Current research projects

A general framework to adjust for missing cofounders in observational studies - Small Area Methodology 4

Project aims

This is a methodological project to help enhance the use of administrative data such as hospital admissions, cancer registrations and mortality in health research. Assessing the impact of a risk factor/exposure X on a health outcome Y in observational (epidemiological) studies is invariably subject to confounding issues. Cohort (individual-level) studies are an ideal source of information as they typically contain a rich set of individual level variables. Nevertheless, a study based only on a cohort may suffer from problems of selection bias and lack of population representativeness. Cohort studies may also lack statistical power to assess rare outcomes, and geographical or other group-level variations which limits the extent to which contextual factors such as area level social deprivation can be investigated.

Routinely collected administrative data are a good alternative in terms of representativeness; however, these data sources typically have a limited number of variables for a large population, and might miss important predictors/confounders leading to potentially biased estimation of the risks.

We propose a general framework that integrates these two sources of data and build a propensity score like index to summarise the values of the confounders from the cohorts/surveys so we will need to impute only one variable when missing; through a flexible model the index will be included in the epidemiological analysis to provide a direct estimate of the link between X and Y.

We are now extending the project to the individual level, to overcome ecological bias, which arises in ecological studies. We are going to evaluate the association between exposure and health outcome at postcode level (from the routinely collected administrative data) and use the survey data to adjust for the additional confounders not available in the administrative dataset.

Period and geography

1994 - 2001
2006 - 2011
1999-2003

Data

NHS Digital HES admitted patient care

CVD/Asthma

Respiratory conditions

ONS Cancer registrations - lung cancer

Health Survey for England Millennium Cohort study

Data from Health Survey for England for 2002 onwards will also be requested, UK Biobank 2006-2010

Contact

Professor Marta Blangiardo

Publications

Wang Y, Pirani M, Hansell AL, Richardson S, Blangiardo M. Using ecological propensity score to adjust for missing confounders in small area studies. Biostatistics. 2017 Nov 9. https://academic.oup.com/biostatistics/article/20/1/1/4607906

A natural experiment of the Western Extension to the London Congestion Zone

Project aims

This project will use data on air pollution concentrations and hospital admissions between 2003 and 2014. Air pollution data (nitrogen dioxide and particulate matter) will be linked to residential addresses. This will allow us to examine exposure to air pollution before, during and after the implementation of the Western Extension Zone. We will assess all hospital admissions, and admissions for all respiratory and all cardiovascular diseases separately. These will be combined with population data to examine hospitalisation rates. We will have one intervention group of the residents compared with two other groups: one from just outside the area and another similar in terms of deprivation.

Period and geography

2003-2014

England

Data

NHS Digital HES: Admitted patient care

Contact

Dr Anthony Laverty

Air Pollution Mixtures -Tools for characterising multi-pollutant patterns of exposure for use in environmental health studies

Project aims

Objective 1: Development of statistical methodology: a general Bayesian profile-based multi-pollutant modelling framework to examine patterns of air pollution exposures and relate these patterns to socio-economic characteristics and health outcomes. 

Objective 2: Substantive Applications: To investigate the benefit of using multi-pollutant profiling methods to characterize patterns of air pollution exposures and relate these exposure patterns to indicators of health and socio-economic status. Patterns of highly correlated exposures at different geographical levels will be characterized using the profiling methodologies. Input data used will be (i) exposure estimates of NO2, NOx, PM2.5, PM10, and Ozone in Greater London from the Environmental Research Group, King’s College London, (ii) air pollutant data including particulate metals concentrations in Greater London and the Thames Valley area from the European Union funded European Study of Cohorts and Air Pollution Effects (ESCAPE) and Transphorm projects.

New statistical models (Bayesian non-parametric profile regression) will be used to fit flexible regression models between exposure profiles and health outcomes such as all-cause and cardiovascular mortality and hospital admissions and birth outcomes (birthweight and pre-term birth). Models will be adjusted for lung cancer incidence (using ONS cancer registration data) as a proxy for smoking. Comparisons will be made with results using standard statistical regression techniques. 

