[Travel time to memory clinics in Bavaria: A geographical analyses within the framework of digiDEM Bayern]. / Räumliche Erreichbarkeit von Gedächtnisambulanzen ­ Eine geographische Analyse im Rahmen von digiDEM Bayern.

BACKGROUND: Memory clinics can contribute significantly to a qualified diagnosis of dementia. Since the accessibility of medical facilities is an important predictor for their utilisation, the aim of this study was to determine the accessibility of memory clinics for persons with dementia in Bavaria. METHODS: We used a Geographic Information System (GIS) to determine travel times to the nearest memory clinic for all Bavarian municipalities based on OpenStreetMap road network data. RESULTS: The majority of the modelled persons with dementia in Bavaria (40%; n = 93,950) live in communities with an average travel time of 20 to 40 minutes to the nearest memory clinic. Almost 7,000 (3%) require more than one hour. Especially persons from rural communities have to travel significantly longer distances than people from urban areas. CONCLUSION: In view of demographic developments, there is an urgent need for memory clinics to be accessible throughout the country for all persons with dementia, regardless of where they live. The systematic development of memory clinics in areas with long travel times or the establishment of mobile diagnostic services could help to improve dementia care.

Neighborhood Greenspace and Socioeconomic Risk are Associated with Diabetes Risk at the Sub-neighborhood Scale: Results from the Prospective Urban and Rural Epidemiology (PURE) Study.

Greenspace and socioeconomic status are known correlates of diabetes prevalence, but their combined effects at the sub-neighborhood scale are not yet known. This study derives, maps, and validates a combined socioeconomic/greenspace index of individual-level diabetes risk at the sub-neighborhood scale, without the need for clinical measurements. In two Canadian cities (Vancouver and Hamilton), we computed 4 greenspace variables from satellite imagery and extracted 11 socioeconomic variables from the Canadian census. We mapped 5125 participants from the Prospective Urban and Rural Epidemiology Study by their residential address and used age- and sex-dependent walking speeds to estimate individual exposure zones to local greenspace and socioeconomic characteristics, which were then entered into a principal component analysis to derive a novel diabetes risk index (DRI-GLUCoSE). We mapped index scores in both study areas and validated the index using fully adjusted logistic regression models to predict individual diabetes status. Model performance was then compared to other non-clinical diabetes risk indices from the literature. Diabetes prevalence among participants was 9.9%. The DRI-GLUCoSE index was a significant predictor of diabetes status, exhibiting a small non-significant attenuation with the inclusion of dietary and physical activity variables. The final models achieved a predictive accuracy of 75%, the highest among environmental risk models to date. Our combined index of local greenspace and socioeconomic factors demonstrates that the environmental component of diabetes risk is not sufficiently explained by diet and physical activity, and that increasing urban greenspace may be a suitable means of reducing the burden of diabetes at the community scale.

COVID-19 incidence in border regions: spatiotemporal patterns and border control measures.

OBJECTIVES: Among the few studies examining patterns of COVID-19 spread in border regions, findings are highly varied and partially contradictory. This study presents empirical results on the spatial and temporal dynamics of incidence in 10 European border regions. We identify geographical differences in incidence between border regions and inland regions, and we provide a heuristic to characterise spillover effects. STUDY DESIGN: Observational spatiotemporal analysis. METHODS: Using 14-day incidence rates (04/2020 to 25/2021) for border regions around Germany, we delineate three pandemic 'waves' by the dates with the lowest recorded rates between peak incidence. We mapped COVID-19 incidence data at the finest spatial scale available and compared border regions' incidence rates and trends to their nationwide values. The observed spatial and temporal patterns are then compared to the time and duration of border controls in the study area. RESULTS: We observed both symmetry and asymmetry of incidence rates within border pairs, varying by country. Several asymmetrical border pairs feature temporal convergence, which is a plausible indicator for spillover dynamics. We thus derived a border incidence typology to characterise (1) symmetric border pairs, (2) asymmetric border pairs without spillover effects, and (3) asymmetric with spillover effects. In all groups, border control measures were enacted but appear to have been effective only in certain cases. CONCLUSIONS: The heuristic of border pairs provides a useful typology for highlighting combinations of spillover effects and border controls. We conclude that border control measures may only be effective if the timing and the combination with other non-pharmaceutical measures is appropriate.

