Local Area Level Research Articles

Modeling co-occurring species: a simulation study on the effects of spatial scale for setting management targets

Many species of marine fish are found in similar habitats and display similar vulnerability to fishing pressure, although their sustainable exploitation rates may differ considerably. Managing and setting harvest limits is challenging for such co-occurring species because the management targets for the less productive species may affect the fishing opportunities for the more productive species. We used simulation modeling to explore the effects of setting multi-species management targets and harvest regulations at local area or coast-wide levels. Setting management targets over the entire coast, and identifying optimal harvest rates within each local area, consistently led to the same or higher yields than setting management targets for each area. Essentially, the global conservation goal can be achieved by protecting areas in which the less productive species is abundant and by taking most of the harvest from other areas. The increases in yield do not increase the coast-wide probabilities of either species being overfished or severely depleted, but do increase these probabilities at the local area level for the less productive species. These results are magnified with increased spatial variation in the ratio of abundance and differences in intrinsic rates of growth among the fished species.

Electric Vehicles and the Smart Grid: Spatial Modelling of Impacts and Opportunities

In this paper we present a novel composite methodology for obtaining spatial projections of the impacts and opportunities arising from the integration of plug-in electric vehicles with future smart electricity grids. We link models of future plug-in electric vehicle uptake, travel by household members, household electricity demand, and recharge of electric vehicles. The analysis is disaggregated in each case to a mesh block or local government area level; vehicle usage and household energy demand fluctuate on a hourly, daily and seasonal basis, subject also to the longer-term trends projected for uptake of the new technology. A similarly fine grain is applied with respect to socio-economic variables. The uptake model combines features of choice modelling, multi-criteria analysis and technology diffusion theory; in this case it was applied to four competing technologies (BEV, PHEV, HEV, ICE), and calibration revealed seven major determinants of uptake: performance, annual costs, purchase cost, household income, driving distance, demographic suitability, and risk or inconvenience. The travel model projects likely patterns of vehicle usage and travel duration based on existing patterns of private vehicle usage. The household demand model includes detailed representation of housing type and usage of electrical appliances. The charge-discharge model embodies plausible algorithms for managing household electricity usage in conjunction with electric vehicle batteries. In the paper we describe the various models and report projected impacts of electric vehicles on peak electrical grid loads for the Australian state of Victoria. The impacts are presented on a spatial basis, to the level of individual mesh blocks and network feeders, under a range of energy management scenarios.

Smoking, Ethnic Residential Segregation, and Ethnic Diversity: A Spatio-temporal Analysis

Ethnic residential segregation is a profound social divide in many societies. In the health arena, U.S. work has been influential in demonstrating the impact of ethnic residential segregation on child health outcomes, showing how it can compound other forms of disadvantage. This article builds on and extends this research by examining the transferability of conclusions concerning the health impact of ethnic residential segregation to a non-U.S. context and to the field of health behavior. Using complete adult population data from the 1996 and 2006 New Zealand Censuses of Population geocoded to local and urban area levels, we examine smoking prevalence and cessation in relation to ethnic segregation and diversity. The article employs a repeated cross-sectional multilevel modeling strategy with smoking and cessation as outcome variables. The differential impact of segregation and diversity on smoking behavior by different ethnic groups is considered, taking into account the confounding effect of socioeconomic status and demographic variation. Conclusions suggest that Māori isolation has little overall effect but ethnic diversity has some relevance. Individual ethnic status and area-level deprivation are more important in understanding smoking behavior.

Volunteers supporting older people in formal care settings in England: personal and local factors influencing prevalence and type of participation.

In the UK context of financial austerity and the promotion of the social responsibility through the concept of the "Big Society," volunteers are becoming a more important part of the labor workforce. This is particularly so in the long-term care (LTC) sector, where both shortages of staff and demands for support are particularly high. This article investigate the levels and profile of contribution of volunteers in the LTC sector using a large national data set, National Minimum Data Set for Social Care, linked to local area levels of rurality and socio-economic status. The analysis shows that volunteer activity in formal care services varies between sectors and service types, with no strong relationship between local area deprivation, unemployment levels, and levels of volunteering. However, some significant association was found with level of rurality. The contribution of volunteers is most evident in provision of counseling, support, advocacy, and advice.

