Imperial College London

ProfessorMartaBlangiardo

Faculty of MedicineSchool of Public Health

Chair in Biostatistics
 
 
 
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m.blangiardo Website

 
 
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528Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Publication Type
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99 results found

Rodríguez de Rivera O, López-Quílez A, Blangiardo MAG, 2018, Assessing the spatial and spatio-temporal distribution of forest species via bayesian hierarchical modeling, Forests, Vol: 9, ISSN: 1999-4907

Climatic change is expected to affect forest development in the short term, as well as the spatial distribution of species in the long term. Species distribution models are potentially useful tools for guiding species choices in reforestation and forest management prescriptions to address climate change. The aim of this study is to build spatial and spatio-temporal models to predict the distribution of four different species present in the Spanish Forest Inventory. We have compared the different models and showed how accounting for dependencies in space and time affect the relationship between species and environmental variables.

Journal article

Costa DNCC, Blangiardo M, Rodas LAC, Nunes CM, Hiramoto RM, Tolezano JE, Bonfietti LX, Bermudi PMM, Cipriano RS, Cardoso GCD, Codeço CT, Chiaravalloti-Neto Fet al., 2018, Canine visceral leishmaniasis in Araçatuba, state of São Paulo, Brazil, and its relationship with characteristics of dogs and their owners: a cross-sectional and spatial analysis using a geostatistical approach, BMC Veterinary Research, Vol: 14, ISSN: 1746-6148

BACKGROUND: The incidence of visceral leishmaniasis (VL), one of the most important neglected diseases worldwide, is increasing in Brazil. The objectives of this study were to determine the canine VL (CanL) seroprevalence in an urban area of Araçatuba municipality and to evaluate its relationship with the characteristics of dogs and their owners. RESULTS: The CanL seroprevalence in the study area was 0.081 (95% credible interval [CI]: 0.068-0.096). The following covariates/categories were positively associated with the occurrence of a seropositive dog: more than 10 dogs that had lived in the house (odds ratio [OR] = 2.36; 95% CI: 1.03-5.43) (baseline: 0-10 dogs); house with dogs that previously died of VL (OR = 4.85; 95% CI: 2.65-8.86) or died of causes other than old age (OR = 2.26; 95% CI: 1.12-4.46) (baseline: natural or no deaths); dogs that spent the day in a sheltered backyard (OR = 2.14; 95% CI: 1.05-4.40); dogs that spent the day in an unsheltered backyard or the street (OR = 2.67; 95% CI: 1.28-5.57) (baseline: inside home). Spatial dependence among observations occurred within about 45.7 m. CONCLUSIONS: The number of dogs that had lived in the house, previous deaths by VL or other cause, and the place the dog stayed during the day were associated with the occurrence of a VL seropositive dog. The short-distance spatial dependence could be related to the vector characteristics, producing a local neighbourhood VL transmission pattern. The geostatistical approach in a Bayesian context using integrated nested Laplace approximation (INLA) allowed to identify the covariates associated with VL, including its spatially dependent transmission pattern.

Journal article

Cai Y, Hansell A, Hodgson S, Elliott P, Fecht D, Gulliver J, Key T, de Hoogh K, Hveem K, Morley D, Vienneau D, Blangiardo Met al., Road traffic noise, air pollution and incident cardiovascular disease: a joint analysis of the HUNT, EPIC-Oxford and UK Biobank cohorts, Environment International, ISSN: 0160-4120

Background: This study aimed to investigate the effects of long-term exposure to road traffic noiseand air pollutionon incident cardiovascular disease (CVD)in three large cohorts: HUNT, EPIC-Oxford and UK Biobank. Methods: In pooled complete-casesample of the three cohorts from Norway and the United Kingdom(N=355,732), 21,081 incident all CVD cases including 5,259ischemic heart disease (IHD)and 2,871cerebrovascular cases were ascertained between baseline (1993-2010)and end of follow-up (2008-2013)through medical recordlinkage. Annual mean 24-hour weighted road traffic noise(Lden) and air pollution (particulate matter with aerodynamic diameter ≤10 μm [PM10],≤2.5 μm [PM2.5]andnitrogen 39dioxide[NO2])exposure at baseline address was modelled using a simplified version of the Common Noise Assessment Methods in Europe (CNOSSOS-EU)and European-wide Land Use Regression models.Individual-level covariate data were harmonised and physically pooled across the three cohorts. Analysis was via Cox proportional hazard model with mutual adjustmentsforboth noise and air pollution andpotential confounders. Results: No significant associations were found between annual mean Ldenand incidentCVD,IHD or cerebrovascular disease in the overall populationexcept that the association withincident IHD was significantamong current-smokers.In the fully adjusted models including adjustmentfor Lden, an interquartile range (IQR) higher PM10(4.1μg/m3) or PM2.5(1.4μg/m3) was associated witha5.8% (95%CI: 2.5%-9.3%) and 3.7% (95%CI: 0.2%-7.4%) higherrisk for all incident CVD respectively. No significant associations were found between NO2and any of the CVD outcomes. Conclusions: We found suggestive evidence of a possible association between road traffic noise and incident IHD, consistent with current literature. Long-term particulate air pollution exposure, even at concentrations below current European air quality standards, w