Spatial-temporal patterns of homicide in socioeconomically deprived settings: violence in Alagoas, Brazil, 2006‒2015.

BACKGROUND: Homicide presents a significant health burden globally, but geographical differences in homicide rates necessitate focussed analyses of spatial and temporal patterns, particularly in affected areas. The highest rates are concentrated in regions in Central and South America, but analyses of sub-regional patterns and sex-specific differences may yield important information for addressing the upstream causes of homicide at the community level. OBJECTIVE: This study examines and presents spatial and temporal patterns of homicide victims from 2006 to 2015 in the state of Alagoas, Brazil, focussing on the municipality scale and differentiated by victims' sex. METHODS: Data comprising victims' age, sex, the date, time, and the municipality of the homicide incident were acquired from the Brazilian National Mortality Information System. These data were aggregated by municipality, and we made quantitative comparisons of sex-specific homicide rates between the capital city of Macieó metropolitan region and the peripheral, predominantly rural regions. Empirical Local Bayes methods were used to adjust per-capita homicide risk estimates and map the results. RESULTS: A total of 19,560 homicides occurred during the study period, with an average of 60.4 per 100,000 inhabitants; the metropolitan region rate was 81.8, compared to 46.5 for the remaining regions. The male homicide rate was 115.9 per 100,000, compared to 7.1 for females. Empirical Local Bayes mapping showed strong clustering of male homicide risk in specific cities near the capital, while female risk was more dispersed throughout the region. CONCLUSIONS: The risk of male victim homicide observed for the metropolitan region of Alagoas was amongst the highest globally, particularly during the period 2012-2014. Geographical differences in male and female risk may indicate differences in risk factors and highlight a need for prevention programmes that take into account gender-specific pathways of violence.

Towards a Situated Spatial Epidemiology of Violence: A Placially-Informed Geospatial Analysis of Homicide in Alagoas, Brazil.

This paper presents an empirically grounded call for a more nuanced engagement and situatedness with placial characteristics within a spatial epidemiology frame. By using qualitative data collected through interviews and observation to parameterise standard and spatial regression models, and through a critical interpretation of their results, we present initial inroads for a situated spatial epidemiology and an analytical framework for health/medical geographers to iteratively engage with data, modelling, and the context of both the subject and process of analysis. In this study, we explore the socioeconomic factors that influence homicide rates in the Brazilian state of Alagoas from a critical public health perspective. Informed by field observation and interviews with 24 youths in low-income neighbourhoods and prisons in Alagoas, we derive and critically reflect on three regression models to predict municipal homicide rates from 2016-2020. The model results indicate significant effects for the male population, persons without elementary school completion, households with reported income, divorced persons, households without piped water, and persons working outside their home municipality. These results are situated in the broader socioeconomic context, trajectories, and cycles of inequality in the study area and underscore the need for integrative and contextually engaged mixed method study design in spatial epidemiology.

Cancer resection rates, socioeconomic deprivation, and geographical access to surgery among urban, suburban, and rural populations across Canada.