Spatial clusters of suicide in Australia

BackgroundUnderstanding the spatial distribution of suicide can inform the planning, implementation and evaluation of suicide prevention activity. This study explored spatial clusters of suicide in Australia, and investigated likely socio-demographic determinants of these clusters.MethodsNational suicide and population data at a statistical local area (SLA) level were obtained from the Australian Bureau of Statistics for the period of 1999 to 2003. Standardised mortality ratios (SMR) were calculated at the SLA level, and Geographic Information System (GIS) techniques were applied to investigate the geographical distribution of suicides and detect clusters of high risk in Australia.ResultsMale suicide incidence was relatively high in the northeast of Australia, and parts of the east coast, central and southeast inland, compared with the national average. Among the total male population and males aged 15 to 34, Mornington Shire had the whole or a part of primary high risk cluster for suicide, followed by the Bathurst-Melville area, one of the secondary clusters in the north coastal area of the Northern Territory. Other secondary clusters changed with the selection of cluster radius and age group. For males aged 35 to 54 years, only one cluster in the east of the country was identified. There was only one significant female suicide cluster near Melbourne while other SLAs had very few female suicide cases and were not identified as clusters. Male suicide clusters had a higher proportion of Indigenous population and lower median socio-economic index for area (SEIFA) than the national average, but their shapes changed with selection of maximum cluster radii setting.ConclusionThis study found high suicide risk clusters at the SLA level in Australia, which appeared to be associated with lower median socio-economic status and higher proportion of Indigenous population. Future suicide prevention programs should focus on these high risk areas.

Incidence of Highly Pathogenic Avian Influenza H5N1 in Nigeria, 2005-2008

Outbreaks of highly pathogenic avian influenza (HPAI) H5N1 occurred in Nigeria between December 2005 and July 2008. We describe temporal and spatial characteristics of these outbreaks at State and Local Government Area (LGA) levels. A total of 25 of 37 States (67.6%; Exact 95% CI: 50.2-82.0%) and 81 of 774 LGAs (10.5%; Exact 95% CI: 8.4-12.8%) were affected by HPAI outbreaks over the period from 2005 to 2008. The incidence risk of HPAI outbreak occurrence at the State level was 5.6% (0.7-18.7%) for 2005, 50.0% (30.7-69.4%) for 2006, 54.5% (29.9-80.3%) for 2007 and 0% for 2008. Only very few LGAs experienced HPAI outbreaks within the affected States. The incidence risk of HPAI outbreak occurrence on a LGA level was 0.3% (0.0-0.9%) for 2005, 6.6% (4.9-8.6%) for 2006, 4.2% (2.9-6.0%) for 2007 and 0% for 2008. The mean period between farmers noticing HPAI outbreaks and reporting them to veterinary authorities, and between reporting HPAI outbreaks and the depopulation of infected premises, was for both 4.5 days; both periods also had medians of 1 day. We have estimated the spatially smoothed incidence risk for the whole outbreak period and identified the existence of a large corridor in the western part of Nigeria and a smaller corridor in south-eastern part, where the risk of HPAI occurrence was lower than in the rest of the country. The effect of HPAI control policies on the outbreaks patterns are discussed, as well as possible reasons why HPAI did not become endemic in Nigeria.

Taking action on the social determinants of health: improving health access for the urban poor in Mongolia.

IntroductionIn recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning.MethodsPrincipal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers.FindingsThe main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies.ConclusionsLessons from Mongolia mirror other international studies which point to the need to measure and take action on the social determinants of health at the local area level in order to adequately reduce persistent inequities in health care access for the urban poor.

Awareness and knowledge of disease surveillance and notification by health-care workers and availability of facility records in Anambra state, Nigeria.

