Electoral Ward Level Research Articles

Street-scale air quality modelling over the West Midlands, United Kingdom: Effect of idealised traffic reduction scenarios

Air pollution is the major environmental risk to human health. Road transport is one of the major sources for air pollution, particularly nitrogen dioxide, in urban areas, and hence traffic control is an important measure in air quality management. A street-scale air quality model, ADMS-Urban, was configured for a case study of the West Midlands, UK to represent a baseline year (2019). Model outputs were evaluated using hourly air pollutant measurement data, and the model demonstrates good performance overall. This modelling tool was then used to explore the effect of five hypothetical traffic reduction scenarios, ranging from 10% to 90% reduction in traffic activity; scenario impacts were analysed over a range of spatial resolutions. The impacts of traffic reduction are highly dependent on spatial resolution (i.e. street scale, electoral ward level and local authority level), which has to be taken into account when formulating policies for managing air quality on local and city-wide scales. There was an almost linear relationship between the predicted annual concentration and traffic reduction for both NO2 and PM2.5. Traffic reduction would principally reduce NO2 concentrations, with even very substantial changes in traffic having more limited effects on reducing PM2.5 concentrations reflecting the importance of regional and non-traffic PM2.5 sources.

Earthquake and Fire Hazard Risk Perception: A Study on the Emerging Rangpur City of Bangladesh

Rangpur city is one of the emerging cities in Bangladesh. In 2012, this city upgraded from municipality to city corporation. On the one hand, the city population started to increase; on the other hand, vulnerability to earthquake and fire hazards are increased due to rapid urbanization. Therefore, we investigate the risk perception of earthquake and fire hazards in Rangpur. The purpose of this study is fourfold: (i) to assess the risk perception of earthquake hazards and fire hazards at the household level; (ii) to investigate the influence of demographic and socio-economic factors on the risk perception of each hazard; (iii) to investigate the preparedness for earthquake and fire hazards; and (iv) to propose planning guidelines and policy interventions for the disaster resilience of the Rangpur city focusing on earthquake and fire hazards. We conducted a questionnaire survey with 558 participants and 9 semi-structured interviews in fifteen electoral wards in Rangpur city. Afterward, we analyzed the data in SPSS and ArcMap platforms. The study results show that socio-demographic indicators such as gender, household ownership type, and residential floor are likely to influence citizens’ risk perception. We also find that the spatial distribution of risk perception of both hazards is diversified at the electoral ward level. At the same time, we observe that the level of preparedness for both hazards is not satisfactory. Based on the study findings, we recommend a few planning guidelines and policy interventions for disaster resilience in Rangpur city.

Challenges and learning in carrying out an enhanced sample to provide small area data for the dental survey of five-year-old children in England.

To investigate the method, learning and challenges of using an enhanced sample to provide small area data for the dental survey of five-year-old children in England. Pilot in six London local authorities, of increased sample size during a national survey to enable a more precise sample size calculation to deliver information accurate at electoral ward level. Challenges were explored through interviews with the teams who either planned or conducted the survey. A revised sample size recommendation for the national guidance on carrying out dental surveys of five-year-old children in England, where caries levels are similar to those seen in the pilot areas; the challenges identified were gaining access to schools and consent from parents, making the calculation for the additional sample and securing sufficient workforce. This paper has described a method for delivering small area caries data by increasing the size of the sample. Learning, and understanding the outcomes and challenges from this work can inform planning and delivery of future surveys using an enhanced sample at ward level.