Journal article

Smith RB, Fecht D, Gulliver J, Beevers S, Dajnak D, Blangiardo M, Ghosh R, Hansell A, Kelly F, Anderson HR, Toledano MBet al., 2017, Impact of London's road traffic air and noise pollution on birth weight: retrospective population based cohort study, BMJ, Vol: 359, Pages: j5299-j5299, ISSN: 1756-1833

Journal article

Wilunda C, Yoshida S, Blangiardo MAG, Pilar Bertran A, Tanaka S, Kawakami Ket al., 2017, Caesarean delivery and anaemia risk in children in 45 low‐ and middle‐income countries, Maternal and Child Nutrition, Vol: 14, ISSN: 1740-8709

Caesarean delivery (CD) may reduce placental transfusion and cause poor iron-related haematological indices in the neonate. We aimed to explore the association between CD and anaemia in children aged <5 years utilising data from Demographic and Health Surveys conducted between 2005 and 2015 in 45 low- and middle-income countries (N = 132,877). We defined anaemia categories based on haemoglobin levels, analysed each country's data separately using propensity-score weighting, pooled the country-specific odds ratios (ORs) using random effects meta-analysis, and performed meta-regression to determine whether the association between CD and anaemia varies by national CD rate, anaemia prevalence, and gross national income. Individual-level CD was not associated with any anaemia (OR 0.95, 95% confidence interval (CI) [0.86, 1.06]; I2 = 40.2%), mild anaemia (OR 0.91, 95% CI [0.81, 1.02]; I2 = 24.8%), and moderate/severe anaemia (OR 0.97, 95% CI [0.85, 1.11]; I2 = 47.7%). CD tended to be positively associated with moderate/severe anaemia in upper middle-income countries and negatively associated with mild anaemia in lower middle-income countries; however, meta-regression did not detect any variation in the association between anaemia and CD by the level of income, CD rate, and anaemia prevalence. In conclusion, there was no evidence for an association between CD and anaemia in children younger than 5 years in low- and middle-income countries. Our conclusions were consistent when we looked at only countries with CD rate >15% with data stratified by individual-level wealth status and type of health facility of birth.

Journal article

Cai Y, Hodgson S, Blangiardo M, Gulliver J, Morley D, Vienneau D, de Hoogh K, Key T, Hveem K, Elliott P, Hansell Aet al., 2017, Road traffic noise and incident cardiovascular disease: a joint analysis of HUNT, EPIC-Oxford and UK Biobank, ICBEN 2017 Proceedings

Aims: This study aimed to investigate the effects of long-term exposure to road traffic noise on incident CVD in three large cohorts: HUNT, EPIC-Oxford and UK Biobank. Methods: In a complete-case sample (N=361,699), 4,014 IHD and 2,109 cerebrovascular incident cases were ascertained between baseline (1993-2010) and end of follow-up (2008-2015) through medical record linkage. Annual mean road traffic noise exposure was modelled at baseline address. Individual-level covariate data were harmonised and data were pooled. Analyses used Cox proportional hazards model with adjustments for confounders, including air pollution. Results: For an interquartile range (IQR) (3.9 dBA) higher daytime noise, a non-significant association with incident IHD was seen (Hazard ratio (HR): 1.015, 95% Confidence Interval (CI): 0.989-1.042), fully adjusted. Statistically significant associations and interaction terms were seen in obese individuals (HR: 1.099, 95%CI: 1.029-1.174), and current-smokers (HR: 1.054, 95%CI: 1.007-1.103). No associations were found for ischemic or hemorrhagic stroke. Conclusions: Our study strengthens the evidence base for an effect of road traffic noise on incident IHD, whilst the association with incident stroke remains unclear.

Journal article

Cai Y, Hansell A, Blangiardo M, Burton P, de Hoogh K, Doiron D, Fortier I, Gulliver J, Hveem K, Mbatchou S, Morley D, Stolk R, Zijlema W, Elliott P, Hodgson Set al., 2017, Long-term exposure to road traffic noise, ambient air pollution and cardiovascular risk factors in the HUNT and Lifelines cohorts, European Heart Journal, Vol: 38, Pages: 2290-2296, ISSN: 1522-9645

