Imperial College London

Dr Frédéric B. Piel

Faculty of MedicineSchool of Public Health

Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 7594 3346f.piel

 
 
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Location

 

Praed StreetSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

84 results found

Piel F, 2023, Spatial and temporal trends and risk factors for intentional carbon monoxide poisoning hospitalizations in England between 2002 and 2016, Journal of Affective Disorders, Vol: 329, Pages: 168-175, ISSN: 0165-0327

IntroductionSuicide and mental health disorders are a recognized increasing public concern. Most suicide prevention rely on evidence from mortality data, although suicide attempts are a better predictor for completed suicides. Understanding spatio-temporal patterns and demographic profiles of people at risk can improve suicide prevention schemes, including for carbon monoxide (CO) poisoning, a common method for gas-related suicides.ObjectiveDescribe spatio-temporal patterns of intentional CO poisoning hospitalization rates in England between 2002 and 2016, and identify population sub-groups at risk.MethodsWe used NHS Digital's Hospital Episode Statistics (HES) routinely collected data on hospital admissions for intentional CO poisoning. We estimated age-standardised rates (ASR) by year, gender and residential small-area characteristics, including rural/urban, deprivation and ethnic composition. Temporal trends were assessed through linear regression and joinpoint regression analysis. Regional differences were explored.ResultsOn average, we identified 178 hospital admissions for intentional CO poisoning per year. The ASR decreased substantially over the study period, particularly among males (average annual percent change of −7.8 % (95 % CI: −11.0; −4.6)), in comparison to 3.9 % (95%CI, −6.4; −1.4) among females. Most admissions (81 %) occurred in males. White men aged 35–44 years were particularly at risk. The ASR in London (0.08/100,000) was almost six times lower than in the South-West (0.47/100,000).ConclusionsThis study provides novel insights into attempted suicides by intentional CO poisoning. Further prevention interventions, targeting sub-groups at risk (i.e. white men in their 30s/40s), need to be developed and implemented to reduce the burden of suicides and of CO poisoning.

Journal article

Piel F, Rees DC, BeBaun MR, Nnodu MR, Ranque B, Thompson AA, Ware RE, Abboud MR, Abraham A, Ambrose EE, Andemariam B, Colah R, Colombatti R, Conran N, Costa FF, Cronin RM, de Montalembert M, Elion J, Esrick E, Greenway AL, Idris I, Issom DZ, Jain D, Jordan LC, Kaplan ZS, King AA, Lloyd-Puryear M, Oppong SA, Sharma A, Sung L, Tshilolo L, Wilkie DJ, Ohene-Frempong Ket al., 2023, Defining global strategies to improve outcomes in sickle cell disease: a Lancet Haematology commission, The Lancet Haematology, ISSN: 2352-3026

Journal article

Pinto VM, Gianesin B, Piel F, De Franceschi L, Rigano P, Longo F, Quota A, Spadola V, Graziadei G, Mazzi F, Cappellini MD, Maggio A, Piga A, Forni GL, De Franceschi Let al., 2023, Morbidity and mortality of sickle cell disease patients is unaffected by splenectomy: evidence from 3 decades follow-up in a high-income setting, Haematologica: the hematology journal, Vol: 108, Pages: 1158-1162, ISSN: 0390-6078

Journal article

Khan MS, Douglas P, Hansell A, Simmonds N, Piel Fet al., 2022, Assessing the health risk of living near composting facilities on lung health, fungal and bacterial disease in cystic fibrosis: a UK CF Registry study, Environmental Health, Vol: 21, Pages: 1-13, ISSN: 1476-069X

AimTo explore the health risk of living near permitted composting sites (PCSs) on disease severity in children and adults with cystic fibrosis (CF) across the UK. MethodsA semi-individual cross-sectional study was used to examine the risk of disease severity in people with CF (pwCF) within and beyond 4 km of PCSs in the UK in 2016. All pwCF registered in the UK CF Registry were eligible for this study. Linear and Poisson regressions, adjusted for age, gender, genotype, BMI, Pseudomonas aeruginosa and deprivation, were used to quantify associations between distance to a PCS and percent predicted forced expiratory volume in one second (ppFEV1), pulmonary exacerbations (#IVdays), and fungal and bacterial infections.ResultsThe mean age of the 9,361 pwCF (3,931 children and 5,430 adults) studied was 20.1 (SD = 14.1) years; 53.3% were male; and 49.2% were homozygous F508del. Over 10% of pwCF (n = 1,015) lived within 4 km of a PCS. We found no statistically significant difference in ppFEV1 and #IVdays/year in children. However, in adults, ppFEV1 was -1.07% lower (95% confidence interval (CI): -2.29%, 0.16%) and #IVdays/year were 1.02 day higher (95%CI: 1.01, 1.04) within 4 km of a PCS. Furthermore, there were statistically significant differences in mean ppFEV1 in CF adults with Aspergillus fumigatus (58.2.% vs 62.0%, p = 0.005) and Candida spp. (56.9% vs 59.9%, p = 0.029) residing within 4 km of a PCS. No associations were identified for allergic bronchopulmonary aspergillosis, P. aeruginosa or Staphylococcus aureus.ConclusionsThis novel national study provides evidence that adults with CF living near a PCS may experience small reductions in lung function, an increased risk of pulmonary exacerbations, and more frequent fungal infections. If confirmed by studies using refined exposure assessment methods accounting for bioaerosol dispersion, these results could have important implications for the living environment of