The Advocacy for Pedestrian Safety Study: Cluster Randomised Trial Evaluating a Political Advocacy Approach to Reduce Pedestrian Injuries in Deprived Communities

ObjectiveTo determine whether advocacy targeted at local politicians leads to action to reduce the risk of pedestrian injury in deprived areas.DesignCluster randomised controlled trial.Setting239 electoral wards in 57 local authorities in England and Wales.Participants617 elected local politicians.InterventionsIntervention group politicians were provided with tailored information packs, including maps of casualty sites, numbers injured and a synopsis of effective interventions.Main outcome measures25–30 months post intervention, primary outcomes included: electoral ward level: percentage of road traffic calmed; proportion with new interventions; school level: percentage with 20 mph zones, Safe Routes to School, pedestrian training or road safety education; politician level: percentage lobbying for safety measures. Secondary outcomes included politicians’ interest and involvement in injury prevention, and facilitators and barriers to implementation.ResultsPrimary outcomes did not significantly differ: % difference in traffic calming (0.07, 95%CI: −0.07 to 0.20); proportion of schools with 20 mph zones (RR 1.47, 95%CI: 0.93 to 2.32), Safe Routes to School (RR 1.34, 95%CI: 0.83 to 2.17), pedestrian training (RR 1.23, 95%CI: 0.95 to 1.61) or other safety education (RR 1.16, 95%CI: 0.97 to 1.39). Intervention group politicians reported greater interest in child injury prevention (RR 1.09, 95%CI 1.03 to 1.16), belief in potential to help prevent injuries (RR 1.36, 95%CI 1.16 to 1.61), particularly pedestrian safety (RR 1.55, 95%CI 1.19 to 2.03). 63% of intervention politicians reported supporting new pedestrian safety schemes. The majority found the advocacy information surprising, interesting, effectively presented, and could identify suitable local interventions.ConclusionsThis study demonstrates the feasibility of an innovative approach to translational public health by targeting local politicians in a randomised controlled trial. The intervention package was positively viewed and raised interest but changes in interventions were not statistically significance. Longer term supported advocacy may be needed.Trial RegistrationCurrent Controlled Trials ISRCTN91381117

White Mobility and Minority Ethnic Concentrations: Exploring Internal Migration Patterns for Electoral Wards in England and Wales using the 2001 Census

Patterns of ethnic residential segregation within England and Wales have been linked to the idea that white people move away from, or avoid moving into, areas with large minority ethnic populations. Using analysis of the 2001 census, this paper explores the internal migration of the ‘White British’ ethnic group within England and Wales at the electoral ward level. It shows migration patterns are more complex than simply ‘white flight’ or ‘white avoidance’: areas of high minority ethnic concentrations with low inflows of the White British ethnic group are also areas of low outflows of the White British ethnic group; areas of high minority ethnic concentrations with high inflows of the White British ethnic group are also areas of high outflows of the White British ethnic group. Local area characteristics are stronger predictors of White British ethnic group mobility than whether the area is characterised by concentrations of minority ethnic groups.

Matching deprivation mapping to urban governance in three Indian mega-cities

Recent discussions of poverty recognize its multi-dimensional character, focusing on multiple sources of deprivation that poor households experience. However, for urban planners and politicians to implement intervention programs effectively in mega-cities, knowledge on sources and spatial patterns of multiple deprivations is needed. Disaggregated analysis potentially allows them to target programs to specific locations, set priorities in line with local needs, and be efficient in the use of funding. This article maps multiple deprivations of households in three Indian mega-cities, at the electoral ward level. It uses the livelihoods approach to address the following questions: 1) Is there a spatial concentration of deprivations within cities and do poverty levels differ between them? 2) Do cities differ in the types of deprivations? and 3) do these cluster within the city? The paper compares Delhi, Mumbai and Chennai, using a multi-criteria model within a geographical information system developed for identifying hotspots of multiple deprivation. It further links the results of deprivation mapping to questions of urban governance by comparing deprivation results with data on slums currently used to target anti-poverty programs. Finally, the opportunities of using spatial data for improving priorities and efficient use of funds in poverty programs are analyzed.