AimsBlood biochemistry may provide information on associations between road traffic noise, air pollution, and cardiovascular disease risk. We evaluated this in two large European cohorts (HUNT3, Lifelines).Methods and resultsRoad traffic noise exposure was modelled for 2009 using a simplified version of the Common Noise Assessment Methods in Europe (CNOSSOS-EU). Annual ambient air pollution (PM10, NO2) at residence was estimated for 2007 using a Land Use Regression model. The statistical platform DataSHIELD was used to pool data from 144 082 participants aged ≥20 years to enable individual-level analysis. Generalized linear models were fitted to assess cross-sectional associations between pollutants and high-sensitivity C-reactive protein (hsCRP), blood lipids and for (Lifelines only) fasting blood glucose, for samples taken during recruitment in 2006–2013. Pooling both cohorts, an inter-quartile range (IQR) higher day-time noise (5.1 dB(A)) was associated with 1.1% [95% confidence interval (95% CI: 0.02–2.2%)] higher hsCRP, 0.7% (95% CI: 0.3–1.1%) higher triglycerides, and 0.5% (95% CI: 0.3–0.7%) higher high-density lipoprotein (HDL); only the association with HDL was robust to adjustment for air pollution. An IQR higher PM10 (2.0 µg/m3) or NO2 (7.4 µg/m3) was associated with higher triglycerides (1.9%, 95% CI: 1.5–2.4% and 2.2%, 95% CI: 1.6–2.7%), independent of adjustment for noise. Additionally for NO2, a significant association with hsCRP (1.9%, 95% CI: 0.5–3.3%) was seen. In Lifelines, an IQR higher noise (4.2 dB(A)) and PM10 (2.4 µg/m3) was associated with 0.2% (95% CI: 0.1–0.3%) and 0.6% (95% CI: 0.4–0.7%) higher fasting glucose respectively, with both remaining robust to adjustment for air/noise pollution.ConclusionLong-term exposures to road traffic noise and ambient air pollution were associated with blood biochemistry, providing a possible link b

Journal article

Scheelbeek P, Chowdhury MAH, Haines A, Alam D, Hoque MA, Butler AP, Khan AE, Mojumder SK, Blangiardo MAG, Elliott P, Vineis Pet al., 2017, Drinking Water Salinity and Raised Blood Pressure: Evidence from a Cohort Study in Coastal Bangladesh., Environmental Health Perspectives, Vol: 125, ISSN: 0091-6765

BACKGROUND: Millions of coastal inhabitants in Southeast Asia have been experiencing increasing sodium concentrations in their drinking-water sources, likely partially due to climate change. High (dietary) sodium intake has convincingly been proven to increase risk of hypertension; it remains unknown, however, whether consumption of sodium in drinking water could have similar effects on health. OBJECTIVES: We present the results of a cohort study in which we assessed the effects of drinking-water sodium (DWS) on blood pressure (BP) in coastal populations in Bangladesh. METHODS: DWS, BP, and information on personal, lifestyle, and environmental factors were collected from 581 participants. We used generalized linear latent and mixed methods to model the effects of DWS on BP and assessed the associations between changes in DWS and BP when participants experienced changing sodium levels in water, switched from "conventional" ponds or tube wells to alternatives [managed aquifer recharge (MAR) and rainwater harvesting] that aimed to reduce sodium levels, or experienced a combination of these changes. RESULTS: DWS concentrations were highly associated with BP after adjustments for confounding factors. Furthermore, for each 100 mg/L reduction in sodium in drinking water, systolic/diastolic BP was lower on average by 0.95/0.57 mmHg, and odds of hypertension were lower by 14%. However, MAR did not consistently lower sodium levels. CONCLUSIONS: DWS is an important source of daily sodium intake in salinity-affected areas and is a risk factor for hypertension. Considering the likely increasing trend in coastal salinity, prompt action is required. Because MAR showed variable effects, alternative technologies for providing reliable, safe, low-sodium fresh water should be developed alongside improvements in MAR and evaluated in "real-life" salinity-affected settings. https://doi.org/10.1289/EHP659.

Journal article

Cai Y, Hodgson S, Blangiardo M, De Hoogh K, Morley D, Gulliver J, Hveem K, Elliott P, Hansell Aet al., 2017, Ambient Air Pollution, Traffic Noise And Adult-Onset Asthma: The Hunt Study, Norway, International Conference of the American-Thoracic-Society (ATS), Publisher: American Thoracic Society, ISSN: 1073-449X

Conference paper

Python A, Illian J, Jones-Todd C, Blangiardo Met al., 2017, Explaining the lethality of boko haram’s terrorist attacks in nigeria, 2009–2014: A hierarchical bayesian approach, BAYSM 2016, Publisher: Springer, Pages: 231-239, ISSN: 2194-1009

Since 2009, Nigeria has been the scene of numerous deadly terrorist attacks perpetrated by the terrorist group Boko Haram. In response to this threat, stakeholders in the fight against terrorism have deployed various counterterrorism policies, the costs of which could be reduced through efficient preventive measures. Statistical models able to integrate complex spatial dependence structures have not yet been applied, despite their potential for providing guidance to assess characteristics of terrorist attacks. In an effort to address this shortcoming, we use a flexible approach that represents a Gaussian Markov random field through stochastic partial differential equation and model the fine-scale spatial patterns of the lethality of terrorism perpetrated by Boko Haram in Nigeria from 2009 to 2014. Our results suggest that the lethality of terrorist attacks is contagious in space and attacks are more likely to be lethal at higher altitudes and far from large cities.

