Imperial College London


Faculty of MedicineSchool of Public Health

Honorary Lecturer



+44 (0)20 7594 2789susan.hodgson Website




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Publication Type

41 results found

Hodgson S, Fecht D, Gulliver J, Daby H, Piel F, Yip F, Strosnider H, Hansell A, Elliott Pet al., Availability, access, analysis and dissemination of small area data, International Journal of Epidemiology, 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.


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


Doiron D, de Hoogh K, Probst-Hensch N, Mbatchou S, Eeftens M, Cai Y, Schindler C, Fortier I, Hodgson S, Gaye A, Stolk R, Hansell Aet al., 2017, Residential Air Pollution and Associations with Wheeze and Shortness of Breath in Adults: A Combined Analysis of Cross-Sectional Data from Two Large European Cohorts., Environmental Health Perspectives, Vol: 125, ISSN: 0091-6765

BACKGROUND: Research examining associations between air pollution exposure and respiratory symptoms in adults has generally been inconclusive. This may be related in part to sample size issues, which also preclude analysis in potentially vulnerable subgroups. OBJECTIVES: We estimated associations between air pollution exposures and the prevalence of wheeze and shortness of breath using harmonized baseline data from two very large European cohorts, Lifelines (2006-2013) and UK Biobank (2006-2010). Our aim was also to determine whether the relationship between air pollution and respiratory symptom prevalence differed between individuals with different characteristics. METHODS: Cross-sectional analyses explored associations between prevalence of self-reported wheeze and shortness of breath and annual mean particulate matter with aerodynamic diameter <2.5μm, 2.5-10μm, and <10μm (PM2.5, PMcoarse, and PM10, respectively) and nitrogen dioxide (NO2) concentrations at place of residence using logistic regression. Subgroup analyses and tests for interaction were performed for age, sex, smoking status, household income, obesity status, and asthma status. RESULTS: All PM exposures were associated with respiratory symptoms based on single-pollutant models, with the largest associations seen for PM2.5 with prevalence of wheezing {odds ratio (OR)=1.16 per 5μg/m³ [95% confidence interval (CI): 1.11, 1.21]} and shortness of breath [OR=1.61 per 5μg/m³ (95% CI: 1.45, 1.78)]. The association between shortness of breath and a 5-μg/m³ increment in PM2.5 was significantly higher for individuals from lower-[OR=1.73 (95% CI: 1.52, 1.97)] versus higher-income households [OR=1.31 (95% CI: 1.11, 1.55); p-interaction=0.005), whereas the association between PM2.5 and wheeze was limited to lower-income participants [OR=1.30 (95% CI: 1.22, 1.38) vs. OR=1.02; (95% CI: 0.96, 1.08); p-interaction<0.001]. Exposure to NO2 also showed positive associations with


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.


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


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.


Zijlema W, Cai Y, Doiron D, Mbatchou S, Fortier I, Gulliver J, de Hoogh K, Morley D, Hodgson S, Elliott P, Key T, Kongsgard H, Hveem K, Gaye A, Burton P, Hansell A, Stolk R, Rosmalen Jet al., 2017, Corrigendum to "Road traffic noise, blood pressure and heart rate: Pooled analyses of harmonized data from 88,336 participants" [Envrion. Res. 151 (2016) 804-813], Environmental Research, Vol: 152, Pages: 520-520, ISSN: 0013-9351


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


Zijlema W, Cai Y, Doiron D, Mbatchou S, Fortier I, Gulliver J, Hoogh KD, Morley D, Hodgson S, Elliott P, Key T, Kongsgard H, Hveem K, Gaye A, Burton P, Hansell A, Stolk R, Rosmalen Jet al., 2016, Road traffic noise, blood pressure and heart rate: Pooled analyses of harmonized data from 88,336 participants, Environmental Research, Vol: 151, Pages: 804-813, ISSN: 0013-9351