Journal article

Chao DL, Oron AP, Chabot-Couture G, Sopekan A, Nnebe-Agumadu U, Bates I, Piel FB, Nnodu Oet al., 2022, Contribution of malaria and sickle cell disease to anaemia among children aged 6-59 months in Nigeria: a cross-sectional study using data from the 2018 Demographic and Health Survey, BMJ Open, Vol: 12, Pages: 1-8, ISSN: 2044-6055

Objectives To estimate the fraction of anaemia attributable to malaria and sickle cell disease (SCD) among children aged 6–59 months in Nigeria.Design Cross-sectional analysis of data from Nigeria’s 2018 Demographic and Health Survey (DHS).Setting Nigeria.Participants 11 536 children aged 6–59 months from randomly selected households were eligible for participation, of whom 11 142 had complete and valid biomarker data required for this analysis. Maternal education data were available from 10 305 of these children.Primary outcome measure Haemoglobin concentration.Results We found that 70.6% (95% CI: 62.7% to 78.5%) of severe anaemia was attributable to malaria compared with 12.4% (95% CI: 11.1% to 13.7%) of mild-to-severe and 29.6% (95% CI: 29.6% to 31.8%) of moderate-to-severe anaemia and that SCD contributed 0.6% (95% CI: 0.4% to 0.9%), 1.3% (95% CI: 1.0% to 1.7%) and 10.6% (95% CI: 6.7% to 14.9%) mild-to-severe, moderate-to-severe and severe anaemia, respectively. Sickle trait was protective against anaemia and was associated with higher haemoglobin concentration compared with children with normal haemoglobin (HbAA) among malaria-positive but not malaria-negative children.Conclusions This approach used offers a new tool to estimate the contribution of malaria to anaemia in many settings using widely available DHS data. The fraction of anaemia among young children in Nigeria attributable to malaria and SCD is higher at more severe levels of anaemia. Prevention of malaria and SCD and timely treatment of affected individuals would reduce cases of severe anaemia.

Journal article

Roca-Barcelo A, Fecht D, Pirani M, Piel FB, Nardocci AC, Vineis Pet al., 2022, Trends in temperature-associated mortality in Sao Paulo (Brazil) between 2000 and 2018: an example of disparities in adaptation to cold and heat, Journal of Urban Health: Bulletin of the New York Academy of Medicine, Vol: 99, Pages: 1012-1026, ISSN: 1099-3460

Exposure to non-optimal temperatures remains the single most deathful direct climate change impact to health. The risk varies based on the adaptation capacity of the exposed population which can be driven by climatic and/or non-climatic factors subject to fluctuations over time. We investigated temporal changes in the exposure–response relationship between daily mean temperature and mortality by cause of death, sex, age, and ethnicity in the megacity of São Paulo, Brazil (2000–2018). We fitted a quasi-Poisson regression model with time-varying distributed-lag non-linear model (tv-DLNM) to obtain annual estimates. We used two indicators of adaptation: trends in the annual minimum mortality temperature (MMT), i.e., temperature at which the mortality rate is the lowest, and in the cumulative relative risk (cRR) associated with extreme cold and heat. Finally, we evaluated their association with annual mean temperature and annual extreme cold and heat, respectively to assess the role of climatic and non-climatic drivers. In total, we investigated 4,471,000 deaths from non-external causes. We found significant temporal trends for both the MMT and cRR indicators. The former was decoupled from changes in AMT, whereas the latter showed some degree of alignment with extreme heat and cold, suggesting the role of both climatic and non-climatic adaptation drivers. Finally, changes in MMT and cRR varied substantially by sex, age, and ethnicity, exposing disparities in the adaptation capacity of these population groups. Our findings support the need for group-specific interventions and regular monitoring of the health risk to non-optimal temperatures to inform urban public health policies.

Journal article

Parkes B, Stafoggia M, Fecht D, Davies B, Bonander C, de Donato F, Michelozzi P, Piel FB, Strömberg U, Blangiardo Met al., 2022, Community factors and excess mortality in the COVID-19 pandemic in England, Italy and Sweden

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Analyses of COVID-19 suggest specific risk factors make communities more or less vulnerable to pandemic related deaths within countries. What is unclear is whether the characteristics affecting vulnerability of small communities within countries produce similar patterns of excess mortality across countries with different demographics and public health responses to the pandemic. Our aim is to quantify community-level variations in excess mortality within England, Italy and Sweden and identify how such spatial variability was driven by community-level characteristics.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We applied a two-stage Bayesian model to quantify inequalities in excess mortality in people aged 40 years and older at the community level in England, Italy and Sweden during the first year of the pandemic (March 2020–February 2021). We used community characteristics measuring deprivation, air pollution, living conditions, population density and movement of people as covariates to quantify their associations with excess mortality.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We found just under half of communities in England (48.1%) and Italy (45.8%) had an excess mortality of over 300 per 100,000 males over the age of 40, while for Sweden that covered 23.1% of communities. We showed that deprivation is a strong predictor of excess mortality across the three countries, and communities with high levels of overcrowding were associated with higher excess mortality in England and Sweden.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>These results highlight some international similarities in factors affecting mortality that will help policy makers target publi