High-risk cancer resection surgeries are increasingly being performed at fewer, more specialised, and higher-volume institutions across Canada. The resulting increase in travel time for patients to obtain treatment may be exacerbated by socioeconomic barriers to access. Focussing on five high-risk surgery types (oesophageal, ovarian/fallopian, liver, lung, and pancreatic cancers), this study examines socioeconomic trends in age-adjusted resection rates and travel time to surgery location for urban, suburban, and rural populations across Canada, excluding Québec, from 2004 to 2012. Significant differences in age-adjusted resection rates were observed between urban (14.9 per 100 000 person-years [95% CI: 12.2, 17.6]), suburban (40.7 [40.1, 41.2]), and rural (32.7 [29.6, 35.9]) populations, with higher rates in suburban and rural areas throughout the study period for all cancer types. Resection rates did not differ between the highest (Q1) and lowest (Q5) socioeconomic strata (Q1: 13.3 [12.2, 14.4]; Q5: 12.0 [10.7, 13.4]), with significantly higher rates among middle-SES patients (Q2: 27.3 [25.6, 29.0]; Q3: 39.6 [37.4, 41.8]; Q4: 37.5 [35.3, 39.7]). Travel times to treatment were consistently higher among the most socioeconomically deprived patients, most notably in suburban and rural areas. The results suggest that the conventional inclusion of suburbs with urban areas in health research may obfuscate important trends for public health policy and programmes.

A multimethod approach for county-scale geospatial analysis of emerging infectious diseases: a cross-sectional case study of COVID-19 incidence in Germany.

BACKGROUND: As of 13 July 2020, 12.9 million COVID-19 cases have been reported worldwide. Prior studies have demonstrated that local socioeconomic and built environment characteristics may significantly contribute to viral transmission and incidence rates, thereby accounting for some of the spatial variation observed. Due to uncertainties, non-linearities, and multiple interaction effects observed in the associations between COVID-19 incidence and socioeconomic, infrastructural, and built environment characteristics, we present a structured multimethod approach for analysing cross-sectional incidence data within in an Exploratory Spatial Data Analysis (ESDA) framework at the NUTS3 (county) scale. METHODS: By sequentially conducting a geospatial analysis, an heuristic geographical interpretation, a Bayesian machine learning analysis, and parameterising a Generalised Additive Model (GAM), we assessed associations between incidence rates and 368 independent variables describing geographical patterns, socioeconomic risk factors, infrastructure, and features of the build environment. A spatial trend analysis and Local Indicators of Spatial Autocorrelation were used to characterise the geography of age-adjusted COVID-19 incidence rates across Germany, followed by iterative modelling using Bayesian Additive Regression Trees (BART) to identify and measure candidate explanatory variables. Partial dependence plots were derived to quantify and contextualise BART model results, followed by the parameterisation of a GAM to assess correlations. RESULTS: A strong south-to-north gradient of COVID-19 incidence was identified, facilitating an empirical classification of the study area into two epidemic subregions. All preliminary and final models indicated that location, densities of the built environment, and socioeconomic variables were important predictors of incidence rates in Germany. The top ten predictor variables' partial dependence exhibited multiple non-linearities in the relationships between key predictor variables and COVID-19 incidence rates. The BART, partial dependence, and GAM results indicate that the strongest predictors of COVID-19 incidence at the county scale were related to community interconnectedness, geographical location, transportation infrastructure, and labour market structure. CONCLUSIONS: The multimethod ESDA approach provided unique insights into spatial and aspatial non-stationarities of COVID-19 incidence in Germany. BART and GAM modelling indicated that geographical configuration, built environment densities, socioeconomic characteristics, and infrastructure all exhibit associations with COVID-19 incidence in Germany when assessed at the county scale. The results suggest that measures to implement social distancing and reduce unnecessary travel may be important methods for reducing contagion, and the authors call for further research to investigate the observed associations to inform prevention and control policy.

Qualitative Field Observation of Pedestrian Injury Hotspots: A Mixed-Methods Approach for Developing Built- and Socioeconomic-Environmental Risk Signatures.