Introduction Exposure to road traffic noise may increase blood pressure and heart rate. It is unclear to what extent exposure to air pollution may influence this relationship. We investigated associations between noise, blood pressure and heart rate, with harmonized data from three European cohorts, while taking into account exposure to air pollution. Methods Road traffic noise exposure was assessed using a European noise model based on the Common Noise Assessment Methods in Europe framework (CNOSSOS-EU). Exposure to air pollution was estimated using a European-wide land use regression model. Blood pressure and heart rate were obtained by trained clinical professionals. Pooled cross-sectional analyses of harmonized data were conducted at the individual level and with random-effects meta-analyses. Results We analyzed data from 88,336 participants, across the three participating cohorts (mean age 47.0 (±13.9) years). Each 10 dB(A) increase in noise was associated with a 0.93 (95% CI 0.76;1.11) bpm increase in heart rate, but with a decrease in blood pressure of 0.01 (95% CI −0.24;0.23) mmHg for systolic and 0.38 (95% CI −0.53; −0.24) mmHg for diastolic blood pressure. Adjustments for PM10 or NO2 attenuated the associations, but remained significant for DBP and HR. Results for BP differed by cohort, with negative associations with noise in LifeLines, no significant associations in EPIC-Oxford, and positive associations with noise &gt;60 dB(A) in HUNT3. Conclusions Our study suggests that road traffic noise may be related to increased heart rate. No consistent evidence for a relation between noise and blood pressure was found.


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.


Bakolis I, Kelly R, Fecht D, Best N, Millett C, Garwood K, Elliott P, Hansell A, Hodgson Set al., 2016, Protective Effects of Smoke-free Legislation on Birth Outcomes in England: A Regression Discontinuity Design, Epidemiology, Vol: 27, Pages: 810-818, ISSN: 1531-5487

Background: Environmental tobacco smoke has an adverse impact on preterm birth and birthweight. England introduced a new law to make virtually all enclosed public places andworkplaces smoke free on July 1 2007. We investigated the effect of smoke-free legislation onbirth outcomes in England using Hospital Episode Statistics (HES) maternity data.Methods: We used regression discontinuity, a quasi-experimental study design, which canfacilitate valid causal inference, to analyse short-term effects of smoke-free legislation on birthweight, low birth weight, gestational age, preterm birth and small for gestational age.Results: We analysed 1,800,906 pregnancies resulting in singleton live-births in Englandbetween January 1 2005 and December 31 2009. In the one to five months following theintroduction of the smoking-free legislation, for those entering their third trimester, the risk oflow birth weight decreased by between 8% (95% CI: 4%-12%) and 14% (95% CI: 5%-23%),very low birth weight between 28% (95% CI: 19%-36%) and 32% (95% CI: 21%-41%), pretermbirth between 4% (95% CI: 1%-8%) and 9% (95% CI: 2%-16%), and small for gestational agebetween 5% (95% CI: 2%-8%) and 9% (95% CI: 2%-15%). The impact of the smoke-freelegislation varied by maternal age, deprivation, ethnicity and region.Conclusions: The introduction of smoke-free legislation in England had an immediate beneficialimpact on birth outcomes overall, although this benefit was not observed across all age, ethnic, ordeprivation groups.


Tyrrell RL, Greenhalgh F, Hodgson S, Wills WJ, Mathers JC, Adamson AJ, Lake AAet al., 2016, Food environments of young people: linking individual behaviour to environmental context, Journal of Public Health, Vol: 39, Pages: 95-104, ISSN: 1741-3842

BACKGROUND: We aimed to identify and characterize the food environments from which young people obtain food and to explore associations between the type of food environment and food intakes. METHODS: Young people (n = 86, mean age 17 years; combined data of two sequential pilot studies (collected in 2008-09) and a study conducted in 2011-12) recorded in 4-day self-complete food diaries what food they consumed and where food was sourced. Nutrient, fruit and vegetable intake was calculated according to the source of food, categorized using a food environment classification tool. RESULTS: Over 4 days, respondents sourced food from an average of 4.3 different food environments. Home food was used daily and was more favourable in terms of nutrient profile than out-of-home food. Food sourced from specialist outlets, convenience stores and retail bakers had the highest energy density. Food from retail bakers and 'takeaway and fast food' outlets were the richest sources of fat while vending machines and convenience stores had the highest percentage of energy from sugar. CONCLUSIONS: This work provides details of 'where' young people obtain food and the nutritional consequences of choosing those food environments. While home food was a significant contributor to total dietary intake, food was obtained from a broad range of environments; particularly takeaway, fast food and education establishments.