Background:Disease surveillance and notification (DSN) is part of the Health Management Information System (HMIS) which comprises databases, personnel, and materials that are organized to collect data which are utilized for informed decision making. The knowledge about DSN is very important for the reporting of notifiable diseases.Objective:The aim of this study is to examine the awareness and knowledge of health-care workers about DSN, and availability of facility records in Anambra State, Nigeria.Materials and Methods:The study was a descriptive cross-sectional one in which relevant data were collected from health-care workers selected by a multistage sampling technique. Qualitative information was also elicited by key informant interviews, whereas an observational checklist, preceded by a desk review was used to examine the availability of facility records.Results:Although 89.8% of the health-care workers were aware of the DSN system, only 33.3, 31.1, and 33.7% of them knew the specific uses of forms IDSR 001, IDSR 002, and IDSR 003 (IDSR: Integrated Diseases Surveillance and Response), respectively. Knowledge of use of the various forms at the facility and local government area (LGA) levels were generally low, although the observational checklist revealed that IDSR 001 and IDSR 002 forms were predominantly found in primary health-care facilities. HMIS forms were less likely to be available in secondary health-care facilities (χ2=7.67, P=0.005).Conclusions:Regular training and retraining of concerned health-care workers on DSN at the LGA level is recommended. This should run concurrently with adequate and regular provision of IDSR forms, copies of the standard case definitions, and other necessary logistics to the health-care facilities by the local and state governments.

Revealing the link between licensed outlets and violence: Counting venues versus measuring alcohol availability

Associations between alcohol-related harms and numbers of outlets at the neighbourhood level have been demonstrated; however, the degree to which alcohol consumption or sales plays a part in levels of violence is not clear. This has contributed to uncertainty regarding the actual mechanisms by which outlet density may influence levels of violence. This ecological cross-sectional study investigated the effect of outlet numbers and alcohol sales on the risk of assault in Western Australia. For 2000/2001, information on type, number and wholesale alcohol purchases of all licensed outlets in operation, police-reported assault offences, socioeconomic/demographic data were obtained from official sources. Multivariate negative binomial regression was applied to at local government area level in order to assess associations between outlet density, alcohol sales and violence occurring in both licensed and domestic settings. Average alcohol sales volume per off-site outlet was significantly associated with all measures of assault. Numbers of on-site outlets significantly predicted violence with the exception of assaults occurring at residential premises. Alcohol sales from off-site outlets predicted violence occurring at on-site outlets. The link between on-site outlets and violence may be primarily underpinned by negative amenity effects while off-site outlet effects occur via increased availability. Alcohol sales volumes from off-site outlets influence levels of violence, which occur at both licensed and residential settings. The substantial and wide-ranging effects of liquor stores on alcohol-related harms may have been underestimated in the literature and by policy makers.

Automated data extraction from general practice records in an Australian setting: Trends in influenza-like illness in sentinel general practices and emergency departments

BackgroundInfluenza intelligence in New South Wales (NSW), Australia is derived mainly from emergency department (ED) presentations and hospital and intensive care admissions, which represent only a portion of influenza-like illness (ILI) in the population. A substantial amount of the remaining data lies hidden in general practice (GP) records. Previous attempts in Australia to gather ILI data from GPs have given them extra work. We explored the possibility of applying automated data extraction from GP records in sentinel surveillance in an Australian setting.The two research questions asked in designing the study were: Can syndromic ILI data be extracted automatically from routine GP data? How do ILI trends in sentinel general practice compare with ILI trends in EDs?MethodsWe adapted a software program already capable of automated data extraction to identify records of patients with ILI in routine electronic GP records in two of the most commonly used commercial programs. This tool was applied in sentinel sites to gather retrospective data for May-October 2007-2009 and in real-time for the same interval in 2010. The data were compared with that provided by the Public Health Real-time Emergency Department Surveillance System (PHREDSS) and with ED data for the same periods.ResultsThe GP surveillance tool identified seasonal trends in ILI both retrospectively and in near real-time. The curve of seasonal ILI was more responsive and less volatile than that of PHREDSS on a local area level. The number of weekly ILI presentations ranged from 8 to 128 at GP sites and from 0 to 18 in EDs in non-pandemic years.ConclusionAutomated data extraction from routine GP records offers a means to gather data without introducing any additional work for the practitioner. Adding this method to current surveillance programs will enhance their ability to monitor ILI and to detect early warning signals of new ILI events.

