Abstract
Small-area studies offer a powerful epidemiological approach to study disease patterns at the population level and assess health risks posed by environmental pollutants. They involve a public health investigation on a geographical scale (e.g. neighbourhood) with overlay of health, environmental, demographic and potential confounder data. Recent methodological advances, including Bayesian approaches, combined with fast-growing computational capabilities, permit more informative analyses than previously possible, including the incorporation of data at different scales, from satellites to individual-level survey information. Better data availability has widened the scope and utility of small-area studies, but has also led to greater complexity, including choice of optimal study area size and extent, duration of study periods, range of covariates and confounders to be considered and dealing with uncertainty. The availability of data from large, well-phenotyped cohorts such as UK Biobank enables the use of mixed-level study designs and the triangulation of evidence on environmental risks from small-area and individual-level studies, therefore improving causal inference, including use of linked biomarker and -omics data. As a result, there are now improved opportunities to investigate the impacts of environmental risk factors on human health, particularly for the surveillance and prevention of non-communicable diseases.
Highlights
A range of environmental exposures may impact human health, but our level of understanding and awareness of these links is highly variable
There has been a focus on the health effects of outdoor air pollution,[1,2,3] climate change[4,5,6] and ionizing radiation,[7,8] possible health risks associated with other widespread exposures, such as noise pollution,[9,10]
Together with a discussion of future challenges going forward, we aim to summarize the basis for rigorous analyses of environment and health risks using the small-area approach
Summary
A range of environmental exposures may impact human health, but our level of understanding and awareness of these links is highly variable. The smoking bans enforced throughout Europe in the 2000s and the recent sugar tax implemented in Mexico and the UK highlight the potential for rapid impact of such public health policies.[14,15] the inability to date to reduce air pollution to legal or recommended levels in London and other large cities reflects some of the challenges involved in translating scientific evidence into policies and their implementation.[16]
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