Nomura S, Parsons AJQ, Hirabayashi M, Kinoshita R, Liao Y, Hodgson Set al., 2016, Social determinants of mid- to long-term disaster impacts on health: A systematic review, International Journal of Disaster Risk Reduction, Vol: 16, Pages: 53-67, ISSN: 2212-4209

Disasters cause a wide range of health impacts. Although there remains a need to understand and improve acute disaster management, a stronger understanding of how health is affected in the medium and longer term is also required to inform the design and delivery of measures to manage post-disaster health risks, and to guide actions taken before and during events which will also lead to reduction in health impact. Social determinants exert a powerful influence on different elements of risk, principally vulnerability, exposure and capacity, and thus, on people's health. As disaster health data and research has tended to focus on the short-term health impacts, no systematic assessment of the social determinants of the mid- to long-term health impacts of disasters has been identified. We assessed the chronic health impacts of disasters and explored the potential socioeconomic determinants of health impact through a systematic review. Our findings, based on 28 studies, highlighted that regardless of health outcomes and event types, the influence of disasters on chronic heath persists beyond the initial disaster period, affecting people's health for months to years. Using the World Health Organization's conceptual framework for the social determinants of health, we identified a total of 35 themes across the three conceptual domains (determinants related to the socioeconomic and political context, structural determinants, and intermediate determinants) as potentially influencing disaster impact. Investment to tackle modifiable underlying determinants could aid disaster risk management, improve medium and long-term health outcomes from disasters, and build community resilience.


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.


Shepherd TJ, Dirks W, Roberts NMW, Patel JG, Hodgson S, Pless-Mulloli T, Walton P, Parrish RRet al., 2016, Tracing fetal and childhood exposure to lead using isotope analysis of deciduous teeth, Environmental Research, Vol: 146, Pages: 145-153, ISSN: 1096-0953

We report progress in using the isotopic composition and concentration of Pb in the dentine and enamel of deciduous teeth to provide a high resolution time frame of exposure to Pb during fetal development and early childhood. Isotope measurements (total Pb and 208Pb/206Pb, 207Pb/206Pb ratios) were acquired by laser ablation inductively coupled mass spectrometry at contiguous 100 micron intervals across thin sections of the teeth; from the outer enamel surface to the pulp cavity. Teeth samples (n=10) were selected from two cohorts of children, aged 5–8 years, living in NE England. By integrating the isotope data with histological analysis of the teeth, using the daily incremental lines in dentine, we were able to assign true estimated ages to each ablation point (first 2–3 years for molars, first 1–2 years for incisors+pre-natal growth). Significant differences were observed in the isotope composition and concentration of Pb between children, reflecting differences in the timing and sources of exposure during early childhood. Those born in 2000, after the withdrawal of leaded petrol in 1999, have the lowest dentine Pb levels (<0.2 µg Pb/g) with 208Pb/206Pb (mean ±2σ: 2.126–2.079) 208Pb/206Pb (mean ±2σ: 0.879–0.856) ratios that correlate very closely with modern day Western European industrial aerosols (PM10, PM2.5) suggesting that diffuse airborne pollution was probably the primary source and exposure pathway. Legacy lead, if present, is insignificant. For those born in 1997, dentine lead levels are typically higher (>0.4 µgPb/g) with 208Pb/206Pb (mean ±2σ: 2.145–2.117) 208Pb/206Pb (mean ±2σ: 0.898–0.882) ratios that can be modelled as a binary mix between industrial aerosols and leaded petrol emissions. Short duration, high intensity exposure events (1–2 months) were readily identified, together with evidence that dentine provides a good proxy for ch


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.