Working paper

Graziadei G, De Franceschi L, Sainati L, Venturelli D, Masera N, Bonomo P, Vassanelli A, Casale M, Lodi G, Voi V, Rigano P, Pinto VM, Quota A, Notarangelo LD, Russo G, Allò M, Rosso R, D'Ascola D, Facchini E, Macchi S, Arcioni F, Bonetti F, Rossi E, Sau A, Campisi S, Colarusso G, Giona F, Lisi R, Giordano P, Boscarol G, Filosa A, Marktel S, Maroni P, Murgia M, Origa R, Longo F, Bortolotti M, Colombatti R, Di Maggio R, Mariani R, Piperno A, Corti P, Fidone C, Palazzi G, Badalamenti L, Gianesin B, Piel FB, Forni GLet al., 2022, Transfusional approach in multi-ethnic Sickle Cell patients: real-world practice data from a Multicenter survey in Italy, Frontiers in Medicine, Vol: 9, ISSN: 2296-858X

Sickle cell disease (SCD) is a worldwide distributed hereditary red cell disorder characterized by recurrent acute vaso-occlusive crises (VOCs and anemia). Gold standard treatments are hydroxycarbamide (HC) and/or different red blood cell (RBC) transfusion regimens to limit disease progression. Here, we report a retrospective study on 1,579 SCD patients (median age 23 years; 802 males/777 females), referring to 34 comprehensive Italian centers for hemoglobinopathies. Although we observed a similar proportion of Caucasian (47.9%) and African (48.7%) patients, Italian SCD patients clustered into two distinct overall groups: children of African descent and adults of Caucasian descent. We found a subset of SCD patients requiring more intensive therapy with a combination of HC plus chronic transfusion regimen, due to partial failure of HC treatment alone in preventing or reducing sickle cell-related acute manifestations. Notably, we observed a higher use of acute transfusion approaches for SCD patients of African descent when compared to Caucasian subjects. This might be related to (i) age of starting HC treatment; (ii) patients' low social status; (iii) patients' limited access to family practitioners; or (iv) discrimination. In our cohort, alloimmunization was documented in 135 patients (8.5%) and was more common in Caucasians (10.3%) than in Africans (6.6%). Alloimmunization was similar in male and female and more frequent in adults than in children. Our study reinforces the importance of donor-recipient exact matching for ABO, Rhesus, and Kell antigen systems for RBC compatibility as a winning strategy to avoid or limit alloimmunization events that negatively impact the clinical management of SCD-related severe complications.

Journal article

Nnodu OE, Oron AP, Sopekan A, Akaba GO, Piel FB, Chao DLet al., 2021, Child mortality from sickle cell disease in Nigeria: a model-estimated, population-level analysis of data from the 2018 Demographic and Health Survey, The Lancet Haematology, Vol: 8, Pages: e723-e731, ISSN: 2352-3026

BackgroundChild mortality from sickle cell disease in sub-Saharan Africa is presumed to be high but is not well quantified. This uncertainty contributes to the neglect of sickle cell disease and delays the prioritisation of interventions. In this study, we estimated the mortality of children in Nigeria with sickle cell disease, and the proportion of national under-5 mortality attributable to sickle cell disease.MethodsWe did a model-estimated, population-level analysis of data from Nigeria's 2018 Demographic and Health Survey (DHS) to estimate the prevalence and geographical distribution of HbSS and HbSC genotypes assuming Hardy-Weinberg equilibrium near birth. Interviews for the survey were done between Aug 14 and Dec 29, 2018, and the embedded sickle cell disease survey was done in a randomly selected third of the overall survey's households. We developed an approach for estimating child mortality from sickle cell disease by combining information on tested children and their untested siblings. Tested children were aged 6–59 months at the time of the survey. Untested siblings born 0–14 years before the survey were also included in analyses. Testing as part of the DHS was done without regard to disease status. We analysed mortality differences using the inheritance-derived genotypic distribution of untested siblings older than the tested cohort, enabling us to estimate excess mortality from sickle cell disease for the older-sibling cohort (ie, those born between 2003 and 2013).FindingsWe analysed test results for 11 186 children aged 6–59 months from 7411 households in Nigeria. The estimated average birth prevalence of HbSS was 1·21% (95% CI 1·09–1·37) and was 0·24% (0·19–0·31) for HbSC. We obtained data for estimating child mortality from 10 195 tested children (who could be matched to the individual mother survey) and 17 205 of their untested siblings. 15 227 of the

Journal article

Egli M, Hartmann A, Rapp Wright H, Ng KT, Piel FB, Barron LPet al., 2021, Quantitative determination and environmental risk assessment of 102 chemicals of emerging concern in wastewater-impacted rivers using rapid direct-injection liquid chromatography-tandem mass spectrometry., Molecules, Vol: 26, Pages: 1-17, ISSN: 1420-3049