Data

ONS mortality

ONS births

ONS cancer registrations

NHS Digital HES admitted patient care & maternity

Contact

Dr Fred Piel

Publications

Georgious P, Richardon S, Best N. Bayesian non-parametric models for spatially indexed data of mixed type. J R Statist Soc Series B Dec 2014. http://onlinelibrary.wiley.com/doi/10.1111/rssb.12097/full

Aircraft noise and cardiovascular outcomes (ANCO)

Project aims

Transport noise is an under-studied ubiquitous environmental pollutant with important implications for public health, transport policy and urban planning. Aircraft noise already affects more people in the UK than any other European country. While there is a large body of research on annoyance and sleep disturbance from aircraft noise, there is very limited epidemiological evidence on aircraft noise and cardiovascular disease despite good biological plausibility for noise impacts on cardiovascular and metabolic functioning. These include physiological and psychological stress responses affecting metabolic factors (e.g. glucose, insulin, body mass index (BMI), waist-hip ratio heart rate variability (HRV) and inflammatory pathways e.g. C-reactive protein (CRP) levels, supported by experimental studies of short-term exposure.  This Medical Research Council funded study aims to investigate associations between aircraft noise near major UK airports measured in different ways (noisy events, average noise) and hospital admissions and mortality. Potential pathways and mechanisms will be further explored using cohort data, for which ethics approvals will be sought separately.

The project will use aircraft noise measures (average noise, noisy events) using data from the Civil Aviation Authority, routine mortality and hospital admission data from NHS Digital and the Office for National Statistics and analysis of individual data from two well-characterised cohorts: UK Biobank giving national coverage, and the SABRE cohort, which is based in west London. Additional data on air pollution and road noise will be sourced from SAHSU datasets and a measurement campaign will be conducted near Heathrow and Gatwick airports for ultrafine particles.

Data

ONS Mortality

NHS Digital HES

Census population from ONS

Aircraft noise, Road traffic noise and air pollution levels from Imperial and Kings study team members, the Civil Aviation Authority, Defra and national Data Air Quality Archive

Contact

Dr Marta Blangiardo

Analysis of HES inpatient data for CO hospital admissions in England

Project aims

Carbon monoxide (CO) poisoning, including Accidental non-fire-related (ANFR) poisoning, is a recognized public health problem.  This study aimed to better characterize the burden of disease in terms of hospital admissions and A&E attendances. The first phase of this study investigated trends CO hospital admissions in England from 2001-2010 (using HES inpatients data) by age, sex, geography, ethnicity and deprivation, with a paper published in 2015

In phase two, A&E attendances for CO poisoning will be investigated, followed by development of methodologies to link across A&E and HES inpatients datasets to explore presentation patterns for patients ultimately diagnosed with CO poisoning and estimation of spatial uncertainty in these patterns or trends. 

Period and geography

2007-2012

Data

NHS Digital HES admitted patient care

Contact

Dr Fred Piel

Publications

Ghosh RE; Close R; McCann LJ; et al. Analysis of hospital admissions due to accidental non-fire-related carbon monoxide poisoning in England, between 2001 and 2010. Journal of Public Health Mar 2015; http://jpubhealth.oxfordjournals.org/content/early/2015/03/27/pubmed.fdv026.long

Roca-Barceló, A., Ghosh, R., Close, R., Fletcher, T., Leonardi, G., Hansell, A.L., Davies, B. & Piel, F.B. (2019) Temporal trends in hospital admissions due to carbon monoxide poisoning in England and other high-income countries. European Journal of Epidemiology Jul 2020.
https://academic.oup.com/jpubhealth/article/38/1/76/2362876

Asthma admissions and grass pollen counts, levels and potency in London and its surroundings

Project aims

Airborne outdoor pollen is a major cause of asthma hospital admissions. Current exposure assessment methods rely primarily on daily changes in the number of airborne pollen counts and thus do not capture changes in the true biological allergenic potential of the air (i.e. allergen levels). Using unique pollen data available in London, this project will test the hypotheses that asthma hospitalizations increase with increasing airborne allergen levels, and that this association is underestimated by current exposure assessment methods based only on pollen counts.