Morley DW, de Hoogh K, Fecht D, Fabbri F, Bell M, Goodman PS, Elliott P, Hodgson S, Hansell AL, Gulliver Jet al., 2015, International scale implementation of the CNOSSOS-EU road traffic noise prediction model for epidemiological studies, Environmental Pollution, Vol: 206, Pages: 332-341, ISSN: 0269-7491

The EU-FP7-funded BioSHaRE project is using individual-level data pooled from several national cohort studies in Europe to investigate the relationship of road traffic noise and health. The detailed input data (land cover and traffic characteristics) required for noise exposure modelling are not always available over whole countries while data that are comparable in spatial resolution between different countries is needed for harmonised exposure assessment. Here, we assess the feasibility using the CNOSSOS-EU road traffic noise prediction model with coarser input data in terms of model performance. Starting with a model using the highest resolution datasets, we progressively introduced lower resolution data over five further model runs and compared noise level estimates to measurements. We conclude that a low resolution noise model should provide adequate performance for exposure ranking (Spearman's rank = 0.75; p < 0.001), but with relatively large errors in predicted noise levels (RMSE = 4.46 dB(A)).


Ochi S, Hodgson S, Landeg O, Mayner L, Murray Vet al., 2015, Medication supply for people evacuated during disasters., Journal of Evidence-Based Medicine, Vol: 8, Pages: 39-41, ISSN: 1756-5391

Medication loss is a major problem in disaster settings, and it is crucial for patients to bring their medication and healthcare items with them when they leave their homes during an evacuation. This article is based on a systematic literature review on medication loss, the objectives of which were to identify the extent and implications of medication loss, to identify the burden of prescription refill, and to make recommendations on effective preparedness. The review revealed that medication loss, prescription loss and refills, and the loss of medical aids are a significant burden on the medical relief teams. The medical aids are not limited to drugs, but include routine medications, medical/allergy records, devices for specific care and daily life, and emergency medications. One possible solution is to make a personal emergency pack and for people to carry this with them at all times. To ensure that patients are adequately prepared, stakeholders, especially health professionals, need to be actively involved in the preparation plans. Since our findings have little impact on disaster risk reduction unless shared broadly, we are now taking actions to spread our findings, such as presenting in conferences and via posters, in order to raise awareness among patients and healthcare professionals. As part of these activities, our findings were presented at the Evidence Aid Symposium on 20 September 2014, at Hyderabad, India.


Hodgson S, Lurz PWW, Shirley MDF, Bythell M, Rankin Jet al., 2015, Exposure misclassification due to residential mobility during pregnancy, International Journal of Hygiene and Environmental Health, Vol: 218, Pages: 414-421, ISSN: 1618-131X

ObjectivesPregnant women are a highly mobile group, yet studies suggest exposure error due to migration in pregnancy is minimal. We aimed to investigate the impact of maternal residential mobility on exposure to environmental variables (urban fabric, roads and air pollution (PM10 and NO2)) and socio-economic factors (deprivation) that varied spatially and temporally.MethodsWe used data on residential histories for deliveries at ≥24 weeks gestation recorded by the Northern Congenital Abnormality Survey, 2000–2008 (n = 5399) to compare: (a) exposure at conception assigned to maternal postcode at delivery versus maternal postcode at conception, and (b) exposure at conception assigned to maternal postcode at delivery versus mean exposure based on residences throughout pregnancy.ResultsIn this population, 24.4% of women moved during pregnancy. Depending on the exposure variable assessed, 1–12% of women overall were assigned an exposure at delivery >1SD different to that at conception, and 2–25% assigned an exposure at delivery >1SD different to the mean exposure throughout pregnancy.ConclusionsTo meaningfully explore the subtle associations between environmental exposures and health, consideration must be given to error introduced by residential mobility.