The rapid source identification and environmental risk assessment (ERA) of hundreds of chemicals of emerging concern (CECs) in river water represent a significant analytical challenge. Herein, a potential solution involving a rapid direct-injection liquid chromatography-tandem mass spectrometry method for the quantitative determination of 102 CECs (151 qualitatively) in river water is presented and applied across six rivers in Germany and Switzerland at high spatial resolution. The method required an injection volume of only 10 µL of filtered sample, with a runtime of 5.5 min including re-equilibration with >10 datapoints per peak per transition (mostly 2 per compound), and 36 stable isotope-labelled standards. Performance was excellent from the low ng/L to µg/L concentration level, with 260 injections possible in any 24 h period. The method was applied in three separate campaigns focusing on the ERA of rivers impacted by wastewater effluent discharges (1 urban area in the Basel city region with 4 rivers, as well as 1 semi-rural and 1 rural area, each focusing on 1 river). Between 25 and 40 compounds were quantified directly in each campaign, and in all cases small tributary rivers showed higher CEC concentrations (e.g., up to ~4000 ng/L in total in the R. Schwarzach, Bavaria, Germany). The source of selected CECs could also be identified and differentiated from other sources at pre- and post- wastewater treatment plant effluent discharge points, as well as the effect of dilution downstream, which occurred over very short distances in all cases. Lastly, ERA for 41 CECs was performed at specific impacted sites, with risk quotients (RQs) at 1 or more sites estimated as high risk (RQ > 10) for 1 pharmaceutical (diclofenac), medium risk (RQ of 1-10) for 3 CECs (carbamazepine, venlafaxine, and sulfamethoxazole), and low risk (RQ = 0.1-1.0) for 7 CECs (i.e., RQ > 0.1 for 11 CECs in total). The application of high-throughput methods like this could ena

Journal article

Stromberg U, Baigi A, Holmen A, Parkes BL, Bonander C, Piel FBet al., 2021, A comparison of small-area deprivation indicators for public-health surveillance in Sweden, Scandinavian Journal of Public Health, Pages: 1-7, ISSN: 0300-8037

Aims:The aims of this study were to construct a small-area index of multiple deprivation (IMD) from single deprivation indicators (SDIs) and to compare the explanatory power of the IMD and SDIs with regard to mortality. We considered a small-area division of Sweden consisting of 5985 DeSO (Demografiska statistikområden), each with a population size between 653 and 4243 at the end of 2018.Methods:Four SDIs were provided by open-source data: (a) the proportion of inhabitants with a low economic standard; (b) the proportion of inhabitants aged 25–64 years with ⩽12 years of schooling; (c) the proportion of inhabitants aged 16–64 years who were not in paid employment; and (d) the proportion of inhabitants who lived in a rented apartment/house. A four-indicator IMD was constructed using factor analysis. As a validation, the IMD and SDIs were compared by exploring their DeSO-level associations with spatially smoothed death rates, with robustness checks of associations across different small-area contexts defined by degree of urbanisation and distribution of immigrants from non-Western countries.Results:The constructed IMD and SDI1 performed essentially equally and outperformed SDI2, SDI3 and SDI4. Associations between IMD/SDI1 and the spatially smoothed death rates were most pronounced within the age range 60–79 years, showing 5–8% lowered rates among those categorised in the least deprived quintiles of IMD and SDI1, respectively, and 7–9% elevated rates among those categorised in the most deprived quintiles. These associations were consistent within each small-area context.Conclusions:We suggest prioritisation of SDI1, that is, a DeSO-level deprivation indicator based on open-access data on economic standard, for public-health surveillance in Sweden.

Journal article

Piel FB, Jobanputra M, Gallagher M, Weber J, Laird SG, McGahan Met al., 2021, Co-morbidities and mortality in patients with sickle cell disease in England: A 10-year cohort analysis using hospital episodes statistics (HES) data, Blood Cells, Molecules, and Diseases, Vol: 89, Pages: 102567-102567, ISSN: 1079-9796

Journal article

Roca Barcelo A, Nardocci A, Souza de Aguilar B, G Ribeiro A, Antunes Failla M, L Hansell A, Regina Cardoso M, B Piel Fet al., 2021, Risk of cardiovascular mortality, stroke and coronary heart mortality associated with aircraft noise around Congonhas airport, São Paulo, Brazil, Environmental Health, Vol: 20, Pages: 1-14, ISSN: 1832-3367

BackgroundNoise pollution is increasingly recognised as a public health hazard, yet limited evidence is available from low- and middle-income countries (LMIC), particularly for specific sources. Here, we investigated the association between day-night average (Ldn) aircraft noise and the risk of death due to cardiovascular disease (CVD), stroke and coronary heart disease (CHD) at small-area level around São Paulo‘s Congonhas airport, Brazil during the period 2011–2016.MethodsWe selected 3259 census tracts across 16 districts partially or entirely exposed to ≥50 dB aircraft noise levels around the Congonhas airport, using pre-modelled 5 dB Ldn noise bands (≤50 dB to > 65 dB). We estimated the average noise exposure per census tract using area-weighting. Age, sex and calendar year-specific death counts for CVD, stroke and CHD were calculated by census tract, according to the residential address at time of death. We fitted Poisson regression models to quantify the risk associated with aircraft noise exposure, adjusting for age, sex, calendar year and area-level covariates including socioeconomic development, ethnicity, smoking and road traffic related noise and air pollution.ResultsAfter accounting for all covariates, areas exposed to the highest levels of noise (> 65 dB) showed a relative risk (RR) for CVD and CHD of 1.06 (95% CI: 0.94; 1.20) and 1.11 (95%CI: 0.96; 1.27), respectively, compared to those exposed to reference noise levels (≤50 dB). The RR for stroke ranged between 1.05 (95%CI: 0.95;1.16) and 0.91 (95%CI: 0.78;1.11) for all the noise levels assessed. We found a statistically significant positive trend for CVD and CHD mortality risk with increasing levels of noise (p = 0.043 and p = 0.005, respectively). No significant linear trend was found for stroke. Risk estimates were generally higher after excluding road traffic density, suggesting t