Period and geography

May 2013 - September 2013

England

Data

NHS Digital HES: Admitted patient care and emergency care

Contact

Dr Elaine Fuertes

Build environment and health in English cities

Project aims

The aim of this project is to evaluate the relationships between air pollution, noise, greenness and neighborhood walkability and mortality within major cities in England. Measures of each of these environmental factors will be linked at postcode level to mortality records and evaluated to assess the strength of relationships after accounting for area-level mobility, ethnicity and other risk factors for death (tobacco, alcohol, physical activity). Project outcomes include descriptive information on the distributions of air pollution, noise, greenness and walkability within and between all cities in England with populations above 500,000. Analyses will identify which of these environmental factors are the strongest predictors of mortality for major (e.g. cardiovascular, respiratory, neurologic) causes. Results will help cities and citizens prioritize environmental factors for healthy urban design.

Data

ONS mortality data

Contact

Dr Daniela Fecht

Climate and climate change

Project aims

This study will look at how climate change affect temperature-related mortality in the UK and how can we reduce its mortality impacts in vulnerable communities. We will quantify the effects of temperature on mortality, and subsequently on hospital admissions, by small area and examines the individual and community determinants of the temperature mortality relationship. 

The aims of the study are to:

  • estimate dose-response relationships for the effects of temperature on mortality by small area in the warm and cold seasons;
  • assess how the dose-response relationships may be applied in a changing climate;
  • identify individual characteristics that make people vulnerable and resilient to the effects of temperature on mortality;
  • identify community characteristics that affect vulnerability and resilience to the effects of temperature on mortality;
  • estimate the effects of temperature on hospital admissions and hospital cost.

Data

ONS mortality

NHS Digital HES admitted patient care

Contact

Professor Majid Ezzati

Publications

Bennett JE, Blangiardo M, Fecht D, Elliott P, Ezzati M. Vulnerability to the mortality effects of warm temperature in the districts of England and Wales. Nature Climate Change 2014; 4(4):269-273 http://www.nature.com/nclimate/journal/v4/n4/full/nclimate2123.html

COMARE - Reports on childhood cancer incidence around nuclear installations in England, Wales and Scotland for the Committee on the Medical Aspects of

Project aims

This project will examine rates of childhood cancers in neighbourhoods around nuclear installations in England, Scotland and Wales. The work has been requested by the Committee on the Medical Aspects of Radiation in the Environment (COMARE) as part of ongoing surveillance of these facilities. We will examine rates of new cancers (incidence) of all childhood cancers and specific subtypes such as leukemia and lymphomas in the vicinity (within 25km) of 49 sites regulated by the Office for Nuclear Regulation, including 10 decommissioned and five partially operational installations.  We will compare rates near sites with national and regional rates to determine if there is any excess. We will also perform statistical tests to investigate whether there are clusters of cancers near sites. Analyses will take into account population and socio-economic characteristics of areas that may influence childhood cancer rates. The work will form part of a future report by COMARE, updating previous reports published in 2011 and 2005.

Period and geography

1974-2016 (or most recent year available)

England, Scotland and Wales

Data

Cancer data from Public Health England and the Office for National Statistics historical data

Welsh Cancer Intelligence & Surveillance Unit and the Scottish Information Services Division

Contact

Dr Bethan Davies

Spatio-temporal patterns in excess mortality and morbidity in England during Covid-19 pandemic

Project aims

As of 23rd March 2020, the UK public health response to the Covid-19 pandemic include school closures and social distancing measures, strongly recommended for people over 70 year, those with an underlying health condition or who are pregnant. In addition, the NHS is expanding critical care capacity to the maximum, freeing up at least 30,000 of the 100,000 general and acute beds and acquiring a further 8,000 beds from within the private sector.  This project aims to inform the UK public health and NHS response to this emergency by determining the spatio-temporal patterns in excess mortality and morbidity during the COVID-19 pandemic.

Period and geography

2015-current

England

Data

NHS Digital HES England

ONS live births and still births

ONS Mortality

PHE Cancer registrations

Contact

Dr Bethan Davies

Publications

Davies B, Parkes B, Bennett J, Fecht D, Blangiardo M, Ezzati M, Elliott P. Community factors and excess mortality in first wave of the COVID-19 pandemic in England. Nat Commun 12, 3755 (2021). https://doi.org/10.1038/s41467-021-23935-x

Spatio-temporal patterns in excess mortality and morbidity during Covid-19 pandemic: cross-country comparison

Project aims

To quantify, describe and understand observed patterns in excess mortality at small-area level during the Covid-19 pandemic in England and Italy and other comparator nations.