Bixby HRH, Hodgson S, Fortunato L, Hansell A, Fecht Det al., 2015, Associations between Green Space and Health in English Cities: An Ecological, Cross-Sectional Study, PLOS One, Vol: 10, ISSN: 1932-6203


Hodgson S, Manmee C, Dirks W, Shepherd T, Pless-Mulloli Tet al., 2014, Determinants of childhood lead exposure in the postleaded petrol era: The Tooth Fairy cohort from Newcastle upon Tyne, Journal of Exposure Science and Environmental Epidemiology, Vol: 25, Pages: 420-426, ISSN: 1559-064X

Lead is an environmental contaminant causing irreversible health effects in children. We used dentine lead levels as a measure of early-life lead exposure and explored determinants of lead exposure in children living in Newcastle upon Tyne, a historically industrialised UK city, in a cohort born since legislation was introduced to remove lead from petrol, paint and water pipes. The “Tooth Fairy study” cohort comprised 69 children aged 5–8 years. We collected upper deciduous incisors from children and questionnaire data from their parents in 2005. We measured lead levels in pre- and postnatal enamel and dentine using laser ablation inductively coupled plasma mass spectrometry, and assessed associations between dentine lead levels and residential, dietary, lifestyle and socio-economic characteristics. Dentine lead levels were low (mean 0.26 μg/g, range 0.06–0.77); however, we observed considerable variability in dentine lead levels within and between children suggestive of differing exposure levels and/or exposure sources across this population. Variables earlier documented to be associated with childhood lead levels were not found to be significant determinants of dentine lead levels in this study. Exposure pathways should continue to be investigated to enable targeted interventions and prevention of lead-induced health impacts in vulnerable populations.


Ochi S, Hodgson S, Landeg O, Mayner L, Murray Vet al., 2014, Disaster-driven evacuation and medication loss: a systematic literature review, PLoS Currents: Disasters, Vol: 6, ISSN: 2157-3999

AIM: The aim of this systematic literature review was to identify the extent and implications of medication loss and the burden of prescription refill on medical relief teams following extreme weather events and other natural hazards.METHOD: The search strategy followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Key health journal databases (Medline, Embase, PsycINFO, Maternity and Infant Care, and Health Management Information Consortium (HMIC)) were searched via the OvidSP search engine. Search terms were identified by consulting MeSH terms. The inclusion criteria comprised articles published from January 2003 to August 2013, written in English and containing an abstract. The exclusion criteria included abstracts for conferences or dissertations, book chapters and articles written in a language other than English. A total of 70 articles which fulfilled the inclusion criteria were included in this systematic review.RESULTS: All relevant information was collated regarding medication loss, prescription loss and refills, and medical aids loss which indicated a significant burden on the medical relief teams. Data also showed the difficulty in filling prescriptions due to lack of information from the evacuees. People with chronic conditions are most at risk when their medication is not available. This systematic review also showed that medical aids such as eye glasses, hearing aids as well as dental treatment are a high necessity among evacuees.DISCUSSION: This systematic review revealed that a considerable number of patients lose their medication during evacuation, many lose essential medical aids such as insulin pens and many do not bring prescriptions with them when evacuated.. Since medication loss is partly a responsibility of evacuees, understanding the impact of medication loss may lead to raising awareness and better preparations among the patients and health care professionals. People who are not prepared could have worse o


Ochi S, Nakagawa A, Lewis J, Hodgson S, Murray Vet al., 2014, The Great East Japan Earthquake Disaster: distribution of hospital damage in Miyagi prefecture., Prehospital and Disaster Medicine, Vol: 29, Pages: 245-253, ISSN: 1945-1938