Impact of patients' socioeconomic status on the distance travelled for hospital admission in the English National Health Service

To compare the distances travelled for inpatient treatment in England between electoral wards prior to the introduction of a policy to extend patient choice and to consider the impact of patients' socio-economic status. Using Hospital Episode Statistics for 2003-04, the distance from a patient's residence to a National Health Service hospital was calculated for each admission. Distances were summed to electoral ward level to give the distribution of distances travelled at ward level. These were analysed to show the distance travelled for different admission types, ages of patient, rural/urban location, and the socioeconomic deprivation of the population of the ward. There is considerable variation in the distances travelled for hospital admission between electoral wards. Some of this is explained by geographical location: individuals living in more rural areas travel further for elective (median 27.2 versus 15.0 km), emergency (25.3 versus 13.9 km) and maternity (25.0 versus 13.9 km) admissions. But individuals located in highly deprived wards travel less far, and this shorter distance is not explained simply by the closer location of hospitals to these wards. Before the introduction of more patient choice, there were considerable differences between individuals in the distances they travelled for hospital care. An increase in patient choice may disproportionately benefit people from less deprived areas.

Socio-economic deprivation is associated with increased proximity to general practices in England: an ecological analysis

As health status is consistently negatively correlated with socio-economic deprivation, the need for health services is generally assumed to be greater in more deprived communities. The Inverse Care Law predicts that access to good quality primary care services in more deprived wards will be less than that in affluent wards. However, the relationship between deprivation and geographical proximity to health services has received little attention. We investigated the relationship between geographical proximity to general practices and a number of markers of socio-economic deprivation at the electoral ward level in the North East of England using various domains of the Index of Multiple Deprivation 2000 (IMD2000). More deprived wards, as measured by the employment, education and income domains of the IMD2000, had greater proximity to general practices, as measured by the access domain of the IMD2000, than affluent wards. This results held in both urban and rural wards. Contrary to our expectations and the predictions of the Inverse Care Law, geographical proximity to general practices was greater in more deprived, compared to more affluent wards. However, geographical proximity to services does not necessarily ensure that services will be accessed or that they are of good quality.

Do rates of hospital admission for falls and hip fracture in elderly people vary by socio-economic status?

Objective. To determine the relationship between hospital admissions for falls and hip fracture in elderly people and area characteristics such as socio-economic deprivation. Study design. Ecological study of routinely collected hospital admissions data for falls and hip fracture in people aged 75 years or over for 1992–1997, linked at electoral ward level with characteristics from census data. Methods. In total, 42,293 and 17,390 admissions were identified for falls and hip fracture, respectively, from 858 electoral wards in Trent. Rate ratios (RRs) for hospital admissions for falls and hip fracture were calculated by the electoral wards' Townsend score divided by quintiles. RRs were estimated by negative binomial regression and adjusted for the ward characteristics of age, gender, ethnicity, rurality, proportion of elderly people living alone and distance from hospital. Results. There was a small but statistically significant association at electoral ward level between hospital admissions for falls and the Townsend score, with the most deprived wards having a 10% higher admission rate for falls compared with the most affluent wards (adjusted RR 1.10, 95% CI 1.01–1.19). No association was found between hospital admission for hip fracture and deprivation (adjusted RR 1.05, 95% CI 0.95–1.16). Conclusion. There is some evidence of an association at electoral ward level between hospital admissions for falls and socio-economic deprivation, with higher rates in deprived areas. No such association was found for hip fracture. Further work is required to assess the impact of interventions on reducing inequalities in hospital admission rates for falls in elderly people.