This study is an extension to the ongoing project 202003/07 Covid-19 Pandemic.

At high spatial resolution and for the duration of the pandemic, we will:

  1. quantify excess mortality by demographic profiles;
  2. map excess mortality at high spatial resolution;
  3. determine the association between area-level factors (demographic, socio-economic, environmental) and excess mortality.
  4. assess differences between in patterns of excess mortality in the first and the second wave;
  5. assess differences in the patterns of excess mortality between countries

Period and geography

2015-2019

England

Data

NHS Digital HES England

ONS Civil Registration Data - Death

Contact

Professor Marta Blangiardo

Evaluating temperature related hospital admission for asthma in England: A nationwide case-crossover study during 2007-2018

Project aims

The Earth’s climate is changing and temperature levels across the globe are rising as anthropogenic factors including greenhouse gas emissions from transportation, power generation, and other uses of fossil fuels, warm the planet. Changes in temperature could increase the risk of an admission to hospital for asthma directly or indirectly by, for example, increasing allergen (e.g. pollen) concentrations that are associated with worsening asthma symptoms. The goal of this project is to examine the effect of warm temperatures on hospital admissions for asthma.

Period and geography

2007-2018

England

Data

NHS Digital HES data; Inpatient and A&E

Contact

Dr Marta Blangiardo

Evaluating the burden of climate-related respiratory disease using high resolution spatiotemporal models

Project aims

This study will develop comprehensive statistical models and quantify the effect of extreme temperatures with respect to respiratory health. Nationwide data will be used and will focus on the four most populous cities which, due to high buildings and poor air quality are known to experience higher temperatures than neighbouring rural areas. The aims of this study are to predict future respiratory hospitalization based on different emissions scenarios and quantify corresponding costs and examine how increasing the land area of green spaces in cities can help decrease future respiratory hospitalizations.

Period and geography

England and Wales

Data

NHS Digital HES

Contact

Dr Garyfallos Konstantinoudis

Evaluating the effect of short- and long-term Ozone exposure on admission to hospital for COPD in England: A nationwide case-crossover study

Project aims

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are one of the commonest reasons for emergency admission to hospital, with 115,000 admissions per year in England. The main causes of COPD exacerbations include bacterial and viral infections, cold weather and interruption of regular treatment. Air-pollution and in particular ambient NOand PM2.5 concentration have been linked with increase COPD symptoms. Fewer studies have focused on the effect of Ozone (O3).  The goal of this project is to examine the effect of short and long term Oexposure on hospital admissions for COPD.

Period and geography

2007-2018

England

Data

NHS Digital HES data; Inpatient and A&E

Contact

Dr Marta Blangiardo

Forecasting small-area mortality using a Bayesian spatio-temporal approach-Small Area Methodology 3

Project aims

The aim of the project is to develop, test and apply statistical methods for estimating both historical and projected trends in total and cause-specific mortality.

Data

ONS Mortality

Contact

Professor Majid Ezzati

Dr James Bennett

Publications

Bennett JE, Li G, Foreman K, Best N, Kontis V, Pearson C, Hambly P, Ezzati M. The future of life expectancy and life expectancy inequalities in England and Wales: Bayesian spatiotemporal forecasting. Lancet April 2015; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60296-3/abstract

Geographic inequalities in AMI case-fatality in hospitalised patients in England: the role of multi-morbidity

Project aims

The overall aim is to understand patterns of multi-morbidity in hospitalised AMI patients and their role in AMI mortality, nationally and sub-nationally.

Period and geography

England

Data

NHS Digital HES: Admitted patient care and emergency care

ONS linked mortality

Contact

Professor Majid Ezzati

Greenspace exposure and health – a question of scale?

Project aims

Greenspaces have started to be considered crucial components to improve public health in cities based on evidence on the health and wellbeing benefits of exposure to green (and blue) spaces.

Recent studies have explored the potential pathways by which greenspaces impact health such as availability, accessibility, and visibility of greenspaces, with sometimes inconclusive results. One explanation is that studies so far have paid little attention to the spatial context in which relationships have been observed with most studies using a single spatial entity, for example, neighbourhoods.