Conference paper

Nomura S, Tsubokura M, Ozaki A, Murakami M, Hodgson S, Blangiardo M, Nishikawa Y, Morita T, Oikawa Tet al., 2017, Towards a long-term strategy for voluntary-based internal radiation contamination monitoring: a population-level analysis of monitoring prevalence and factors associated with monitoring participation behavior in Fukushima, Japan, International Journal of Environmental Research and Public Health, Vol: 14, ISSN: 1660-4601

Following Japan’s 2011 Fukushima nuclear incident, we assessed voluntary-based monitoring behavior in Minamisoma City—located 10–40 km from the Fukushima nuclear plant—to inform future monitoring strategies. The monitoring in Minamisoma included occasional free of charge internal-radiation-exposure measurements. Out of around 70,000 individuals residing in the city before the incident, a total of 45,788 residents (female: 52.1%) aged ≥21 were evaluated. The monitoring prevalence in 2011–2012 was only 30.2%, and this decreased to 17.9% in 2013–2014. Regression analyses were performed to estimate factors associated with the monitoring prevalence and participation behavior. The results show that, in comparison with the age cohort of 21–30 years, the cohort of 71–80 and ≥81 years demonstrated significantly lower monitoring prevalence; female residents had higher monitoring prevalence than male residents; those who were living in evacuation zones at the time of the incident had higher monitoring prevalence than those who lived outside any of the evacuation zones; for those living outside Fukushima and neighboring Prefectures post-incident monitoring prevalence decreased significantly in 2013–2014. Our findings inform the discussion on the concepts of radiation risk perception and accessibility to monitoring and societal decision-making regarding the maintenance of the monitoring program with low monitoring prevalence. We also stress the possibility that the monitoring can work both to check that internal contamination levels are within acceptable limits, and as a risk communication tool, alleviating individuals’ concern and anxiety over radiation contamination.

Journal article

Douglas P, Freni-Sterrantino A, Leal Sanchez M, Ashworth DC, Ghosh RE, Fecht D, Font A, Blangiardo M, Gulliver J, Toledano MB, Elliott P, De Hoogh K, Fuller GW, Hansell ALet al., 2017, Estimating Particulate Exposure from Modern Municipal Waste Incinerators in Great Britain, Environmental science & technology, Vol: 51, Pages: 7511-7519, ISSN: 0013-936X

Municipal Waste Incineration (MWI) is regulated through the European Union Directive on Industrial Emissions (IED), but there is ongoing public concern regarding potential hazards to health. Using dispersion modeling, we estimated spatial variability in PM10 concentrations arising from MWIs at postcodes (average 12 households) within 10 km of MWIs in Great Britain (GB) in 2003-2010. We also investigated change points in PM10 emissions in relation to introduction of EU Waste Incineration Directive (EU-WID) (subsequently transposed into IED) and correlations of PM10 with SO2, NOx, heavy metals, polychlorinated dibenzo-p-dioxins/furan (PCDD/F), polycyclic aromatic hydrocarbon (PAH) and polychlorinated biphenyl (PCB) emissions. Yearly average modeled PM10 concentrations were 1.00 × 10-5 to 5.53 × 10-2 μg m-3, a small contribution to ambient background levels which were typically 6.59-2.68 × 101 μg m-3, 3-5 orders of magnitude higher. While low, concentration surfaces are likely to represent a spatial proxy of other relevant pollutants. There were statistically significant correlations between PM10 and heavy metal compounds (other heavy metals (r = 0.43, p = <0.001)), PAHs (r = 0.20, p = 0.050), and PCBs (r = 0.19, p = 0.022). No clear change points were detected following EU-WID implementation, possibly as incinerators were operating to EU-WID standards before the implementation date. Results will be used in an epidemiological analysis examining potential associations between MWIs and health outcomes.

Journal article

Dehbi HM, Blangiardo M, Gulliver J, Fecht D, de Hoogh K, Al-Kanaani Z, Tillin T, Hardy R, Chaturvedi N, Hansell ALet al., 2016, Air pollution and cardiovascular mortality with over 25 years follow-up: A combined analysis of two British cohorts, Environment International, Vol: 99, Pages: 275-281, ISSN: 1873-6750

BACKGROUND: Adverse effects of air pollution on cardiovascular disease (CVD) mortality are well established. There are comparatively fewer studies in Europe, and in the UK particularly, than in North America. We examined associations in two British cohorts with >25years of follow-up. METHODS: Annual average NO2, SO2 and black smoke (BS) air pollution exposure estimates for 1991 were obtained from land use regression models using contemporaneous monitoring data. From the European Study of Cohorts and Air Pollution (ESCAPE), air pollution estimates in 2010-11 were obtained for NO2, NOx, PM10, PMcoarse and PM2.5. The exposure estimates were assigned to place of residence 1989 for participants in a national birth cohort born in 1946, the MRC National Study of Health and Development (NSHD), and an adult multi-ethnic London cohort, Southall and Brent Revisited (SABRE) recruited 1988-91. The combined median follow-up was 26years. Single-pollutant competing risk models were employed, adjusting for individual risk factors. RESULTS: Elevated non-significant hazard ratios for CVD mortality were seen with 1991 BS and SO2 and with ESCAPE PM10 and PM2.5 in fully adjusted linear models. Per 10μg/m(3) increase HRs were 1.11 [95% CI: 0.76-1.61] for BS, 1.05 [95% CI: 0.91-1.22] for SO2, 1.16 [95% CI: 0.70-1.92] for PM10 and 1.30 [95% CI: 0.39-4.34] for PM2.5, with largest effects seen in the fourth quartile of BS and PM2.5 compared to the first with HR 1.24 [95% CI: 0.91-1.61] and 1.21 [95% CI: 0.88-1.66] respectively. There were no consistent associations with other ESCAPE pollutants, or with 1991 NO2. Modelling using Cox regression led to similar results. CONCLUSION: Our results support a detrimental long-term effect for air pollutants on cardiovascular mortality.