Journal article

Stromberg U, Parkes BL, Baigi A, Bonander C, Holmen A, Peterson S, Piel FBet al., 2021, Small-area data on socioeconomic status and immigrant groups for evaluating equity of early cancer detection and care, Acta Oncologica, Vol: 60, Pages: 347-352, ISSN: 0284-186X

Journal article

Layton D, Piel F, Telfer P, 2020, Real-time national survey of COVID-19 in hemoglobinopathy and rare inherited anemia patients, Haematologica: the hematology journal, Vol: 105, Pages: 2651-2654, ISSN: 0390-6078

Journal article

Faust CL, Rangkuti F, Preston SG, Boyd A, Flammer P, Bia B, Rose NJ, Piel FB, Smith AL, Dobson AP, Gupta S, Penman BSet al., 2020, Alpha globin variation in the long-tailed macaque suggests malaria selection

<jats:title>Abstract</jats:title><jats:p>Human haemoglobin variants, such as sickle, confer protection against death from malaria; consequently, frequencies of such variants are often greatly elevated in humans from malaria endemic regions. Among non-human primates, the long-tailed macaque,<jats:italic>Macaca fascicularis</jats:italic>, also displays substantial haemoglobin variation. Almost all<jats:italic>M. fascicularis</jats:italic>haemoglobin variation is in the alpha globin chain, encoded by two linked genes:<jats:italic>HBA1</jats:italic>and<jats:italic>HBA2</jats:italic>. We demonstrate that alpha globin variation in<jats:italic>M. fascicularis</jats:italic>correlates with the strength of malaria selection. We identify a range of missense mutations in<jats:italic>M. fascicularis</jats:italic>alpha globin and demonstrate that some of these exhibit a striking<jats:italic>HBA1</jats:italic>or<jats:italic>HBA2</jats:italic>specificity, a pattern consistent with computational simulations of selection on genes exhibiting copy number variation. We propose that<jats:italic>M. fascicularis</jats:italic>accumulated amino acid substitutions in its alpha globin genes under malaria selection, in a process that closely mirrors, but does not entirely converge with, human malaria adaptation.</jats:p>

Journal article

Roca-Barceló A, Crabbe H, Ghosh R, Freni-Sterrantino A, Fletcher T, Leonardi G, Hoge C, Hansell A, Piel Fet al., 2020, Temporal trends and demographic risk factors for hospital admissions due to carbon monoxide poisoning in England, Preventive Medicine, Vol: 136, ISSN: 0091-7435

Unintentional non-fire related (UNFR) carbon monoxide (CO) poisoning is a preventable cause of morbidity and mortality. Epidemiological data on UNFR CO poisoning can help monitor changes in the magnitude of this burden, particularly through comparisons of multiple countries, and to identify vulnerable sub-groups of the population which may be more at risk. Here, we collected data on age- and sex- specific number of hospital admissions with a primary diagnosis of UNFR CO poisoning in England (2002–2016), aggregated to small areas, alongside area-level characteristics (i.e. deprivation, rurality and ethnicity). We analysed temporal trends using piecewise log-linear models and compared them to analogous data obtained for Canada, France, Spain and the US. We estimated age-standardized rates per 100,000 inhabitants by area-level characteristics using the WHO standard population (2000–2025). We then fitted the Besag York Mollie (BYM) model, a Bayesian hierarchical spatial model, to assess the independent effect of each area-level characteristic on the standardized risk of hospitalization. Temporal trends showed significant decreases after 2010. Decreasing trends were also observed across all countries studied, yet France had a 5-fold higher risk. Based on 3399 UNFR CO poisoning hospitalizations, we found an increased risk in areas classified as rural (0.69, 95% CrI: 0.67; 0.80), highly deprived (1.77, 95% CrI: 1.66; 2.10) or with the largest proportion of Asian (1.15, 95% CrI: 1.03; 1.49) or Black population (1.35, 95% CrI: 1.20; 1.80). Our multivariate approach provides strong evidence for the identification of vulnerable populations which can inform prevention policies and targeted interventions.

Journal article

Piel F, 2020, Implementing newborn screening for sickle cell disease as part of immunization programmes in Nigeria: a feasibility study, The Lancet Haematology, Vol: 7, Pages: e534-e540, ISSN: 2352-3026

BackgroundSickle cell disease is highly prevalent in sub-Saharan Africa, where it accounts for substantial morbidity and mortality. Newborn screening is paramount for early diagnosis and enrolment of affected children into a comprehensive care programme. Up to now, this strategy has been greatly impaired in resource-poor countries, because screening methods are technologically and financially intensive; affordable, reliable, and accurate methods are needed. We aimed to test the feasibility of implementing a sickle cell disease screening programme using innovative point-of-care test devices into existing immunisation programmes in primary health-care settings.MethodsBuilding on a routine immunisation programme and using existing facilities and staff, we did a prospective feasibility study at five primary health-care centres within Gwagwalada Area Council, Abuja, Nigeria. We systematically screened for sickle cell disease consecutive newborn babies and infants younger than 9 months who presented to immunisation clinics at these five centres, using an ELISA-based point-of care test (HemoTypeSC). A subgroup of consecutive babies who presented to immunisation clinics at the primary health-care centres, whose mothers gave consent, were tested by the HemoTypeSC point-of-care test alongside a different immunoassay-based point-of-care test (SickleSCAN) and the gold standard test, high-performance liquid chromatography (HPLC).FindingsBetween July 14, 2017, and Sept 3, 2019, 3603 newborn babies and infants who presented for immunisation were screened for sickle cell disease at five primary health-care centres using the ELISA-based point-of-care test. We identified 51 (1%) children with sickle cell anaemia (HbSS), four (<1%) heterozygous for HbS and HbC (HbSC), 740 (21%) with sickle cell trait (HbAS), 34 (1%) heterozygous for HbA and HbC (HbAC), and 2774 (77%) with normal haemoglobin (HbAA). Of the 55 babies and infants with confirmed sickle cell disease, 41 (75%) were enrol