Introduction: In catastrophic events, a key to reducing health risks is to maintainfunctioning of local health facilities. However, little research has been conducted on what types and levels of care are the most likely to be affected by catastrophic events.Problem: The Great East Japan Earthquake Disaster (GEJED) was one of a few‘‘megadisasters’’ that have occurred in an industrialized society. This research aimed to develop an analytical framework for the holistic understanding of hospital damage due to the disaster.Methods: Hospital damage data in Miyagi Prefecture at the time of the GEJED werecollected retrospectively. Due to the low response rate of questionnaire-based surveillance (7.7%), publications of the national and local governments, medical associations, other nonprofit organizations, and home web pages of hospitals were used, as well as literature and news sources. The data included information on building damage, electricity and water supply, and functional status after the earthquake. Geographical data for hospitals, coastline, local boundaries, and the inundated areas, as well as population size and seismic intensity were collected from public databases. Logistic regression was conducted to identify the risk factors for hospitals ceasing inpatient and outpatient services. The impact was displayed on maps to show the geographical distribution of damage.Results: Data for 143 out of 147 hospitals in Miyagi Prefecture (97%) were obtained.Building damage was significantly associated with closure of both inpatient and outpatient wards. Hospitals offering tertiary care were more resistant to damage than those offering primary care, while those with a higher proportion of psychiatric care beds were more likely to cease functioning, even after controlling for hospital size, seismic intensity, and distance from the coastline.Conclusions: Implementation of building regulations is vital for all health care facilities,irrespective of func


Hansell AL, Beale LA, Ghosh RE, Fortunato L, Fecht Det al., 2014, The Environment and Health Atlas for England and Wales, Publisher: Oxford University Press, ISBN: 9780198706946

The Environment and Health Atlas for England and Wales is an authoritative collection of over 80 full color maps showing geographic patterns of common environmental exposures and diseases of public health importance, along with interpretive ...


Baker PN, Critchley RJ, Jameson S, Hodgson S, Reed MR, Gregg PJ, Deehan DJet al., 2013, Revision knee replacement in England and Wales: an audit of hospital volume, The Bulletin of the Royal College of Surgeons of England, Vol: 95, Pages: 1-5, ISSN: 1473-6357

Increasing surgeon and hospital volume improves outcome following a range of surgical procedures, including primary and revision knee surgery. Increasing operative volume leads intuitively to greater familiarity and experience. This is particularly important for those surgeons and centres undertaking complex procedures that are often performed infrequently.


Shepherd TJ, Dirks W, Manmee C, Hodgson S, Banks DA, Averley P, Pless-Mulloli Tet al., 2012, Reconstructing the life-time lead exposure in children using dentine in deciduous teeth, Science of the Total Environment, Vol: 425, Pages: 214-222, ISSN: 0048-9697

Data are presented to demonstrate that the circumpulpal dentine of deciduous teeth can be used to reconstruct a detailed record of childhood exposure to lead. By combining high spatial resolution laser ablation ICP-MS with dental histology, information was acquired on the concentration of lead in dentine from in utero to several years after birth, using a true time template of dentine growth. Time corrected lead analyses for pairs of deciduous molars confirmed that between-tooth variation for the same child was negligible and that meaningful exposure histories can be obtained from a single, multi-point ablation transect on longitudinal sections of individual teeth. For a laser beam of 100 μm diameter, the lead signal for each ablation point represented a time span of 42 days. Simultaneous analyses for Sr, Zn and Mg suggest that the incorporation of Pb into dentine (carbonated apatite) is most likely controlled by nanocrystal growth mechanisms. The study also highlights the importance of discriminating between primary and secondary dentine and the dangers of translating lead analyses into blood lead estimates without determining the age or duration of dentine sampled. Further work is in progress to validate deciduous teeth as blood lead biomarkers.


Hodgson S, Beale L, Parslow RC, Feltbower RG, Jarup Let al., 2012, Creating a national register of childhood type 1 diabetes using routinely collected hospital data, Pediatric Diabetes, Vol: 13, Pages: 235-243, ISSN: 1399-5448