Little is known about how different spheres of influence in terms of spatial scales (e.g. local authorities, wards, neighbourhoods,) can influence the direction, strength and significance of statistical relationships of varying greenspace exposure metrics with health. This project will investigate the effect the scale on the relationships of greenspace exposure with health outcomes in a UK city context, using Greater Manchester as a case study.

Period and geography

England

Data

NHS Digital HES England; Inpatient

Contact

Dr Daniela Fecht

Health Impact Assessment of air pollution on asthma in London (2)

Project aims

Following a decrease in air pollution in London due to emission reduction policies such as the introduction of the T-charge and the Ultra Low Emission Zone, we will estimate how asthma admissions associated with air pollution in London might have changed since 2016. This is a follow-up from our previous health impact assessment of air pollution on asthma in London conducted in 2019.

Period and geography

2014-2016 & 2017-2019

London

Data

NHS Digital HES England; Inpatient and A&E

Contact

Dr Daniela Fecht

Health Inequality

Project aims

Growing policy concerns about health inequalities highlight the importance of examining associations between deprivation and health outcome more comprehensively than has been done to date. We have therefore extended the work done on the Multiple Deprivation study, aiming at quantifying the patterns of major causes of mortality and morbidity in relation to socio-economic factors, such as income, employment and education. We are considering all-cause mortality as well as mortality from specific causes and incidence of specific cancers. The purpose is to quantify the variation in disease rates at small area scale and determine variation by socio-economic factors.

Data

ONS Mortality

ONS Cancer registrations

Contact

Professor Majid Ezzati

Impact of environmental factors on cystic fibrosis disease progression

Project aims

The objective of this project is to investigate the impact of environmental factors (including air pollution and climate) on disease progression and a range of specific complications, such as respiratory infections and liver disease. We will particularly aim at identifying potential clusters of patients or disease complications and explore possible environmental risk factors at small area level. While space-time analyses will be conducted using data from the CF Registry, using HES inpatient data on CF would provide a useful validation of the CF Registry data and could provide valuable additional data.

Period and geography

1990-2015

Data

NHS Digital HES admitted patient care data on Cystic fibrosis  

Contact

Dr Fred Piel

Impact of environmental inequities on health in England

Project aims

Aim of this project is to analyse the relationship between environmental exposures, socio-economic characteristics and health in Great Britain and explore temporal trends and spatial patterns in these relationships.

Period and geography

1991-2016

England

Data

Hospital Episode Statistics admitted patient care

ONS mortality including infant mortality

ONS still births

PHE cancer incidence

WCISU cancer incidence and Scottish cancer incidence

Contact

Dr Daniela Fecht

Professor John Gulliver

PhD: Impact of the London Ultra Low Emission Zone on health outcomes across the life course

Project aims

The Ultra Low Emission Zone (ULEZ) was introduced in central London in April 2019. To enter the zone, vehicles are required to meet set emissions standards, or else pay a charge. The ULEZ is predicted to positively impact health outcomes, by reducing the exposure of residents living within the ULEZ to traffic-related air pollution. This project aims to measure the health impacts and assess whether the health impacts differ depending on demographic or socio-economic factors. The health impacts of interest include birth outcomes, childhood asthma and adult cardiovascular and respiratory health.

Period and geography

2014-2022

England

Data

NHS Digital HES

ONS live births

ONS Mortality

Contact

Rosemary Chamberlain

Dr Daniela Fecht

Long term expose to air-pollution and COVID‐19 mortality: The role of pre‐existing conditions

Project aims

This project builds on current research of our team investigating the effect of long-term exposure to air pollution on COVID-19 mortality. In a recent paper we found a 3% increase in COVID-19 mortality for every 1μg/m^3 increase in the long-term exposure to NO2. Nevertheless, long term exposure to air-pollution can trigger certain comorbidities (e.g. chronic obstructive pulmonary disease), which are known to increase COVID-19 mortality. Thus, the effect we reported can be attributed to certain comorbidities. 

Period and geography

England

Data

NHS Digital HES

ONS Mortality

Contact

Dr Garyfallos Konstantinoudis

Model for small-area trends in cause-specific and all-cause mortality - Small Area Methodology 2

Project aims

The aim of the project is to develop, test and apply statistical methods for estimating both historical and projected trends in total and cause-specific mortality.