Journal article

Stromberg U, Parkes B, Holmen A, Peterson S, Holmberg E, Baigi A, Piel Fet al., 2020, Disease mapping of early- and late-stage cancer to monitor inequalities in early detection: a study of cutaneous malignant melanoma, European Journal of Epidemiology, Vol: 35, Pages: 537-547, ISSN: 0393-2990

We consider disease mapping of early- and late-stage cancer, in order to identify and monitor inequalities in early detection. Our method is demonstrated by mapping cancer incidence at high geographical resolution using data on 10,302 cutaneous malignant melanoma (CMM) cases within the 3.7 million population of South-West Sweden. The cases were geocoded into small-areas, each with a population size between 600 and 2600 and accessible socio-demographic data. Using the disease mapping application Rapid Inquiry Facility (RIF) 4.0, we produced regional maps to visualise spatial variations in stage I, II and III–IV CMM incidences, complemented by local maps to explore the variations within two urban areas. Pronounced spatial disparities in stage I CMM incidence were revealed by the regional and local maps. Stage I CMM incidence was markedly higher in wealthier small-areas, in particular within each urban area. A twofold higher stage I incidence was observed, on average, in the wealthiest small-areas (upper quintile) than in the poorest small-areas (lower quintile). We identified in the regional map of stage III–IV CMM two clusters of higher or lower than expected late-stage incidences which were quite distinct from those identified for stage I. In conclusion, our analysis of CMM incidences supported the use of this method of cancer stage incidence mapping for revealing geographical and socio-demographic disparities in cancer detection.

Journal article

Oron A, Chao D, Ezeanolue E, Ezenwa L, Piel F, Ojogun O, Ojogun T, Uyoga S, Williams T, Nnodu Oet al., 2020, Caring for Africa’s Sickle Cell children: will we rise to the challenge?, BMC Medicine, Vol: 18, ISSN: 1741-7015

BackgroundMost of the world’s sickle cell disease (SCD) burden is in Africa, where it is a major contributor to child morbidity and mortality. Despite the low cost of many preventive SCD interventions, insufficient resources have been allocated, and progress in alleviating the SCD burden has lagged behind other public-health efforts in Africa. The recent announcement of massive new funding for research into curative SCD therapies is encouraging in the long term, but over the next few decades, it is unlikely to help Africa’s SCD children substantially.Main discussionA major barrier to progress has been the absence of large-scale early-life screening. Most SCD deaths in Africa probably occur before cases are even diagnosed. In the last few years, novel inexpensive SCD point-of-care test kits have become widely available and have been deployed successfully in African field settings. These kits could potentially enable universal early SCD screening. Other recent developments are the expansion of the pneumococcal conjugate vaccine towards near-universal coverage, and the demonstrated safety, efficacy, and increasing availability and affordability of hydroxyurea across the continent. Most elements of standard healthcare for SCD children that are already proven to work in the West, could and should now be implemented at scale in Africa. National and continental SCD research and care networks in Africa have also made substantial progress, assembling care guidelines and enabling the deployment and scale-up of SCD public-health systems. Substantial logistical, cultural, and awareness barriers remain, but with sufficient financial and political will, similar barriers have already been overcome in efforts to control other diseases in Africa.Conclusion and recommendationsDespite remaining challenges, several high-SCD-burden African countries have the political will and infrastructure for the rapid implementation and scale-up of comprehensive SCD childcare programs. A

Journal article

Fecht D, Piel F, Cockings S, Hodgson S, Martin D, Waller LAet al., 2020, Advances in mapping population and demographic characteristics at small area levels, International Journal of Epidemiology, Vol: 49, Pages: i15-i25, ISSN: 1464-3685

Temporally and spatially highly resolved information on population characteristics, including demographic profile (e.g. age and sex), ethnicity and socio-economic status (e.g. income, occupation, education), are essential for observational health studies at the small-area level. Time-relevant population data are critical as denominators for health statistics, analytics and epidemiology, to calculate rates or risks of disease. Demographic and socio-economic characteristics are key determinants of health and important confounders in the relationship of environmental contaminants and health. In many countries, census data have long been the source of small-area population denominators and confounder information. A strength of the traditional census model has been its careful design and high level of population coverage, allowing high-quality detailed data to be released for small areas periodically, e.g. every ten years. The timeliness of data, however, becomes a challenge when temporally and spatially highly accurate annual (or even more frequent) data at high spatial resolution 31are needed, for example, for health surveillance and epidemiological studies. Additionally, the approach to collecting demographic population information is changing in the era of openand big data and may eventually evolve to using combinations of administrative and other data, supplemented by surveys. We discuss different approaches to address these challenges including a) the U. S. American Community Survey, a rolling sample of the U.S. population census, b) the use of spatial analysis techniques to compile temporally and spatially high-resolution demographic data, and c) the use of administrative and big data sources as proxies for demographic characteristics.