Introduction: There is no national register of childhood type 1 diabetes mellitus for England. Our aim was to assess the feasibility of using routine hospital admissions data as a surrogate for a childhood diabetes register across England, and to create a geographically referenced childhood diabetes dataset for use in epidemiologic studies and health service research.Methods: Hospital Episodes Statistics data for England from April 1992 to March 2006 referring to a type 1 diabetes diagnosis in 0–14 yr olds were cleaned to approximate an incident dataset. The cleaned data were validated against regional population-based register data, available for Yorkshire and the area of the former Oxford Regional Health Authority.Results: There were 32 665 unique cases of type 1 and type unknown diabetes over the study period. The hospital-derived data improved in quality over time (91% concordance with regional register data over the period 2000–2006 vs. 52% concordance over the period 1992–1999), and data quality was better for younger (0–9 yr) (86.5% concordance with regional register data) than older cases (10–14 yr). Overall incidence was 24.99 (95% confidence interval 24.71–25.26) per 100 000. Basic trends in age distribution, seasonality of onset, and incidence matched well with previously reported findings.Conclusion: We were able to create a surrogate register of childhood diabetes based on national hospital admissions data, containing approximately 2300 cases/yr, and geo-coded to a high resolution. For younger cases (0–9 yr) and more recent years (from 2000) these data will be a useful resource for epidemiological studies exploring the determinants of childhood diabetes.


Hodgson S, Namdeo A, Araujo-Soares V, Pless-Mulloli Tet al., 2012, Towards an interdisciplinary science of transport and health: a case study on school travel, Journal of Transport Geography, Vol: 21, Pages: 70-79, ISSN: 1873-1236

Background and aimThis paper was conceptualised and informed by discussions at the 2nd Workshop in a UKTRC funded series on ‘Social Impacts and Equity in Transport’. Presentations made by a range of stakeholders as well as a specially commissioned play stimulated our thoughts on how to encourage better interaction between health and transport researchers. We chose school travel as a case study as it exemplifies two key aspects of the wider transport and health debates; (i) the increasing trend towards reliance on car travel, described here in the context of sedentary lifestyles, traffic congestion, pollution, and parental attitudes, and (ii) school travel occurs at a critical life-stage during which behaviour patterns are formed that are likely to be influential in later life, thus making it an important target point for interventions.MethodsWe present evidence from four distinct, but complementary, theoretical perspectives: transport, exposure, behaviour and sustainability. We draw common lessons and identify challenges using a range of conceptual frameworks: integrated psychological model of transport choices, Dahlgren and Whitehead’s ‘layers of influence’ model, Hosking et al.’s ‘pathways from transport to health’, and Hanlon et al.’s integral theory. We demonstrate the benefits and challenges of holistic interaction and collaboration between disciplines to better understand the key issues and develop policy interventions that are meaningful and effective.Results and conclusionsNone of the pre-existing conceptual models were fully able to encompass the societal and individual level influences on school travel. However, we present an interim model for further discussion and debate.


Forrest LF, Hodgson S, Parker L, Pearce MSet al., 2011, The influence of childhood IQ and education on social mobility in the Newcastle Thousand Families birth cohort, BMC Public Health, Vol: 11, ISSN: 1471-2458

Background: It has been suggested that social, educational, cultural and physical factors in childhood and earlyadulthood may influence the chances and direction of social mobility, the movement of an individual betweensocial classes over his/her life-course. This study examined the association of such factors with intra-generationaland inter-generational social mobility within the Newcastle Thousand Families 1947 birth cohort.Methods: Multivariable logistic regression was used to examine the potential association of sex, housingconditions at age 5 years, childhood IQ, achieved education level, adult height and adverse events in earlychildhood with upward and downward social mobility.Results: Childhood IQ and achieved education level were significantly and independently associated with upwardmobility between the ages of 5 and 49-51 years. Only education was significantly associated (positively) withupward social mobility between 5 and 25 years, and only childhood IQ (again positively) with upward socialmobility between 25 and 49-51 years. Childhood IQ was significantly negatively associated with downward socialmobility. Adult height, childhood housing conditions, adverse events in childhood and sex were not significantdeterminants of upward or downward social mobility in this cohort.Conclusions: As upward social mobility has been associated with better health as well as more general benefits tosociety, supportive measures to improve childhood circumstances that could result in increased IQ and educationalattainment may have long-term population health and wellbeing benefits.


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