Road traffic injuries constitute a significant global health burden; the World Health Organization estimates that they result in 1.35 million deaths annually. While most pedestrian injury studies rely predominantly on statistical modelling, this paper argues for a mixed-methods approach combining spatial analysis, environmental scans, and local knowledge for assessing environmental risk factors. Using data from the Nova Scotia Trauma Registry, severe pedestrian injury cases and ten corresponding hotspots were mapped across the Halifax Regional Municipality. Using qualitative observation, quantitative environmental scans, and a socioeconomic deprivation index, we assessed hotspots over three years to identify key social- and built-environmental correlates. Injuries occurred in a range of settings; however, clear patterns were not observed based on land use, age, or socio-economic status (SES) alone. Three hotspots revealed an association between elevated pedestrian injury and a pattern of geographic, environmental, and socio-economic factors: low- to middle-SES housing separated from a roadside attraction by several lanes of traffic, and blind hills/bends. An additional generalized scenario was constructed representing common risk factors across all hotspots. This study is unique in that it moves beyond individual measures (e.g., statistical, environmental scans, or geographic information systems (GIS) mapping) to combine all three methods toward identifying environmental features associated with pedestrian motor vehicle crashes (PMVC).

The Local Food Environment and Obesity: Evidence from Three Cities.

OBJECTIVE: This study aimed to identify the association between the food environment and obesity. METHODS: BMI and waist circumference (WC) were measured in 8,076 participants from three cities. The number of fast-food restaurants, full-service restaurants, bars/pubs, markets, and liquor stores within 500 m of each participant was documented. The association between the food environment (ratio of fast-food to full-service restaurants, ratio of bars/pubs to liquor stores, and presence of markets) with obesity (BMI ≥ 30 kg/m2 ) and abdominal obesity (WC ≥ 102 cm for males or WC ≥ 88 cm for females) was investigated, adjusted for age, sex, education level, neighborhood deprivation, neighborhood type, and total hours per week of walking and taking into account city-level clustering. RESULTS: The ratios of fast-food to full-service restaurants and of bars/pubs to liquor stores were positively associated with obesity (OR = 1.05 [CI: 1.02-1.09] and OR = 1.08 [CI: 1.04-1.13], respectively). The ratio of bars/pubs to liquor stores was positively associated with abdominal obesity (OR = 1.10 [CI: 1.05-1.14]). There was no association between markets and either obesity or abdominal obesity. CONCLUSIONS: Features of the food environment have varying associations with obesity. These features have an additive effect, and future studies should not focus on only one feature in isolation.

Epidemiological and spatial characteristics of interpersonal physical violence in a Brazilian city: A comparative study of violent injury hotspots in familial versus non-familial settings, 2012-2014.

This study explores both epidemiological and spatial characteristics of domestic and community interpersonal violence. We evaluated three years of violent trauma data in the medium-sized city of Campina Grande in North-Eastern Brazil. 3559 medical and police records were analysed and 2563 cases were included to identify socioeconomic and geographic patterns. The associations between sociodemographic, temporal, and incident characteristics and domestic violence were evaluated using logistic regression. Using Geographical Information Systems (GIS), we mapped victims' household addresses to identify spatial patterns. We observed a higher incidence of domestic violence among female, divorced, or co-habitant persons when the violent event was perpetrated by males. There was only a minor chance of occurrence of domestic violence involving firearms. 8 out of 10 victims of domestic violence were women and the female/male ratio was 3.3 times greater than that of community violence (violence not occurring in the home). Unmarried couples were twice as likely to have a victim in the family unit (OR = 2.03), compared to married couples. Seven geographical hotspots were identified. The greatest density of hotspots was found in the East side of the study area and was spatially coincident with the lowest average family income. Aggressor sex, marital status, and mechanism of injury were most associated with domestic violence, and low-income neighbourhoods were coincident with both domestic and non-domestic violence hotspots. These results provide further evidence that economic poverty may play a significant role in interpersonal, and particularly domestic violence.

Volunteer First Responders for Optimizing Management of Mass Casualty Incidents.