Journal article

Piel FB, Cockings S, 2020, Using large and complex datasets for small-area environment-health studies: from theory to practice, International Journal of Epidemiology, Vol: 49, Pages: i1-i3, ISSN: 0300-5771

Journal article

Blangiardo M, Boulieri A, Diggle P, Piel F, Shaddick G, Elliott Pet al., 2020, Advances in spatio-temporal models for non-communicable disease surveillance, International Journal of Epidemiology, Vol: 49, Pages: i26-i37, ISSN: 1464-3685

Surveillance systems are commonly used to provide early warning detection or to assess an impact of an intervention/policy. Traditionally, the methodological and conceptual frameworks for surveillance have been designed for infectious diseases, but the rising burden of non-communicable diseases (NCDs) worldwide suggests a pressing need for surveillance strategies to detect unusual patterns in the data and to help unveil important risk factors in this setting. Surveillance methods need to be able to detect meaningful departures from expectation and exploit dependencies within such data to produce unbiased estimates of risk as well as future forecasts. This has led to the increasing development of a range of space-time methods specifically designed for NCD surveillance.We present an overview of recent advances in spatio-temporal disease surveillance for NCDs using hierarchically specified models. This provides a coherent framework for modelling complex data structures, dealing with data sparsity, exploiting dependencies between data sources and propagating the inherent uncertainties present in both the data and the modelling process. We then focus on three commonly used models within the Bayesian Hierarchical Model (BHM) framework and through a simulation study we compare their performance.We also discuss some challenges faced by researchers when dealing with NCD surveillance, including how to account for false detection and the modifiable areal unit problem. Finally, we consider how to use and interpret the complex models, how model selection may vary depending on the intended user group and how best to communicate results to stakeholders and the general public.

Journal article

Hodgson S, Fecht D, Gulliver J, Daby H, Piel F, Yip F, Strosnider H, Hansell A, Elliott Pet al., 2020, Availability, access, analysis and dissemination of small area data, International Journal of Epidemiology, Vol: 49, Pages: i4-i14, ISSN: 1464-3685

In this era of ‘big data’, there is growing recognition of the value of environmental, health, social and demographic data for research. Open government data initiatives are growing in number and in terms of content. Remote sensing data are finding widespread use in environmental research, including in low- and middle-income settings. While our ability to study environment and health associations across countries and continents grows, data protection rules and greater patient control over the use of their data present new challenges to using health data in research. Innovative tools that circumvent the need for the physical sharing of data by supporting non-disclosive sharing of information, or that permit spatial analysis without researchers needing access to underlying patient data can be used to support analyses while protecting data confidentiality. User-friendly visualisations, allowing small area data to be seen and understood by non-expert audiences are revolutionising public and researcher interactions with data. The UK Small Area Health Statistics Unit’s Environment and Health Atlas for England and Wales, and the US National Environmental Public Health Tracking Network offer good examples. Open data facilitates user-generated outputs, and ‘mash-ups’, and user generated inputs from social media, mobile devices, and wearable tech are new data streams which will find utility in future studies, and bring novel dimensions with respect to ethical use of small area data.

Journal article

Piel FB, Parkes B, Hambly P, Roca-Barceló A, McCallion M, Leonardi G, Strosnider H, Yip F, Elliott P, Hansell ALet al., 2020, Software application profile: the Rapid Inquiry Facility 4.0: an open access tool for environmental public health tracking, International Journal of Epidemiology, Vol: 49, Pages: i38-i48, ISSN: 0300-5771

The Rapid Inquiry Facility 4.0 (RIF) is a new user-friendly and open-access tool, developed by the UK Small Area Health Statistics Unit (SAHSU), to facilitate environment public health tracking (EPHT) or surveillance (EPHS). The RIF is designed to help public health professionals and academics to rapidly perform exploratory investigations of health and environmental data at the small-area level (e.g. postcode or detailed census areas) in order to identify unusual signals, such as disease clusters and potential environmental hazards, whether localized (e.g. industrial site) or widespread (e.g. air and noise pollution). The RIF allows the use of advanced disease mapping methods, including Bayesian small-area smoothing and complex risk analysis functionalities, while accounting for confounders. The RIF could be particularly useful to monitor spatio-temporal trends in mortality and morbidity associated with cardiovascular diseases, cancers, diabetes and chronic lung diseases, or to conduct local or national studies on air pollution, flooding, low-magnetic fields or nuclear power plants.

Journal article

Piel F, Fecht D, Hodgson S, Blangiardo M, Toledano M, Hansell A, Elliott Pet al., 2020, Small-area methods for investigation of environment and health, International Journal of Epidemiology, Vol: 49, Pages: 686-699, ISSN: 1464-3685

Small-area studies offer a powerful epidemiological approach to study disease patterns at the population level and assess health risks posed by environmental pollutants. They involve a public health investigation on a geographic scale (e.g. neighbourhood) with overlay of health, environmental, demographic and potential confounder data. Recent methodological advances, including Bayesian approaches, combined with fast growing computational capabilities permit more informative analyses than previously possible, including the incorporation of data at different scales, from satellites to individual-level survey information. Better data availability has widened the scope and utility of small-area studies, but also led to greater complexity, including choice of optimal study area size and extent, duration of study periods, range of covariates and confounders to be considered, and dealing with uncertainty. The availability of data from large, well-phenotyped cohorts such as UK Biobank enables the use of mixed-level study designs and the triangulation of evidence on environmental risks from small-area and individual-level studies, therefore improving causal inference, including use of linked biomarker and -omics data. As a result, there are now improved opportunities to investigate the impacts of environmental risk factors on human health, particularly for the surveillance and prevention of non-communicable diseases.