Data

ONS Mortality

Contact

Professor Majid Ezzati

Dr James Bennett

Publications

Bennett JE, Li G, Foreman K, Best N, Kontis V, Pearson C, Hambly P, Ezzati M. The future of life expectancy and life expectancy inequalities in England and Wales: Bayesian spatiotemporal forecasting. Lancet April 2015; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60296-3/abstract

NIH Spatial uncertainty in small area analysis from survey and administrative data

Project aims

The aims of this collaborative project with researchers from Emory and Harvard universities are: i) to describe spatial uncertainty, with a particular focus on census data and sampling-based risk denominators and covariates (e.g., from the US American Community Survey (ACS) or UK Population Coverage Survey (PCS)); ii) to model spatial uncertainty through a flexible, model-based framework that accounts for uncertain elements within small area estimation and disease mapping accurately, reliably, and reproducibly; and iii) to develop improved ways of communicating and visualizing spatial uncertainty.

Data

PHE cancer registrations: lung cancer

ONS mortality (under-5 mortality)

Contact

Dr Fred Piel

Pathways to equitable health cities

Project aims

This project aims to understand the impacts of planning and policy actions on population health and on health inequalities, focusing on cities in five countries (Bangladesh, Canada, China, Ghana and the UK). We will capture spatial inequalities in health focusing on mortality, hospitalisation, cancer incidence and birth outcomes (prematurity and birth weight) using methods from spatial and spatio-temporal statistics. We will also use environmental epidemiological models to simulate how specific actions related to housing, neighbourhood design, transportation, sanitation, water and safety and health services impact population health, which will help inform planning and policy decisions. Our work is in close collaboration with the PHE.

Data

ONS/NHS Digital/PHE:

HES Admitted Patient Care, HES Accident and Emergency Attendances

Birth and Death registrations

Cancer incidence from 2001 onwards.

Environmental exposures will be assigned to health records using the residential postcode and following standard SAHSU procedures.

Contact

Professor Majid Ezzati

PhD topic: Time series analysis of air pollution

Project aims

It is now widely accepted that air pollution is harmful to human health. The association between elevated ambient air pollution and the increment of hospital admissions due to respiratory and cardiovascular disease has been reported in many studies. Most of these studies rely on data from air pollution monitors, which might be sparse. We have developed detailed air pollution exposure maps for nitrogen dioxide (NO2), particulate matter (PM2.5, PM10), and ozone (O3) at fine spatial and temporal scales for Great Britain from 2010 to 2015. This study will examine the relationship between short-term air pollution exposure and the risk of hospital admission for respiratory and cardiovascular diseases.

Data

NHS Digital HES admitted patient care

Contact

Dr Daniela Fecht

Professor John Gulliver

Population and socio-economic data update - Small Area Methodology 6

Project aims

Most small area studies use spatially and temporally detailed population and socio-economic data either as denominator population for calculating rates or risks or as confounder information.
The aims of this project are:

  • To update the socio-economic database (e.g. Carstairs index, ethnicity) in light of the decennial census at small area level
  • To update and clean the existing SAHSU postcode database which includes annual residential postcodes in Great Britain (currently 1981 – 2019) and to attach the census geographical identifiers
  • To explore the impact of the denominator population on rate calculation by exploring the effects of different denominator estimates (a) SAHSU population, b) ONS population) on mortality rates in England between 2001 and 2015 and explore spatial differences by region and Local authority.

Data

ONS mortality

Contact

Dr Daniela Fecht

Project scoping - sample size estimations

Project aims

Good research practice involves designing and conducting research studies that are appropriate based on the research questions and hypotheses. For the epidemiological studies that SAHSU undertake, this includes considering whether the analysis will be able to detect a difference in the occurrence of the outcome in individuals or communities who have different levels of exposure to the environmental factors under study, and considering how precise the resulting estimates of the associations between exposures and outcomes will be. These questions are formally assessed through sample size calculations.