Deprivation, Ill-Health and the Ecological Fallacy

SummaryThe use of ecological studies in explaining the relationship between deprivation and ill-health is widespread in many health applications. However, inferences drawn from these studies about individuals are susceptible to serious bias known as the ecological fallacy. Our paper demonstrates the ecological fallacy effect in this context but also shows how it can be considerably reduced by taking into account different population structures at the aggregate level. Two regression analyses of limiting long-term illness are performed, one at the individual level and one at the electoral ward level, using the 1991 UK census sample of anonymized records and the small area statistics. The analyses compare several measures of deprivation including the standard Carstairs index, with the separate variables which make up the indices, to determine their effectiveness in explaining rates of illness. Two of the deprivation scores are constructed using latent variable modelling techniques which enable a score to be generated at the individual level as well as at the ward level. It is shown that, given the right choice of socioeconomic variables and taking into account the age structure of the population, it should be possible to construct a single aggregate deprivation index that will explain most of the variation in rates of illness across the study region.

Temperature, housing, deprivation and their relationship to excess winter mortality in Great Britain, 1986-1996.

To examine the associations between temperature, housing, deprivation and excess winter mortality using census variables as proxies for housing conditions. Small area ecological study at electoral ward level. Setting Great Britain between 1986 and 1996. Men and women aged 65 and over. Deaths from all causes (International Classification of Diseases, Ninth Revision [ICD-9] codes 0-999), coronary heart disease (ICD-9 410-414), stroke (ICD-9 430-438) and respiratory diseases (ICD-9 460-519). Odds of death occurring in winter period of the four months December to March compared to the rest of the year. During the study period (excluding the influenza epidemic year of 1989/90), a total of 1,682,687 deaths occurred in winter and 2,825,223 deaths occurred during the rest of the year among people aged > or =65 (around 30,000 excess winter deaths per year). A trend of higher excess winter mortality with age was apparent across all disease categories (P < 0.01). There was a significant association between winter mortality and temperature with a 1.5% higher odds of dying in winter for every 1 degrees C reduction in 24-h mean winter temperature. The amount of rain, wind and hours of sunshine were inversely associated with excess winter mortality. Selected housing variables derived from the English House Condition Survey showed little agreement with census-derived variables at electoral ward level. For all-cause mortality there was little association between deprivation and excess winter mortality, although lack of central heating was associated with a higher risk of dying in winter (odds ratio [OR] = 1.016, 95% CI : 1.009-1.022). Excess winter mortality continues to be an important public health problem in Great Britain. There was a strong inverse association with temperature. Lack of central heating was associated with higher excess winter mortality. Further work is needed to disentangle the complex relationships between different indicators of housing quality and other measures of socioeconomic deprivation and their relationship to the high number of excess winter deaths in Great Britain.

Life expectancy as a summary of mortality in a population: statistical considerations and suitability for use by health authorities

OBJECTIVETo investigate the sampling distribution and usefulness of expectation of life in comparisons of mortality at health district level or below.DESIGNDerivation of a formula for the variance of the expectation...

Tooth decay and deprivation in young children

Objective To measure the relationship between tooth decay, contact with dental services and deprivation at electoral ward level. Setting The study was carried out in 1998 in Ellesmere Port in the North West of England. Subjects and Materials All children younger than six years resident in Ellesmere Port registered with GDS services and those using CDS services were matched against the HA population register to identify unregistered children. Rates for children aged 3-5 years 'in contact' with primary dental care services, whether CDS or GDS, were calculated at ward level. One calibrated examiner examined all 5-year-old children in Ellesmere Port and dmft scores were calculated at ward level. Ward deprivation was measured using the Jarman score. Bivariate linear regressions at ward level were performed in turn between: dmft and Jarman score; rates for 3-5-year-olds in contact with dental services and Jarman score; and dmft and rates for 3-5-year-olds in contact with dental services. Results A significant linear relationship was observed between dmft and Jarman score (P=0.02, R2 = 0.43). Significant inverse relationships were found between rates for 3-5-year-olds in contact with dental services and Jarman score (P=0.001, R2 = 0.67), and also between dmft and rates for 3-5-year-olds in contact with dental services (P=0.002, R2 = 0.65). Conclusions A strong inverse relationship was found between dental caries and contact with primary dental care services at electoral ward level. This relationship needs to be explored over a wider geographical area to establish if it is consistent and independent of deprivation.