Journal article

Cai Y, Zijlema WL, Doiron D, Blangiardo M, Burton PR, Fortier I, Gaye A, Gulliver J, de Hoogh K, Hveem K, Mbatchou S, Morley DW, Stolk RP, Elliott P, Hansell AL, Hodgson Set al., 2016, Ambient air pollution, traffic noise and adult asthma prevalence: a BioSHaRE approach, European Respiratory Journal, Vol: 49, ISSN: 0903-1936

We investigated the effects of both ambient air pollution and traffic noise on adult asthma prevalence, using harmonised data from three European cohort studies established in 2006–2013 (HUNT3, Lifelines and UK Biobank).Residential exposures to ambient air pollution (particulate matter with aerodynamic diameter <=10 µm (PM10) and nitrogen dioxide (NO2)) were estimated by a pan-European Land Use Regression model for 2007. Traffic noise for 2009 was modelled at home addresses by adapting a standardised noise assessment framework (CNOSSOS-EU). A cross-sectional analysis of 646 731 participants aged >=20 years was undertaken using DataSHIELD to pool data for individual-level analysis via a “compute to the data” approach. Multivariate logistic regression models were fitted to assess the effects of each exposure on lifetime and current asthma prevalence.PM10 or NO2 higher by 10 µg·m-3 was associated with 12.8% (95% CI 9.5–16.3%) and 1.9% (95% CI 1.1–2.8%) higher lifetime asthma prevalence, respectively, independent of confounders. Effects were larger in those aged >=50 years, ever-smokers and less educated. Noise exposure was not significantly associated with asthma prevalence.This study suggests that long-term ambient PM10 exposure is associated with asthma prevalence in western European adults. Traffic noise is not associated with asthma prevalence, but its potential to impact on asthma exacerbations needs further investigation.Long-term ambient PM10 exposure is associated with asthma prevalence in three European adult cohorts http://ow.ly/En4b3049S7X

Journal article

Nomura S, Blangiardo M, Tsubokura M, Ochi S, Hodgson Set al., 2016, School restrictions on outdoor activities and weight status in adolescent children after Japan's 2011 Fukushima Nuclear Power Plant disaster: a mid- to long-term retrospective analysis, BMJ Open, Vol: 6, ISSN: 2044-6055

Objective Radiation fears following Japan’s 2011 Fukushima nuclear disaster impacted levels of physical activity in local children. We assessed the post- versus pre-disaster weight status in school children, and evaluated to what extent school restrictions on outdoor activities that were intended to reduce radiation exposure risk affected child weight.ParticipantsWe considered children aged 13–15 years from four of the five secondary schools in Soma City (n=1,030, 99.1% of all children in the city), located in 35–50 km from the Fukushima nuclear plant, post- (2012 and 2015) and pre-disaster (2010).MethodsWeight status, in terms of body mass index (BMI), percentage of overweight (POW), and incidence of obesity and underweight (defined as a POW ≥ 20% and ≤ -20%, respectively), were examined and compared pre- and post-disaster using regression models. We also constructed models to assess the impact of school restrictions on outdoor activity on weight status.ResultsAfter adjustment for covariates, a slight decrease in mean BMI and POW was detected in females in 2012 (-0.37, 95% CI: -0.68 to -0.06; and -1.97, 95% CI: -3.57 to -0.36, respectively). For male children, obesity incidence increased in 2012 (odds ratio for obesity: 1.45, 95% CI: 1.02 to 2.08). Compared to pre-disaster weight status, no significant weight change was identified in 2015 in either males or females. School restrictions on outdoor activities were not significantly associated with weight status.ConclusionsFour years following the disaster, weight status has recovered to the pre-disaster levels for both males and females; however a slight decrease in weight in females, and a slight increased risk of obesity was observed in males one year following the disaster. Our findings could be used to guide actions taken during the early phase of a radiological disaster to manage the post-disaster health risks in adolescent children.