Period and geography

Project specific

Data

All project specific

Contact

Dr Bethan Davies

Reduced noise Impacts on Short-Term Aircraft Noise and Cardiovascular Outcomes (RISTANCO)

Project aims

The aim of this NIHR funded study is to examine short-term impacts of aircraft noise on acute cardiovascular hospital admissions and mortality events and also to examine potential mitigation strategies through respite periods if associations are detected. The study will exploit the natural experiment of short-term changes in aircraft noise related to flight path changes due to operational reasons and wind direction changes, which make major changes to noise levels on the ground. A case-crossover approach will be used to look at impact of aircraft noise and noise changes on same day and lagged days. Time varying confounders such as air pollution and temperature will be included in the model. Confounders such as personal lifestyle habits, age, sex, ethnicity and day of week effects will be controlled for by the analysis design.

Data

NHS Digital HES data

Mortality data from ONS stroke coronary heart disease and cardiovascular disease
Meteorological Office data for meteorological data on temperature and humidity

Air pollution data provided by the Environmental Research Group at Kings College London, 2011

Census and the small area-level Index of Multiple Deprivation (IMD) data

Contact

Dr Marta Blangiardo

Small area variation in coronary heart disease event rates, mortality and survival in England

Project aims

When broken down by medical causes, one half of the regional differentials in mortality in England are accounted for by Coronary heart disease (CHD). It is however unknown what proportion of the variance in CHD mortality among small area units such as wards or local authorities is due to differences in CHD event rates vs. treatment. Incident CHD, unlike incident cancer or sexually transmitted disease, is not comprehensively recorded in England. While circulatory diseases are the single largest medical cause of death, very little is known about the differences between small areas in event rates or prognosis of CHD. This limits the evaluation of current preventive and health service interventions aimed at reducing CHD incidence and improving survival, especially in the worst-off regions. The HES linked mortality data will then be used in a geographically referenced Bayesian hierarchical model, to derive consistent and comparable quantification of CHD event rates for small areas in England.

Data

ONS Mortality

NHS Digital HES admitted patient care

Contact

Professor Majid Ezzati

Publications

Asaria P, Fortunato L, Fecht D, Tzoulaki I, Abellan JJ, Hambly P, de Hoogh K, Ezzati M, Elliott P. Trends and inequalities in cardiovascular disease mortality across 7932 English electoral wards, 1982-2006: Bayesian spatial analysis. International Journal of Epidemiology 2012; 41(6):1737-1749 http://ije.oxfordjournals.org/content/41/6/1737

Media

Imperial News: Heart disease map of England highlights growing social inequality in older ages

Richard Horton, Editor-in-Chief, The Lancet, asks people to send the paper to their MP

BBC News: Over-65s heart death gap 'wider' between rich and poor

Hackney Gazette: Hackney one of worst places in country for heart disease

Spatio-temporal patterns in kidney cancer incidence in adults in England, 1981-2019

Project aims

Incidence rates of kidney cancer in the UK have doubled since the 1990s and it is currently the 7th most commonly diagnosed cancer (n=12,900 cases per year).  This temporal trend cannot be fully explained by secular changes in smoking or obesity prevalence. To generate hypotheses on the aetiology of kidney cancer risk, we will apply spatio- temporal epidemiological methods to analyse variability in the incidence of kidney cancer in England.

Period and geography

1981-2019

England

Data

PHE Cancer Registrations

NHS Digital HES England: admitted patient care

ONS Mortality

Contact

Dr Bethan Davies

PhD: Understanding effect modifiers of the relationship between health and exposure to urban green and blue space

Project aims

Despite a body of evidence linking green and blue space exposure to physical health benefits, specific effect modifiers of this association are currently understudied or unknown. The aim of this PhD project is to identify and assess important factors that might act as modifiers of the relationship between urban green/blue space and health.

Period and geography

England

Data

NHS Digital HES: Admitted patient care

Contact

Richard Belcher

Vulnerability to Climate Change: Inequalities in exposure, susceptibility and adaptation capacity in two metropolises

Project aims

The overall aim of this PhD is to characterize the vulnerability to temperature changes of the citizens of Sao Paulo (Brazil), London and Greater Manchester (United Kingdom), from the perspective of their exposure, sensitivity and adaptation capacity, and to quantify the impact of these vulnerabilities on the temperature-related mortality and morbidity (i.e. hospital admission and A&E data) association, for all-cause and specific outcomes using data between 1990 and 2020 (when available).

Period and geography

1990-2020

England

Data

NHS Digital HES: Admitted patient care and Emergency care

Contact

Professor Paolo Vineis