Dental caries, contact with dental services and deprivation in young children: their relationship at a small area level.

To measure the relationship between tooth decay, contact with dental services and deprivation at electoral ward level. The study was carried out in 1998 in Ellesmere Port in the North West of England. All children younger than six years resident in Ellesmere Port registered with GDS services and those using CDS services were matched against the HA population register to identify unregistered children. Rates for children aged 3-5 years 'in contact' with primary dental care services, whether CDS or GDS, were calculated at ward level. One calibrated examiner examined all 5-year-old children in Ellesmere Port and dmft scores were calculated at ward level. Ward deprivation was measured using the Jarman score. Bivariate linear regressions at ward level were performed in turn between: dmft and Jarman score; rates for 3-5-year-olds in contact with dental services and Jarman score; and dmft and rates for 3-5-year-olds in contact with dental services. A significant linear relationship was observed between dmft and Jarman score (P=0.02, R2 = 0.43). Significant inverse relationships were found between rates for 3-5-year-olds in contact with dental services and Jarman score (P=0.001, R2 = 0.67), and also between dmft and rates for 3-5-year-olds in contact with dental services (P=0.002, R2 = 0.65). A strong inverse relationship was found between dental caries and contact with primary dental care services at electoral ward level. This relationship needs to be explored over a wider geographical area to establish if it is consistent and independent of deprivation.

The effect of water fluoridation and social deprivation on tooth decay

We examined the effect of both artificial and natural water fluoridation on tooth decay in 5-year-olds, after controlling for deprivation by the use of the Jarman Under Privileged Area score.Five-year-old children (n= 10,004) in electoral wards in three areas—naturally fluoridated Hartlepool, fluoridated Newcastle & North Tyneside and non-fluoridated Salford & Trafford—were dentally examined and statistically significant, positive correlations were demonstrated regardless of the level of water fluoridation between deprivation and tooth decay. Weighted multiple linear regression showed a statistically significant interaction between ward Jarman score, mean tooth decay and both types of water fluoridation, confirming that in more deprived areas there is a statistically greater reduction in tooth decay.At a Jarman score of zero (the English average) there was a predicted 44% reduction in decay in 5-year-olds in fluoridated areas, increasing to a 54% reduction in wards with a Jarman score of 40. In an area with natural fluoridation at a level of 1.2ppm the reduction was 66%, increasing to 74% in electoral wards with a Jarman score of 40.Tooth decay is associated with social deprivation and water fluoridation is more efficacious in deprived areas at an electoral ward level. The findings confirm that the implementation of water fluoridation, especially in areas of social deprivation, has been effective in halving tooth decay in 5-year-old children.

Deprivation and excess winter mortality.

OBJECTIVE: To investigate the effect of material deprivation on the winter rise in mortality and temperature dependent variations in mortality. DESIGN: Ecological comparison of seasonal mortality at electoral ward level....

'My ward is more deprived than yours'.

Increasingly, additional resources for infrastructure development and healthcare are directed at deprived areas. The commitment of the present government to reducing inequalities in health is likely to focus attention on identifying and providing special help to areas considered to be particularly deprived. This study compares the use of different deprivation measures at electoral ward level to rank wards according to deprivation and illustrates how the use of different deprivation measures may influence resourcing decisions. The 20 local authority electoral wards making up the city of Plymouth, Devon, were studied. Some of the wards within Plymouth are amongst the most deprived in England. The scores for each ward for different measures of deprivation--Townsend, Jarman, the Department of Environment's Index of Local Conditions and Breadline Britain--were calculated and the wards ranked according to the deprivation score for each measure. Decisions on funding bids and resource allocation for wards within Plymouth were reviewed in the light of the relative deprivation status of the wards according to the various measures. The ranking of electoral wards for the selected measures of deprivation showed variation according to the measure used. The measure of deprivation chosen may have influenced resourcing decisions. Measures of deprivation are closely correlated one with another. However, by judicious choice of the deprivation measure used a ward can achieve a marked change in rank order. This may exert considerable influence on the decisions made by government departments, local authorities and health authorities when allocating resources.