Are we still ‘Flying Blind?’ Crime Data and Local Crime Prevention in New South Wales

Numerous authors and commentators have highlighted the importance of crime data for effective local crime prevention planning, practice and its evaluation. Understanding the exact nature of a crime problem is central to preventive efforts and determining the success of associated interventions. Despite the significant amount of data provided by the New South Wales (NSW) Bureau of Crime Statistics and Research, access to relevant local crime data continues to be an impediment to effective crime prevention planning practice in NSW. Data is often only available at the local government area level, which is generally too large for effective crime prevention planning. Spatial, temporal and other critical data is also often unavailable. Further, police are generally cautious about providing crime data to external agencies. In the continuing absence of a data sharing protocol or framework, local crime prevention efforts will continue to ‘fly blind’ (Weatherburn 2004) in New South Wales.

Sustained High Rates Of Job Creation And Destruction In Substate Economies

<p class="Ariel12" style="text-align: justify; margin: 0in 0.5in 0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; mso-bidi-font-style: italic;">Widely utilized net employment change statistics actually mask an extremely volatile process of job creation and destruction.<span style="mso-spacerun: yes;">  </span>In the past decade economists have addressed this problem by exploiting newly available longitudinal data series to estimate these job flows and the subsequent amount of job churning at the national, state and MSA level.<span style="mso-spacerun: yes;">  </span>This study is unique in that it uses an innovative technique to capture job flows within and between industries at the local area level where longitudinal BLS data series are not available. </span></p><p class="Ariel12" style="text-align: justify; margin: 0in 0.5in 0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; mso-bidi-font-style: italic;"> </span></p><p class="Ariel12" style="text-align: justify; margin: 0in 0.5in 0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; mso-bidi-font-style: italic;">The geographic unit of analysis in this paper is a Cohesive Commercial Statistical Area™ (CCSA), a substate aggregate of cities and towns sharing common economic interests but not a Metropolitan Statistical Area.<span style="mso-spacerun: yes;">  </span>The paper examines job flows in two very different Massachusetts substate economies: the MetroWest CCSA, a technology sensitive research and development economy, and the South Shore CCSA, a mature economy with a competitive edge in financial services. This study establishes that a sizable portion of disaggregated job flows can be captured at a substate level using available employment data. Building upon techniques used in earlier studies, the authors confirmed very high levels of employment volatility, “job churning”, in both substate regions. </span></p><p class="Ariel12" style="text-align: justify; margin: 0in 0.5in 0pt;"><span style="font-size: 10pt; mso-bidi-font-style: italic;"><span style="font-family: Arial;"> </span></span></p><p class="Ariel12" style="text-align: justify; margin: 0in 0.5in 0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; mso-bidi-font-style: italic;">The authors found that over two decades, job reallocation rates in MetroWest averaged 9%, affecting one out of 11 jobs annually. The study traced the pattern of job creation and destruction over the course of local business cycles and found that both job creation and destruction existed during all phases of the business cycle. Although, as expected, job creation dominated the expansion phase and destruction dominated the contraction phase, the total amount of job reallocation (creation plus destruction) remained relatively stable through all stages of the business cycle.<span style="mso-spacerun: yes;">   </span>However, the composition of the job reallocation varied dramatically by stage of business cycle.<span style="mso-spacerun: yes;">  </span>A Job Replacement Ratio has been developed as a quick test to confirm economic expansion or contraction and to focus economic development efforts.</span></p>