Journal article

Hansell A, Ghosh R, Blangiardo M, Perkins C, Vienneau D, Goffe K, Briggs D, Gulliver Jet al., 2016, Respiratory mortality risks in England and Wales associated with air pollution exposures up to 38 years previously, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936

Conference paper

Liverani S, Lavigne A, Blangiardo M, 2016, Modelling collinear and spatially correlated data, Publisher: ELSEVIER SCI LTD

Working paper

Boulieri A, Blangiardo MB, Hansell AH, 2016, Investigating trends in asthma and COPD through multiple data sources: a small area study, Spatial and Spatio-temporal Epidemiology, Vol: 19, Pages: 28-36, ISSN: 1877-5853

This paper investigates trends in asthma and COPD by using multiple datasources to help understanding the relationships between disease prevalence, morbidityand mortality. GP drug prescriptions, hospital admissions, and deaths are analysedat clinical commissioning group (CCG) level in England from August 2010 to March2011. A Bayesian hierarchical model is used for the analysis, which takes into accountthe complex space and time dependencies of asthma and COPD, while it is alsoable to detect unusual areas. Main findings show important discrepancies across thedifferent data sources, reflecting the different groups of patients that are represented.In addition, the detection mechanism that is provided by the model, together withinference on the spatial, and temporal variation, provide a better picture of therespiratory health problem.

Journal article

Liverani S, Lavigne A, Blangiardo MAG, 2016, Modelling collinear and spatially correlated data, Spatial and Spatio-temporal Epidemiology, ISSN: 1877-5853

In this work we present a statistical approach to distinguish and interpret the complexrelationship between several predictors and a response variable at the small area level, in thepresence of i) high correlation between the predictors and ii) spatial correlation for the response.Covariates which are highly correlated create collinearity problems when used in a standardmultiple regression model. Many methods have been proposed in the literature to address thisissue. A very common approach is to create an index which aggregates all the highly correlatedvariables of interest. For example, it is well known that there is a relationship between socialdeprivation measured through the Multiple Deprivation Index (IMD) and air pollution; thisindex is then used as a confounder in assessing the effect of air pollution on health outcomes(e.g. respiratory hospital admissions or mortality). However it would be more informative tolook specifically at each domain of the IMD and at its relationship with air pollution to betterunderstand its role as a confounder in the epidemiological analyses.In this paper we illustrate how the complex relationships between the domains of IMD and airpollution can be deconstructed and analysed using profile regression, a Bayesian non-parametricmodel for clustering responses and covariates simultaneously. Moreover, we include an intrinsicspatial conditional autoregressive (ICAR) term to account for the spatial correlation of theresponse variable.

Journal article

Scheelbeek PFD, Chowdhury MAH, Haines A, Alam A, Hoque MA, Butler AP, Khan AE, Mojumder SK, Blangiardo MAG, Elliott P, Vineis Pet al., 2016, High concentrations of sodium in drinking water and raised blood pressure in coastal deltas affected by episodic seawater inundations, Lancet Global Health, Vol: 4, ISSN: 2214-109X

Background In times of seawater inundation in coastal deltas, unprotected drinking water sources, such as ponds andshallow tube wells, take on salt water with each inundation. Daily consumption of these saline sources contributes tooverall sodium intake. Although there is evidence that a high dietary salt intake is an important risk factor forhypertension, little is known about the eff ect of high concentrations of sodium in drinking water on populationhealth. In this longitudinal study, we aimed to measure the eff ect of high concentrations of sodium in drinking wateron blood pressure and to assess the reversibility of raised blood pressure when conventional drinking water sourceswere replaced by low-saline water.Methods We used a multistage sampling process to recruit participants aged 18 years or older from the salinityaffectedsub-districts of Dacope, Batiagatha, and Paikgatchha in coastal Bangladesh. Most participants consumeddrinking water from highly saline sources, such as ponds and tube-wells, while a small percentage had access torainwater. In March, 2013, we recorded: baseline concentrations of sodium in drinking water; participants’ bloodpressure; and personal, lifestyle, and environmental characteristics. During the study period, some study participantsgained access to low-saline drinking water alternatives that were installed for use in the dry season, when water fromponds becomes more saline. In March, 2014, and May, 2014, we made follow-up assessments of drinking watersodium, blood pressure, and repeated the questionnaire about personal, lifestyle, and environmental characteristics.We used generalised linear mixed methods to model the eff ect of drinking water sodium on blood pressure andassess reversibility of raised blood pressure when participants switched from conventional drinking water sources tolow-saline alternatives.Findings We included data from 581 participants in analysis, of which 277 (48%) were male. Median age was 38 years(IQR 30&

Journal article

Blangiardo M, Cameletti M, 2016, Computational issues and R packages for spatial data analysis, Handbook of Spatial Epidemiology, Pages: 417-447, ISBN: 9781482253016

Book chapter

Blangiardo MAG, Finazzi F, Cameletti M, 2016, Two-stage Bayesian model to evaluate the effect of air pollution on chronic respiratory diseases using drug prescriptions, Spatial and Spatio-temporal Epidemiology, Vol: 18, Pages: 1-12, ISSN: 1877-5853

Exposure to high levels of air pollutant concentration is known to be associatedwith respiratory problems which can translate into higher morbidity andmortality rates. The link between air pollution and population health hasmainly been assessed considering air quality and hospitalization or mortalitydata. However this approach limits the analysis to individuals characterizedby severe conditions. In this paper we evaluate the link between air pollutionand respiratory diseases using general practice drug prescriptions for chronicrespiratory diseases, which allow to draw conclusions based on the generalpopulation.We propose a two-stage statistical approach: in the first stage we specifya space-time model to estimate the monthly NO2 concentration integratingseveral data sources characterized by different spatio-temporal resolution;in the second stage we link the concentration to the β2-agonists prescribedmonthly by general practices in England and we model the prescription ratesthrough a small area approach.

