles and a complete region code database. Many countries also lack data on disease and residence of individuals. For example, one of the papers mentioned that not all countries have a cancer registry, which becomes a barrier to conducting ecological studies. Moreover, we only started adopting electronic health records in the last few decades. Before that, most data is only available in paper form, meaning there is substantial difficulty in retrieving data and conducting statistical analysis using computers.

Second, GIS systems that are easy to use have only emerged relatively recently. I have tried using GIS and they are powerful tools for analysis. They have statistical packages integrated and could handle complex what-if questions with lots of conditionals. With the right data, I could get my answer in a few clicks. However, I imagine a few decades ago, GIS system may have been a lot more difficult to use. Statistical packages may not have been available, requiring researchers to write their own codes from scratch. The need for so much manual labour may have barred researchers from conducting spatial research, as compared to other quantitative and statistical analysis which could be done easily on spreadsheets like Excel.

Spatial Epidemiology could be considered as an integrated science since it incorporates the ideas and principles of lots of discipline. The fundamental usage of spatial epidemiology was rooted in public health when John Snow mapped cholera cases in London, finding links of disease with water. Spatial epidemiology uses statistical methods such as Bayesian analysis and Moran’s I for spatial autocorrelation. It uses the tools of GIS from geography, studying the relationship between people and the environment. It also uses the idea of environmental science and social science, since it considers pollution and socioeconomic status as risk factors and determinants of disease.

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?

It is because environmental factors could be important risk factors to a disease. Example given in the papers were the high incidence of hepatoma in Asia found to be linked to hepatitis B, higher risks of cancer when working in the furniture industry, risk of cancers when living close to an overhead power line, et cetera. These risks are often unknown or undiscovered until the relevant investigation is done. These studies may not reveal a definite causal relation, but they answer important public health questions, such that the public will know whether they have increased risk for a certain disease when they are exposed to a specific thing. I could think of a few more examples from where I live. For example, miners and construction workers in China show a much higher prevalence of COPD and lung cancer. This is because they are constantly exposed to ash, dust, and asbestos in their work environment. In Hong Kong, a building had a serious outbreak of SARS in 2003. When investigating why the virus spread so quickly, researchers found that this is due to the building design, where virus particles could travel easily from floor to floor in the central air vent. These examples get to show that our working and living environment could drastically influence our health and disease.

[Soe Htike]

1. Reasons for Limited Incorporation of Locations in Epidemiological Research and the Interdisciplinary Nature of Spatial Epidemiology
The lack of attention to location in epidemiological research has historical reasons. Collecting and analyzing spatial data has been challenging, and early studies were limited by the lack of tools and methods to capture and interpret geographic information accurately. It was easier to focus on individual attributes (person) and temporal trends (time) as these aspects were simpler to quantify and analyze with the available technology.
Spatial components have not been used much because it’s hard to take into account differences in space and the influence of many environmental factors. Traditional ways of studying illnesses were not good at dealing with the complicated patterns of space data, so people preferred to work with easier information. Also, there were problems with keeping space data private and secret, which made it harder for researchers to study geography.
Spatial epidemiology is a mix of different fields that helps us understand how health issues are connected to specific places. It combines geography, statistics, environmental science, sociology, and public health. This approach allows us to study how diseases are spread out in different areas and what causes them. We use GIS and spatial statistics to visualize and analyze the data effectively. By using knowledge from different areas, spatial epidemiology can deal with complex health problems that result from many different factors, such as environmental exposures and economic conditions. This approach not only improves the depth of health research but also helps in creating targeted public health plans and policies.

2. Importance of Place as a Disease Determinant
It’s widely known that where a person lives or works can affect their health. The physical environment, like air and water quality, access to green spaces, and exposure to pollutants, can directly affect a person’s health. For example, people in areas with a lot of air pollution are more likely to have breathing and heart problems. Living near factories or places that handle hazardous waste can mean being around harmful substances, which can lead to higher rates of certain cancers and other health problems.
Living in low-income neighborhoods may lead to higher rates of chronic diseases because people might not have easy access to healthy food or medical care. Also, communities where people get along well and support each other may help reduce health risks. On the other hand, communities with weak support systems could make health risks worse.
Cultural norms and practices specific to different regions can influence health behaviors and outcomes. For instance, dietary habits, physical activity levels, and smoking rates can vary significantly across regions, leading to differences in disease prevalence. The design of urban spaces and transportation systems can also impact lifestyle choices and physical activity levels, affecting the incidence of obesity, diabetes, and other lifestyle-related diseases.