OBJECTIVE: Rapid response to a trauma incident is vital for saving lives. However, in a mass casualty incident (MCI), there may not be enough resources (first responders and equipment) to adequately triage, prepare, and evacuate every injured person. To address this deficit, a Volunteer First Responder (VFR) program was established. METHODS: This paper describes the organizational structure and roles of the VFR program, outlines the geographical distribution of volunteers, and evaluates response times to 3 MCIs for both ambulance services and VFRs in 2000 and 2016. RESULTS: When mapped, the spatial distribution of VFRs and ambulance stations closely and deliberately reflects the population distribution of Israel. We found that VFRs were consistently first to arrive at the scene of an MCI and greatly increased the number of personnel available to assist with MCI management in urban, suburban, and rural settings. CONCLUSIONS: The VFR program provides an important and effective life-saving resource to supplement emergency first response. Given the known importance of rapid response to trauma, VFRs likely contribute to reduced trauma mortality, although further research is needed in order to examine this question specifically. (Disaster Med Public Health Preparedness. 2019;13:287-294).

Socioeconomic disparities in head and neck cancer patients' access to cancer treatment centers.

INTRODUCTION: Both socioeconomic status and travel time to cancer treatment have been associated with treatment choice and patient outcomes. An improved understanding of the relationship between these two dimensions of access may enable cancer control experts to better target patients with poor access, particularly in isolated suburban and rural communities. METHODS: Using geographical information systems, head and neck cancer patients across British Columbia, Canada from 1981 to 2009, were mapped and their travel times to the nearest treatment center at their time of diagnosis were modelled. Patients' travel times were analysed by urban, suburban, and rural neighborhood types and an index of multiple socioeconomic deprivation was used to assess the role of socioeconomic status in patients' spatial access. RESULTS: Significant associations between socioeconomic deprivation and spatial access to treatment were identified, with the most deprived quintiles of patients experiencing nearly twice the travel time as the least deprived quintile. The sharpest disparities were observed among the most deprived patient populations in suburban and rural areas. However, the establishment of new treatment centers has decreased overall travel times by 28% in recent decades. CONCLUSIONS: Residence in a neighborhood with high socioeconomic deprivation is strongly associated with head and neck cancer patients' spatial access to cancer treatment centers. Patients residing in the most socioeconomically deprived neighborhoods consistently have longer travel times in urban, suburban, and rural communities in the study area.

Delineation of Spatial Variability in the Temperature-Mortality Relationship on Extremely Hot Days in Greater Vancouver, Canada.

BACKGROUND: Climate change has increased the frequency and intensity of extremely hot weather. The health risks associated with extemely hot weather are not uniform across affected areas owing to variability in heat exposure and social vulnerability, but these differences are challenging to map with precision. OBJECTIVES: We developed a spatially and temporally stratified case-crossover approach for delineation of areas with higher and lower risks of mortality on extremely hot days and applied this approach in greater Vancouver, Canada. METHODS: Records of all deaths with an extremely hot day as a case day or a control day were extracted from an administrative vital statistics database spanning the years of 1998-2014. Three heat exposure and 11 social vulnerability variables were assigned at the residential location of each decedent. Conditional logistic regression was used to estimate the odds ratio for a 1°C increase in daily mean temperature at a fixed site with an interaction term for decedents living above and below different values of the spatial variables. RESULTS: The heat exposure and social vulnerability variables with the strongest spatially stratified results were the apparent temperature and the labor nonparticipation rate, respectively. Areas at higher risk had values ≥ 34.4°C for the maximum apparent temperature and ≥ 60% of the population neither employed nor looking for work. These variables were combined in a composite index to quantify their interaction and to enhance visualization of high-risk areas. CONCLUSIONS: Our methods provide a data-driven framework for spatial delineation of the temperature--mortality relationship by heat exposure and social vulnerability. The results can be used to map and target the most vulnerable areas for public health intervention. Citation: Ho HC, Knudby A, Walker BB, Henderson SB. 2017. Delineation of spatial variability in the temperature-mortality relationship on extremely hot days in greater Vancouver, Canada. Environ Health Perspect 125:66-75; http://dx.doi.org/10.1289/EHP224.