Journal article

Hansell A, Ghosh RE, Blangiardo M, Perkins C, Vienneau D, Goffe K, Briggs D, Gulliver Jet al., 2016, Historic air pollution exposure and long-term mortality risks in England and Wales: prospective longitudinal cohort study, Thorax, Vol: 71, Pages: 330-338, ISSN: 1468-3296

Introduction Long-term air pollution exposure contributes to mortality but there are few studies examining effects of very long-term (>25 years) exposures.Methods This study investigated modelled air pollution concentrations at residence for 1971, 1981, 1991 (black smoke (BS) and SO2) and 2001 (PM10) in relation to mortality up to 2009 in 367 658 members of the longitudinal survey, a 1% sample of the English Census. Outcomes were all-cause (excluding accidents), cardiovascular (CV) and respiratory mortality.Results BS and SO2 exposures remained associated with mortality decades after exposure—BS exposure in 1971 was significantly associated with all-cause (OR 1.02 (95% CI 1.01 to 1.04)) and respiratory (OR 1.05 (95% CI 1.01 to 1.09)) mortality in 2002–2009 (ORs expressed per 10 μg/m3). Largest effect sizes were seen for more recent exposures and for respiratory disease. PM10 exposure in 2001 was associated with all outcomes in 2002–2009 with stronger associations for respiratory (OR 1.22 (95% CI 1.04 to 1.44)) than CV mortality (OR 1.12 (95% CI 1.01 to 1.25)). Adjusting PM10 for past BS and SO2 exposures in 1971, 1981 and 1991 reduced the all-cause OR to 1.16 (95% CI 1.07 to 1.26) while CV and respiratory associations lost significance, suggesting confounding by past air pollution exposure, but there was no evidence for effect modification. Limitations include limited information on confounding by smoking and exposure misclassification of historic exposures.Conclusions This large national study suggests that air pollution exposure has long-term effects on mortality that persist decades after exposure, and that historic air pollution exposures influence current estimates of associations between air pollution and mortality.

Journal article

Nomura S, Blangiardo M, Tsubokura M, Ozaki A, Morita T, Hodgson Set al., 2016, Postnuclear disaster evacuation and chronic health in adults in Fukushima, Japan: a long-term retrospective analysis, BMJ Open, Vol: 6, ISSN: 2044-6055

Objective Japan's 2011 Fukushima Daiichi Nuclear Power Plant incident required the evacuation of over a million people, creating a large displaced population with potentially increased vulnerability in terms of chronic health conditions. We assessed the long-term impact of evacuation on diabetes, hyperlipidaemia and hypertension.Participants We considered participants in annual public health check-ups from 2008 to 2014, administrated by Minamisoma City and Soma City, located about 10–50 km from the Fukushima nuclear plant.Methods Disease risks, measured in terms of pre-incident and post-incident relative risks, were examined and compared between evacuees and non-evacuees/temporary-evacuees. We also constructed logistic regression models to assess the impact of evacuation on the disease risks adjusted for covariates.Results Data from a total of 6406 individuals aged 40–74 years who participated in the check-ups both at baseline (2008–2010) and in one or more post-incident years were analysed. Regardless of evacuation, significant post-incident increases in risk were observed for diabetes and hyperlipidaemia (relative risk: 1.27–1.60 and 1.12–1.30, respectively, depending on evacuation status and post-incident year). After adjustment for covariates, the increase in hyperlipidaemia was significantly greater among evacuees than among non-evacuees/temporary-evacuees (OR 1.18, 95% CI 1.06 to 1.32, p<0.01).Conclusions The singularity of this study is that evacuation following the Fukushima disaster was found to be associated with a small increase in long-term hyperlipidaemia risk in adults. Our findings help identify discussion points on disaster planning, including preparedness, response and recovery measures, applicable to future disasters requiring mass evacuation.

Journal article

Boulieri A, Liverani S, de Hoogh K, Blangiardo Met al., 2016, A space-time multivariate Bayesian model to analyse road traffic accidents by severity, Journal of the Royal Statistical Society. Series A. Statistics in Society, Vol: 180, Pages: 119-139, ISSN: 0964-1998

his paper investigates the dependencies between severity levels ofroad traffic accidents, accounting at the same time for spatial and temporal cor-relations. The study analyses road traffic accidents data at ward level in Englandover the period 2005-2013. We include in our model multivariate spatially struc-tured and unstructured effects to capture the respective dependencies betweenseverities, within a Bayesian hierarchical formulation. We also include a tempo-ral component to capture the time effects and we carry out an extensive modelcomparison. The results show important associations in both spatially structuredand unstructured effects between severities, while a downward temporal trend isobserved for low and high severity levels. Maps of posterior accident rates indi-cate elevated risk within big cities for accidents of low severity and in suburbanareas in the north and on the southern coast of England for accidents of high2Boulieriet al.severity. Posterior probability of extreme rates is used to suggest the presenceof hot spots in a public health perspective.