[Palinee]

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?

Data availability and quality are barriers in epidemiological research. Assessment of data, especially in cancer registries, should take place. If it is inaccurate or missing any cases, it can lead to misleading or invalid estimates of risk. Such assessments should be conducted routinely. Residential history should be updated to accurately represent the location of the case. Data quality should include accuracy, representativeness, and validity. Also, a smaller population size can lead to errors. Similarly, small geographic areas can introduce confounding factors that may create false associations. Confidentiality is another issue, as some countries grant individuals rights over their personal data and require consent for its use. This can pose challenges to research.
Spatial epidemiology can be applied as an interdisciplinary science. Together with GIS technology, they offer efficient and cost-effective solutions for geography-based applications. These applications vary across many subjects, providing associations between diseases and factors of interest, as well as identifying clusters statistically

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?

The environment where people grow up, live, and work is one of the determinants of health. Place can influence the health outcomes of a person. Geographic correlation analysis studies the geographic variation in exposure to environmental variables. For example, where you live can influence respiratory diseases if the place you live is exposed to heavy pollution of PM2.5 or frequent car exhaust emissions without preventive measures. Even if where you live has natural physical factors such as contaminated water or soil, it can influence your health in various ways.

[Pyae Thu Tun]

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?

In epidemiological research, there is limited incorporation of location data which may be due to several factors. The use of spatial information in data analysis may often be perceived as a complex process. But today’s technology improvements might reduce those complexities and make it more accessible to utilize spatial information.
Another challenge is that patient data comes with a private and sensitive nature including location data. Recording the precise location of an individual may potentially compromise their privacy of them and it is important to be cautious when utilizing such information. Furthermore, certain regions vary in data recording practices which need serious attention to ensure the quality of the location data.
We can consider spatial epidemiology an interdisciplinary science because it relies on knowledge from multiple fields. It needs to have a comprehensive understanding of epidemiology, geography, and statistics to utilize spatial epidemiology effectively. So it needs to comprehend the epidemiology of diseases, understand geographical concepts, and employ statistical methods for analysis.

2. Explain why it is widely recognized that the place where an individual lives or works should be considered a potential disease determinant and give some examples?

Recognizing an individual’s living or working environment as a potentially disease-determining factor is important. Environmental factors play an important role in disease transmission as in the case of vector-borne diseases such as malaria and dengue. Environmental conditions have a significant influence on the habitats of disease vectors such as mosquitoes. Understanding location and environmental factors is important in implementing suitable interventions as different mosquito species transmit distinct diseases.
Furthermore, different locations or areas have different access to healthcare services. It is more prominent in rural or remote areas. We can adjust or adapt healthcare interventions to be effective by understanding the environmental and geographical aspects of these areas. For example, remote areas may have more challenges accessing healthcare services. It is highlighted that we need to consider the place of residence or work as a determinant of disease outcomes.

[Myat Htoo Linn]

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?

As I can understand from reading the assigned papers, one reason is the limited incorporation of the places in epidemiological research rather than focusing on the person and time over place historically. This may also be one reason as GIS evolved only in the early 1960s with the primary intention of using forestry mapping as an operational. Historical integration and insufficient software for special analysis would be a challenge in epidemiological studies. This is also linked to the lack of appropriate databases regarding the use of special data for epidemiological research.
Another reason will be data availability and quality which hinder the integration of special analysis. In the Special Epidemiology paper, the accurate small-area studies needed high-quality data, the studies relying on routine data sources cannot carry out a detailed validation process and this will lead to the inaccuracy of the findings in the studies. For instance, there is no national cancer registry in many regions, which makes it difficult to study environmental health problems accurately. It can also reflect our real setting and practices in my country, we didn’t usually collect special data concerning public health and epidemiological studies which was not incorporated as the other components, so we couldn’t get insight into it. Other confidentiality issues and study design could be also hindrances to location incorporation in epidemiological research.