Socio-economic deprivation: a significant determinant affecting stage of oral cancer diagnosis and survival.

BACKGROUND: Many factors contribute to socioeconomic status (SES), yet in most survival studies only income is used as a measure for determining SES. We used a complex, composite, census-based metric for socioeconomic deprivation to better distinguish individuals with lower SES and assess its impact on survival and staging trends of oral cancers. METHODS: Oropharyngeal (OPC) and oral cavity cancer (OCC) cases were identified from the British Columbia cancer registry between 1981-2009 and placed into affluent and deprived neighborhoods using postal codes linked to VANDIX (a composite SES index based on 7 census variables encompassing income, housing, family structure, education, and employment). Stage and cancer-specific survival rates were examined by sex, SES, and time period. RESULTS: Approximately 50 % of OPC and OCC cases of both sexes resided in SES deprived neighborhoods. Numbers of cases have increased in recent years for all but OCC in men. The deprivation gap in survival between affluent and deprived neighborhoods widened in recent years for OPC and OCC in men, while decreasing for OPC and increasing slightly for OCC in women. Greater proportions of OCC cases were diagnosed at later stage disease for both sexes residing in deprived neighborhoods, a trend not seen for OPC. CONCLUSION: SES remains a significant independent determinant of survival for both OPC and OCC when using a composite metric for SES. OPC survival rates among men have improved, albeit at slower rates in deprived communities. OCC screening programs need to be targeted towards SES-deprived neighborhoods where greater proportions of cases were diagnosed at a later stage and survival rates have significantly worsened in both sexes.

Disparities in Paediatric Injury Mortality between Aboriginal and Non-Aboriginal Populations in British Columbia, 2001-2009.

Injury is the leading cause of death among children and youth in Canada. Significant disparities in injury mortality rates have been observed between Aboriginal and non-Aboriginal populations, but little is known about the age-, sex-, and mechanism-specific patterns of injury causing death. This study examines paediatric mortality in British Columbia from 2001 to 2009 using comprehensive vital statistics registry data. We highlight important disparities in Aboriginal and non-Aboriginal mortality rates, and use the Preventable Years of Life Lost (PrYLL) metric to identify differences between age groups and the mechanisms of injury causing death. A significantly greater age-adjusted mortality rate was observed among Aboriginal children (OR = 2.08, 95% CI: 1.41, 3.06), and significantly higher rates of death due to assault, suffocation, and fire were detected for specific age groups. Mapped results highlight regional disparities in PrYLL across the province, which may reflect higher Aboriginal populations in rural and remote areas. Crucially, these disparities underscore the need for community-specific injury prevention policies, particularly in regions with high PrYLL.

Spatial distribution of individuals with symptoms of depression in a periurban area in Lima: an example from Peru.

PURPOSE: To map the geographical distribution and spatial clustering of depressive symptoms cases in an area of Lima, Peru. METHODS: Presence of depressive symptoms suggesting a major depressive episode was assessed using a short version of the Center for Epidemiologic Studies Depression Scale. Data were obtained from a census conducted in 2010. One participant per selected household (aged 18 years and above, living more than 6 months in the area) was included. Residence latitude, longitude, and elevation were captured using a GPS device. The prevalence of depressive symptoms was estimated, and relative risks (RRs) were calculated to identify areas of significantly higher and lower geographical concentrations of depressive symptoms. RESULTS: Data from 7946 participants, 28.3% male, mean age 39.4 (SD, 13.9) years, were analyzed. The prevalence of depressive symptoms was 17.0% (95% confidence interval = 16.2%-17.8%). Three clusters with high prevalence of depressive symptoms (primary cluster: RR = 1.82; P = .003 and secondary: RR = 2.83; P = .004 and RR = 5.92; P = .01), and two clusters with significantly low prevalence (primary: RR = 0.23; P = .016 and secondary: RR = 0; P = .035), were identified. Further adjustment by potential confounders confirmed the high prevalence clusters but also identified newer ones. CONCLUSIONS: Screening strategies for depression, in combination with mapping techniques, may be useful tools to target interventions in resource-limited areas.