Journal article

Nomura S, Blangiardo M, Tsubokura M, Ozaki A, Morita T, Hodgson Set al., 2016, Post-nuclear disaster evacuation and chronic health in Adults in Fukushima, Japan: A long-term retrospective analysis, Pages: 468-471

© 2016 CURRAN-CONFERENCE. All rights reserved. Objective: Japan's 2011 Fukushima Daiichi Nuclear Power Plant incident required the evacuation of over a million people, creating a large displaced population with potentially increased vulnerability in terms of chronic health conditions. We assessed the long-term impact of evacuation on diabetes, hyperlipidemia, and hypertension. Participants: We considered participants in annual public health check-ups from 2008 to 2014, administrated by Minamisoma City and Soma City, located about 10-50 km from the Fukushima nuclear plant. Methods: Disease risks, measured in terms of pre- and post-incident relative risks, were examined and compared between evacuees and non-/temporary-evacuees. We also constructed logistic regression models to assess the impact of evacuation on the disease risks adjusted for covariates. Results: Data from a total of 6, 406 individuals aged 40-74 who participated in the check-ups both at baseline (2008-2010) and in one or more post-incident years were analyzed. Regardless of evacuation, significant post-incident increases in risk were observed for diabetes and hyperlipidemia (Relative Risk: 1.27 to 1.60 and 1.12 to 1.30, respectively, depending on evacuation status and post-incident year). After adjusted covariates, the increase in hyperlipidemia was significantly greater among evacuees than among non-/temporary-evacuees (Odds Ratio: 1.18, 95% CI: 1.06-1.32, p<0.01). Conclusions: The novelty of this study is that evacuation following the Fukushima disaster was found to be associated with a small increase in long term hyperlipidemia risk in adults. Our findings help identify discussion points on disaster planning, including preparedness, response and recovery measures applicable to future disasters requiring mass evacuation.

Conference paper

Nomura S, Blangiardo M, Tsubokura M, Nishikawa Y, Gilmour S, Kami M, Hodgson Set al., 2016, Post-nuclear disaster evacuation and survival amongst elderly people in Fukushima: a comparative analysis between evacuees and non-evacuees, Preventive Medicine, Vol: 82, Pages: 77-82, ISSN: 1096-0260

BACKGROUND: Considering the health impacts of evacuation is fundamental to disaster planning especially for vulnerable elderly populations; however, evacuation-related mortality risks have not been well-investigated. We conducted an analysis to compare survival of evacuated and non-evacuated residents of elderly care facilities, following the Great East Japan Earthquake and subsequent Fukushima Dai-ichi nuclear power plant incident on 11th March 2011. OBJECTIVE: To assess associations between evacuation and mortality after the Fukushima nuclear incident; and to present discussion points on disaster planning, with reference to vulnerable elderly populations. METHODS: The study population comprised 1,215 residents admitted to seven elderly care facilities located 20-40km from the nuclear plant in the five years before the incident. Demographic and clinical characteristics were obtained from medical records. Evacuation histories were tracked until mid 2013. Main outcome measures are hazard ratios in evacuees versus non-evacuees using random-effects Cox proportional hazards models, and pre- and post-disaster survival probabilities and relative mortality incidence. RESULTS: Experiencing the disasters did not have a significant influence on mortality (hazard ratio 1.10, 95% confidence interval: 0.84-1.43). Evacuation was associated with 1.82 times higher mortality (95% confidence interval: 1.22-2.70) after adjusting for confounders, with the initial evacuation from the original facility associated with 3.37 times higher mortality risk (95% confidence interval: 1.66-6.81) than non evacuation. CONCLUSIONS: The government should consider updating its requirements for emergency planning for elderly facilities and ensure that, in a disaster setting, these facilities have the capacity and support to shelter in place for at least sufficient time to adequately prepare initial evacuation.

Journal article

Halonen JI, Blangiardo M, Toledano MB, Fecht D, Gulliver J, Anderson HR, Beevers SD, Dajnak D, Kelly F, Tonne Cet al., 2016, Long-term exposure to traffic pollution and hospital admissions in London, Environmental pollution, Vol: 208, Pages: 48-57, ISSN: 1873-6424

Journal article

Halonen JI, Blangiardo M, Toledano MB, Fecht D, Gulliver J, Ghosh R, Anderson HR, Beevers S, Dajnak D, Kelly F, Wilkinson P, Tonne Cet al., 2016, Is long-term exposure to traffic pollution associated with mortality? A small-area study in London, Environmental Pollution, Vol: 208, Pages: 25-32, ISSN: 0269-7491

Journal article

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