Spatial epidemiology will be an interdisciplinary science as it integrates the concepts of epidemiology, geography, statistics, environmental science, and public health. It enables studying spatial patterns of the diseases with statistical methods based on the potential geographical, environmental, and social determinants. It can also explore the individual-level risk factors that interact with the above factors which may offer insights into public health interventions.

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?

The main consideration will be the interaction between genetic factors, lifestyle, cultural practices, and environment can be different between the places where the individual lives or works, and these divergent interactions can be the potential disease determinants in the areas. Geographic variations in these factors can significantly influence health outcomes as living in industrial areas with poor air quality can be harmful to an individual’s health and urban planners for healthier environments can impact lower rates of the related diseases. It is also granted in some geographic correlation studies for the health outcomes; the study of local lung cancer excess was associated with residence near or employment in the arsenic industry (Blot and Fraumeni 1975, 194) and a positive association of mortality with measures of particulate matter pollution was found across six cities in USA, adjusting for other potential confounding data measured at the individual level (Dockery et al. 1993). This was also recognized only a highly localized or individual-based study can investigate the issue, and we could work on it to understand more spatial epidemiological studies.

[Nichcha Subdee]

1. What are possible reasons locations in epidemiological research have not been incorporated as much as other components in epidemiological research?
= In my opinion, limitations in data availability and quality, along with privacy concerns, are the most likely reasons for limiting the incorporation of locations in epidemiological research. Obtaining high-quality spatial data requires significant resources, including personnel, data collection devices, and funding, and it is a time-consuming process. Additionally, location data can reveal personal information about subjects. Therefore, ensuring informed consent for the use of detailed location data is a significant concern that limits the use of location information in spatial epidemiological research.
How can spatial epidemiology be considered as an interdisciplinary science?
= Because the purpose of using spatial epidemiology is to understand how health and disease spread in different areas (locations), the combination of multiple types of data, including epidemiological, clinical, geographic, and even environmental data, needed to be collected and analyzed to get the results. Therefore, spatial epidemiology is considered to be 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?
= The place where an individual lives or works usually influences their health conditions, acting as a potential disease determinant. As mentioned in the paper, an individual who lives in a poor environment (e.g., poor sanitation, pollutants, low socioeconomic status) tends to experience negative health outcomes. This conclusion can be illustrated by John Snow’s investigation of the cholera outbreak in London in 1854. The poor management of a water pump’s sanitation led to its contamination with cholera. People living near the contaminated pump used it and contracted the disease, which eventually turned into an outbreak. Also, the investigation showed that living closer to the contaminated water pump led to a higher number of infected people, highlighting the significant impact of living and working environments on health outcomes.

[Phyo]

• 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?
Locations and area studies are not considered at the same level as other determinants in epidemiology. There were several constraints in the past, such as the availability of high-quality data and confidentiality issues explained in the paper. We have still found a lack of proper records regarding specific disease mortality data in some developing countries, which hinders the summarization of environmental health problems. Poor data quality has been experienced in disease diagnosis and registration, including the patient’s location, even in developed countries. Thus, exposure and duration to certain health events in a specific location are quite challenging to be inferred to relate to the occurrence of the disease. Similarly, before the HIPAA Act in 1996, secondary use of epidemiology data was limited for the purpose of healthcare analysis because several data were gathered for different reasons, leading to the restriction in the usage of spatial data.
Spatial epidemiology can be regarded as an interdisciplinary science, particularly in healthcare, because concepts and knowledge from several disciplines are applied in spatial epidemiology to allow us to understand the correlation between exposure in a certain area and disease outcome. Disease distribution, mapping, intervention and response, population migration, social status, etc, are integrated into this study to deal with health challenges and overcome health problems.

• 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.
Estimating the degree of exposure to specific risks in an area is an essential element in predicting certain health outcomes. When someone lives close to a polluted river or ocean, his/her health might be severely affected by the source of waste or toxins. Depending on the pollution level, people close to the polluted water will likely suffer from respiratory diseases, skin infections and waterborne diseases. Contaminated water sources bring neighbouring pollution, not only acute infectious diseases but also causative agents/risks for chronic diseases.

[Author]

Posts