Suburbanisation of oral cavity cancers: evidence from a geographically-explicit observational study of incidence trends in British Columbia, Canada, 1981-2010.

BACKGROUND: Recent studies have demonstrated an elevated risk of oral cavity cancers (OCC) among socioeconomically deprived populations, whose increasing presence in suburban neighbourhoods poses unique challenges for equitable health service delivery. The majority of studies to date have utilised aspatial methods to identify OCC. In this study, we use high-resolution geographical analyses to identify spatio-temporal trends in OCC incidence, emphasising the value of geospatial methods for public health research. METHODS: Using province-wide population incidence data from the British Columbia Cancer Registry (1981-2009, N = 5473), we classify OCC cases by census-derived neighbourhood types to differentiate between urban, suburban, and rural residents at the time of diagnosis. We map geographical concentrations by decade and contrast trends in age-adjusted incidence rates, comparing the results to an index of socioeconomic deprivation. RESULTS: Suburban cases were found to comprise a growing proportion of OCC incidence. In effect, OCC concentrations have dispersed from dense urban cores to suburban neighbourhoods in recent decades. Significantly higher age-adjusted oral cancer incidence rates are observed in suburban neighbourhoods from 2006 to 2009, accompanied by rising socioeconomic deprivation in those areas. New suburban concentrations of incidence were found in neighbourhoods with a high proportion of persons aged 65+ and/or born in India, China, or Taiwan. CONCLUSIONS: While the aging of suburban populations provides some explanation of these trends, we highlight the role of the suburbanisation of socioeconomically deprived and Asia-born populations, known to have higher rates of risk behaviours such as tobacco, alcohol, and betel/areca consumption. Specifically, betel/areca consumption among Asia-born populations is suspected to be a primary driver of the observed geographical shift in incidence from urban cores to suburban neighbourhoods. We suggest that such geographically-informed findings are complementary to potential and existing place-specific cancer control policy and targeting prevention efforts for high-risk sub-populations, and call for the supplementation of epidemiological studies with high-resolution mapping and geospatial analysis.

Intentional injury and violence in Cape Town, South Africa: an epidemiological analysis of trauma admissions data.

BACKGROUND: Injury is a truly global health issue that has enormous societal and economic consequences in all countries. Interpersonal violence is now widely recognized as important global public health issues that can be addressed through evidence-based interventions. In South Africa, as in many low- and middle-income countries (LMIC), a lack of ongoing, systematic injury surveillance has limited the ability to characterize the burden of violence-related injury and to develop prevention programmes. OBJECTIVE: To describe the profile of trauma presenting to the trauma centre of Groote Schuur Hospital in Cape Town, South Africa - relating to interpersonal violence, using data collected from a newly implemented surveillance system. Particular emphasis was placed on temporal aspects of injury epidemiology, as well as age and sex differentiation. DESIGN: Data were collected prospectively using a standardized trauma admissions form for all patients presenting to the trauma centre. An epidemiological analysis was conducted on 16 months of data collected from June 2010 to October 2011. RESULTS: A total of 8445 patients were included in the analysis, in which the majority were violence-related. Specifically, 35% of records included violent trauma and, of those, 75% of victims were male. There was a clear temporal pattern: a greater proportion of intentional injuries occur during the night, while unintentional injury peaks late in the afternoon. In total, two-third of all intentional trauma is inflicted on the weekends, as is 60% of unintentional trauma. Where alcohol was recorded in the record, 72% of cases involved intentional injury. Sex was again a key factor as over 80% of all records involving alcohol or substance abuse were associated with males. The findings highlighted the association between violence, young males, substance use, and weekends. CONCLUSIONS: This study provides the basis for evidence-based interventions to reduce the burden of intentional injury. Furthermore, it demonstrates the value of locally appropriate, ongoing, systematic public health surveillance in LMIC.