Journal article

Nnodu O, Isa H, Nwegbu M, Ohiaeri C, Adegoke S, Chianumba R, Ugwu N, Brown B, Olaniyi J, Okocha E, Lawson J, Hassan A-A, Diaku-Akinwumi I, Madu A, Ezenwosu O, Tanko Y, Kangiwa U, Girei A, Israel-Aina Y, Ladu A, Egbuzu P, Abjah U, Okolo A, Akbulut-Jerada N, Fernandez M, Piel F, Adekile Aet al., 2019, HemoTypeSC, a low-cost point-of-care testing device for sickle cell disease: promises and challenges, Blood Cells, Molecules, and Diseases, Vol: 78, Pages: 22-28, ISSN: 1079-9796

BackgroundSickle cell disease (SCD) is a neglected burden of growing importance. >312,000 births are affected annually by sickle cell anaemia (SCA). Early interventions such as newborn screening, penicillin prophylaxis and hydroxyurea can substantially reduce the mortality and morbidity associated with SCD. Nevertheless, their implementation in African countries has been mostly limited to pilot projects. Recent development of low-cost point-of-care testing (POCT) devices for sickle haemoglobin (HbS) could greatly facilitate the diagnosis of those affected.MethodsWe conducted the first multi-centre, real-world assessment of a low-cost POCT device, HemoTypeSC, in a low-income country. Between September and November 2017, we screened 1121 babies using both HemoTypeSC and HPLC and confirmed discordant samples by molecular diagnosis.FindingsWe found that, in optimal field conditions, the sensitivity and specificity of the test for SCA were 93.4% and 99.9%, respectively. All 14 carriers of haemoglobin C were successfully identified. Our study reveals an overall accuracy of 99.1%, but also highlights the importance of rigorous data collection, staff training and accurate confirmatory testing. It suggests that HPLC results might not be as reliable in a resource-poor setting as usually considered.InterpretationThe use of such a POCT device can be scaled up and routinely used across multiple healthcare centres in sub-Saharan Africa, which would offer great potential for the identification and management of vast numbers of individuals affected by SCD who are currently undiagnosed.

Journal article

Hockham C, Ekwattanakit S, Bhatt S, Penman B, Gupta S, Viprakasit V, Piel Fet al., 2019, Estimating the burden of α-thalassaemia in Thailand using a comprehensive prevalence database for Southeast Asia, eLife, Vol: 8, ISSN: 2050-084X

Abstract Severe forms of α-thalassaemia, haemoglobin H disease and haemoglobin Bart’s hydrops fetalis, are an important public health concern in Southeast Asia. Yet information on the prevalence, genetic diversity and health burden of α-thalassaemia in the region remains limited. We compiled a geodatabase of α-thalassaemia prevalence and genetic diversity surveys and, using geostatistical modelling methods, generated the first continuous maps of α-thalassaemia mutations in Thailand and sub-national estimates of the number of newborns with severe forms in 2020. We also summarised the current evidence-base for α-thalassaemia prevalence and diversity for the region. We estimate that 3,595 (95% credible interval 1,717 – 6,199) newborns will be born with severe α-thalassaemia in Thailand in 2020, which is considerably higher than previous estimates. Accurate, fine-scale epidemiological data are necessary to guide sustainable national and regional health policies for α-thalassaemia control. Our maps and newborn estimates are an important first step towards this aim. Funding This work was supported by European Union’s Seventh Framework Programme (FP7//2007-2013)/European Research Council [268904 – DIVERSITY]

Journal article

Hockham C, Gupta S, Penman B, Bhatt S, Piel Fet al., 2019, Estimating the burden of α-thalassaemia in Thailand using a comprehensive prevalence database for Southeast Asia, eLife, Vol: 8, ISSN: 2050-084X

Severe forms of α-thalassaemia, haemoglobin H disease and haemoglobin Bart’s hydrops fetalis, are an important public health concern in Southeast Asia. Yet information on the prevalence, genetic diversity and health burden of α-thalassaemia in the region remains limited. We compiled a geodatabase of α-thalassaemia prevalence and genetic diversity surveys and, using geostatistical modelling methods, generated the first continuous maps of α-thalassaemia mutations in Thailand and sub-national estimates of the number of newborns with severe forms in 2020. We also summarised the current evidence-base for α-thalassaemia prevalence and diversity for the region. We estimate that 3595 (95% credible interval 1,717–6,199) newborns will be born with severe α-thalassaemia in Thailand in 2020, which is considerably higher than previous estimates. Accurate, fine-scale epidemiological data are necessary to guide sustainable national and regional health policies for α-thalassaemia management. Our maps and newborn estimates are an important first step towards this aim.

Journal article

De Franceschi L, Lux C, Piel FB, Gianesin B, Bonetti F, Casale M, Graziadei G, Lisi R, Pinto V, Putti MC, Rigano P, Rosso R, Russo G, Spadola V, Pulvirenti C, Rizzi M, Mazzi F, Ruffo G, Forni GLet al., 2019, Access to emergency department of acute events and identification of sickle cell disease in refugees, Blood, Vol: 133, Pages: 2100-2103, ISSN: 1528-0020

Journal article

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