Bayesian Modeling of Incidence and Progression of Disease from ...
Mapping For Wellness: Then and Now - American College of ... · 10/30/2017 2 Objectives •...
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Mapping For Wellness: Then and Now
John Ritter, Ph.D.Geomatics Dept.
Oregon Institute of TechnologyKlamath Falls, OR 97601
Sponsors
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Objectives
• Understand how medical mapping can inform our study of disease incidence and progression.
• See how 2-dimensional regression analysis can be used to model disease incidence
• See how spatial analyses (i.e. GIS) can be used to help direct resources needed to address current health issues
Mapping Wellness: Then and Now
Downtown Salem, OR: A Mapping Example
Log in from the ArcGIS Maps ribbon to Unlock Map.
Mapping Wellness: Then and Now
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Then
Plague: Bari, Naples 1690-1692
Mapping Wellness: Then and Now Source: Koch, Tom.
(2005); Scasciamacchia, et al. (2012)
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New York City: 1795 Yellow Fever Outbreak (Seaman, 1798)
Mapping Wellness: Then and Now Source: Altonen, Brian.
Sanitary Map for Leeds (Chadwick, 1842)
Mapping Wellness: Then and Now Credit: Wellcome Library, London
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London: 1849 Cholera Density (Grainger, 1850)
Mapping Wellness: Then and Now Source: Koch, T and Denike, K. (2007)
Soho’s Saint James ParishThe Broad Street Pump Analysis
(Snow, 1854)
Mapping Wellness: Then and Now Source: Koch, T.
and K Denike (2010); Wired.com
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Now
Risk Factors for Childhood Trauma
• Poverty
• Poor Housing / Poor Nutrition
• Unstable Families
• Foster Care
• Domestic Violence
• Substance Abuse
• Behavioral Health
• Unsafe Neighborhoods
Mapping Wellness: Then and Now Credit: John A. Kitzhaber, M.D., Apr., 2017
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Foster Care Episodes by CCO
Mapping Wellness: Then and Now Credit: John A. Kitzhaber, M.D., Apr., 2017
• Mapping Disease Incidents in Klamath Falls, OR
- Working in tandem with personnel from SLMC and SLWC, approximately 60,000 (de-identified) patient records for 2012 were obtained for the following disease categories:
- Diabetes (DM)
- Hypertension (Htn)
- Obesity (OB)
- Cholesterol (HL)
- Stroke (ST)
- Heart Disease (HD)
- Smoking (SM)
- Data were also obtained on the
total cost of care
Mapping Wellness: Then and Now
Klamath Falls Wellness Mapping Initiative
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Mapping Wellness: Then and Now
Klamath Falls, ORWalkability vs Disease Incident Density (#/sq-km)
Obesity
Ordinary Least Squares (OLS)
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Results• Heart Disease (HD)
- Variable significance
- HL, Walk, AvgHHInc – passed
- Spatial Autocorrelation – passed
- Normally Distributed in value – passed
- VIF – passed
- Adjusted R-Sq: 0.43
- Map of locally varying R-sq
Mapping Wellness: Then and Now
Hot Spot AnalysisGetis-Ord Gi*
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Hot Spot Analysis: Definitions
Mapping Wellness: Then and Now
Study Area with Neighborhood
& Feature Neighborhood
&Feature
Feature
Klamath Falls, ORHot Spot Analysis for Disease Incidence Density
Mapping Wellness: Then and Now
Obesity
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Cluster & Outlier AnalysisAnselin Local Morans I
Cluster & Outlier Analysis: Definitions
Mapping Wellness: Then and Now
Study Area with Neighborhood
& Feature Neighborhood
With FeatureOmitted
Feature
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Cluster & Outlier Analysis: Definitions
There are four possible outcomes.
• Clusters:
- HH – the disease incidence in the feature area is higher than that within its neighborhood and the disease incidence of its neighborhood is higher than that of other neighborhoods in the study area
- LL – the disease incidence in the feature area is lower than that within its neighborhood and the disease incidence of its neighborhood is lower than that of other neighborhoods in the study area
Mapping Wellness: Then and Now
Cluster & Outlier Analysis: Definitions
Outliers:
- HL – the disease incidence in the feature area is higher than that within its neighborhood and the disease incidence of its neighborhood is lower than that of other neighborhoods in the study area.
- LH - the disease incidence in the feature area is lower than that within its neighborhood and the disease incidence of its neighborhood is higher than that of other neighborhoods in the study area.
Note that this analysis can’t be done in any other way other than in a spatial context. Even though one could sort the data in a tabular construct to find the ‘high’ or ‘low’ values, these would be the ‘global’ high/low values. This process enables one to find the ‘local’ high/low value, i.e. outliers.
The areas that show HL or LH results are almost always the most interesting.
Mapping Wellness: Then and Now
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Klamath Falls, ORCluster & Outlier Analysis for Disease Incidence
Density
Mapping Wellness: Then and Now
Obesity
Incident Density Hot Spot Analysis Cluster & Outlier Analysis
Obesity
Diabetes
Heart
Disease
LinkLinkLink
LinkLinkLink
LinkLinkLink
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Grouping Analysis
Results• Obesity, Diabetes, Heart
Disease
Mapping Wellness: Then and Now
• Green areas
• highest in OB; lowest in HD
• Red areas
• highest in DM and HD
• Blue areas
• uniformly low in OB, DM, and HD
The values for each variable, for each census block group, were placed into one of three groups such that values for features within a group were most similar to each other.
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Klamath Falls Wellness Mapping: Conclusions
• The results of this analysis show that remediation efforts should be specifically directed towards the extended downtown and south-central suburbs
• Grouping analysis shows OB, DM, Htn, and HL to be ‘high’ in the extended downtown area and DM, Htn, OB, HL, and HD to be ‘high’ in the south-central area
• Based on these results a protected bike lane has been proposed that would pass through the extended downtown area
Mapping Wellness: Then and Now
Klamath County Tobacco Retail Licensing Program
• In April 2016, Klamath County Public Health received a
grant to propose a tobacco retail licensing ordinance
throughout the county. Tobacco retail licensing (TRL),
similar to an alcohol or marijuana license, requires
retailers to obtain a license in exchange for the privilege of
selling tobacco products.
• Currently, Oregon is one of only 10 states without a TRL
ordinance.
• The following link shows the distribution of average household income across the county superimposed upon the tobacco retailer-school proximity display.
Swipe map of Schools-Tobacco Retailers/Ave HH Income
Mapping Wellness: Then and Now
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Blue Zones Initiative - Healthy Klamath
Mapping Wellness: Then and Now
References
• Koch, Tom. (2005). Mapping the Miasma: Air, Health, and Place in Early Medical Mapping. Cartographic Perspectives. 4-27. 10.14714/CP52.376.
• Koch, Tom and Kenneth Denike. (2007). Aaron's Solution, Instructor's Problem: Teaching Surface Analysis Using GIS. Journal of Geography. 106. 69-77. 10.1080/00221340701487608.
• Koch, Tom and Kenneth Denike: Essential, Illustrative, or … Just Propaganda? Rethinking John Snow’s Broad Street Map. Cartographica, 45(1): 19-31 (2010).
• Scasciamacchia, S., Serrecchia, L., Giangrossi, L., Garofolo, G., Balestrucci, A., Sammartino, G....Fasanella, A. (2012). Plague Epidemic in the Kingdom of Naples, 1656–1658. Emerging Infectious Diseases, 18(1), 186-188. https://dx.doi.org/10.3201/eid1801.110597.
Mapping Wellness: Then and Now