Population-based incidence trends of oropharyngeal and oral cavity cancers by sex among the poorest and underprivileged populations.

BACKGROUND: Oral cancer is an important health issue, with changing incidence in many countries. Oropharyngeal cancer (OPC, in tonsil and oropharygeal areas) is increasing, while oral cavity cancer (OCC, other sites in the mouth) is decreasing. There is the need to identify high risk groups and communities for further study and intervention. The objective of this study was to determine how the incidence of OPC and OCC varied by neighbourhood socioeconomic status (SES) in British Columbia (BC), including the magnitude of any inequalities and temporal trends. METHODS: ICDO-3 codes were used to identify OPC and OCC cases in the BC Cancer Registry from 1981-2010. Cases were categorized by postal codes into SES quintiles (q1-q5) using VANDIX, which is a census-based, multivariate weighted index based on neighbourhood average household income, housing tenure, educational attainment, employment and family structure. Age-standardized incidence rates were determined for OPC and OCC by sex and SES quintiles and temporal trends were then examined. RESULTS: Incidence rates are increasing in both men and women for OPC, and decreasing in men and increasing in women for OCC. This change is not linear or proportionate between different SES quintiles, for there is a sharp and dramatic increase in incidence according to the deprivation status of the neighbourhood. The highest incidence rates in men for both OPC and OCC were observed in the most deprived SES quintile (q5), at 1.7 times and 2.2 times higher, respectively, than men in the least deprived quintile (q1). For OPC, the age-adjusted incidence rates significantly increased in all SES quintiles with the highest increase observed in the most deprived quintile (q5). Likewise, the highest incidence rates for both OPC and OCC in women were observed in the most deprived SES quintile (q5), at 2.1 times and 1.8 times higher, respectively, than women in the least deprived quintile (q1). CONCLUSION: We report on SES disparities in oral cancer, emphasizing the need for community-based interventions that address access to medical care and the distribution of educational and health promotion resources among the most SES deprived communities in British Columbia.

A GIS-based spatiotemporal analysis of violent trauma hotspots in Vancouver, Canada: identification, contextualisation and intervention.

BACKGROUND: In 2002, the WHO declared interpersonal violence to be a leading public health problem. Previous research demonstrates that urban spaces with a high incidence of violent trauma (hotspots) correlate with features of built environment and social determinants. However, there are few studies that analyse injury data across the axes of both space and time to characterise injury-environment relationships. This paper describes a spatiotemporal analysis of violent injuries in Vancouver, Canada, from 2001 to 2008. METHODS: Using geographic information systems, 575 violent trauma incidents were mapped and analysed using kernel density estimation to identify hotspot locations. Patterns between space, time, victim age and sex and mechanism of injury were investigated with an exploratory approach. RESULTS: Several patterns in space and time were identified and described, corresponding to distinct neighbourhood characteristics. Violent trauma hotspots were most prevalent in Vancouver's nightclub district on Friday and Saturday nights, with higher rates in the most socioeconomically deprived neighbourhoods. Victim sex, age and mechanism of injury also formed strong patterns. Three neighbourhood profiles are presented using the dual axis of space/time to describe the hotspot environments. CONCLUSIONS: This work posits the value of exploratory spatial data analysis using geographic information systems in trauma epidemiology studies and further suggests that using both space and time concurrently to understand urban environmental correlates of injury provides a more granular or higher resolution picture of risk. We discuss implications for injury prevention and control, focusing on education, regulation, the built environment and injury surveillance.