Supply of in-patient medical services for elderly people and geographical variation in medical admissions in a health district in England

Geographical variation in the utilisation of in-patient medical services for elderly people in a health district in England was examined in relation to supply of in-patient geriatric medical care and indicators of need. An ecological study design based on electoral wards was used. The health district had a resident population of 67 919 aged 65 y or more and was divided into three localities, each with a different supply of in-patient medical services for elderly people. Locality A had a traditional model of geriatric medical care, Locality B an integrated model and Locality C an age-related model. Localities A and C also had a high provision of general practice hospital beds. The main outcome measure was the age and sex standardised hospital admission ratio for people aged 65 y or more admitted under geriatric medicine, general medicine or general practice in April 1991–March 1992. There were 8829 admissions in 1991/2, 48% in general medicine, 40% in geriatric medicine and 12% in general practice, giving an overall unadjusted admission rate of 130 per 1000 population aged 65 y or more for the three specialties combined. Locality A had the highest, and Locality B the lowest, unadjusted admission rate for the three specialties combined. This rate remained highest in Locality A if second and subsequent admissions in the same period were excluded. Lengths of stay in geriatrics were longest in this locality but lengths of stay for the three specialties combined were similar in the three localities. Multiple regression was used to examine the effect of three indicators of need, the Jarman score, standardised mortality ratio and prevalence of limiting long-term illness, on standardised admission ratios at the electoral ward level. Jarman score had a significant independent association with the standardised admission ratio but adjustment for this factor did not alter the ranking of the three localities, with the standardised admission ratio remaining highest in Locality A. Subject to the limitations of the study, the results suggest that factors related to the supply of in-patient medical services may be associated with geographical variation in medical admissions for elderly people.

Analysis of hospitalization rates by electoral ward: relationship to accessibility and deprivation data.

The objective of this paper is to investigate the relevance of access to hospital services in explaining utilization rates at a District Health Authority level in the UK. In order to test the hypothesis that access is important, it is necessary to develop a means of scoring access factors and then combining these scores with other more recognized influences on hospitalization rates e.g. deprivation measures. Acknowledging that hospitalization rates are not merely products of a population's socio-economic characteristics, the effect of accessibility to hospital services for the resident population is investigated through the derivation of an access score using both private and public transport from electoral ward of residence. Deprivation and accessibility to services were both found to be significant factors in determining hospitalization rates at electoral ward level. The chosen supply variable--number of GPs--was not found to be significant in any of the models developed using linear regression techniques. To conclude, it appears that access plays an important role in determining hospitalization rates within a given population. If high hospitalization rates are accepted as an indicator of effectively met demand then policy makers may have to consider increasing the accessibility of hospital services.

Census based deprivation indices: their weighting and validation.

KEY ISSUES--Over one hundred years of social science research has shown that different social groups have different probabilities of suffering from multiple deprivation; yet census based deprivation indices frequently assign equal weightings to each of their component variables. This becomes highly problematic when these indices are used as the basis for allocating resources to local and health authorities. In order to ensure fairness and accuracy in resource allocation these indices should be both weighted and validated. STUDY RESULTS--Weightings are derived from the Breadline Britain in the 1990s survey to produce a census based deprivation index that estimates the percentage of poor households at electoral ward level. Examples of validation methodology are discussed and the estimate of the proportion of poor households is shown to be highly correlated with both low income and morbidity as estimated from the 1991 census. DATA SOURCES--The 1991 census local base statistics (LBS) and small area statistics (SAS) aggregated for the 8519 electoral wards of England. The Breadline Britain in the 1990s survey: a nationally representative survey of 1831 households specifically designed to measure poverty and multiple deprivation.