The EPPO prioritization process for invasive alien plants

Although invasive alien plants are gaining increased attention within EPPO countries, there is no existing widely agreed method to identify those alien plants that are considered invasive and represent the highest priority for pest risk analysis. In the framework of the ad hoc Panel on Invasive Alien Species, EPPO proposes a prioritization process for invasive alien plants designed (i) to produce a list of invasive alien plants that are established or could potentially establish in the EPPO region and (ii) to determine which of these have the highest priority for an EPPO pest risk analysis. The process consists of compiling available information on alien plants according to pre‐determined criteria, and can be run at the EPPO region level, or at a country or local area level. These criteria examine whether the species is alien in the area under study, and whether it is established or not. The criteria used primarily rely on observations in the EPPO region but, if the species is not established, the invasive behaviour of the species in other countries should be investigated, as well as the suitability of the ecoclimatic conditions in the area under consideration. The spread potential, the potential negative impacts on native species, habitats and ecosystems, as well as on agriculture, horticulture or forestry are considered. If the species qualifies as an invasive alien plant of major concern through this first set of questions, the process then investigates the efficiency of international measures (to be justified through a pest risk analysis) to prevent the entry and spread of the species. The second set of questions are designed to determine whether the species is internationally traded or enters new countries through international pathways for which the risk of introduction is superior to natural spread, and whether the species still has a significant suitable area for further spread. If used by several EPPO countries, this prioritization process represents an opportunity to provide consistent country lists of invasive alien plant species, as well as a tool for dialogue and exchange of information.

Use of measures of socioeconomic deprivation in planning primary health care workforce and defining health care need in Australia

To examine whether measures of remoteness areas adequately reveal high need populations, measured against socioeconomic disadvantage and physician to population ratios. Exploratory spatial analysis of relationships between remoteness areas, medical workforce supply and the index of relative socioeconomic disadvantage (IRSD). Bivariate analyses examined associations between remoteness areas and IRSD. From this analysis, a composite score of deprivation was constructed combining measures of remoteness areas, physician to population ratios and IRSD, and validated against health outcome measures. These measures included avoidable mortality per 100,000, risk behaviour rate per 1000, diabetes rate per 1000. All analyses were conducted at the statistical local area level and weighted to be population representative. The percentage of small areas and populations within the most socioeconomically disadvantaged quintile rose with increasing remoteness. However, 12.8% of small areas within major cities and 40.7% of outer regional areas were also within the lowest socioeconomic quintile. There was a strong relationship between our composite score of deprivation and avoidable mortality, risk rate, diabetes rate and per cent Indigenous. Regression analysis examined the relationship between each element of the composite score and health outcomes. This revealed that the association between avoidable mortality and remoteness was lost after controlling for per cent Indigenous. Using remoteness areas alone to prioritize workforce incentive programs and training requirements has significant limitations. Including measures of socioeconomic disadvantage and workforce supply would better target health inequities and improve resource allocation in Australia.

Ageing across the UK

The wellbeing of the older population in the UK is a priority to local and national government and health authorities, as well as to people themselves. The population aged over 65 is progressively becoming a larger percentage of the nation's population. The effects of falling mortality rates are especially visible among the ‘oldest old’. At the same time, however, the older population is supported by a shrinking labour force. This article explores regional and sub-regional variations in the concentration of older people. The populations of London and Northern Ireland have smaller proportions of older people than other regions. The South West and Wales have higher proportions and local authority level data suggest a pattern of settlement in coastal and rural areas. Population projections indicate, on the basis of past trends, the expected future growth in the population at older ages. The article also investigates measures of wellbeing of the ageing population including benefits and income deprivation, life expectancy, aspects of health and social care, older workers, and qualifications and learning. At local authority and small area level, variations in the older population often appear to correspond to the rural or urban nature of the areas concerned. The article includes case studies of income deprivation of older people at Lower Layer Super Output Area (LSOA) level in the North West and the South East regions.

Modelling Potential Socio‐economic Determinants of Building Fires in South East Queensland

AbstractThis paper investigates the relationships between areas of building fire incidence, levels of socio‐economic disadvantage and the underlying socio‐economic characteristics in the South East Queensland (SEQ) region, Australia. Disaggregated fire incident data was acquired from the Queensland Fire and Rescue Service (QFRS) and then aggregated to the Statistical Local Area (SLA) level. The Australian Bureau of Statistics (ABS) defined index of socio‐economic disadvantage (called ‘SEIFA’) has been used as the basis to identify relationships between socio‐economic disadvantage and building fires. A regression model was then developed to predict the incidence of building fires using a range of socio‐economic variables. Five significant predictors were identified that include: i) percentage of unemployed, ii) proportion of Indigenous population, iii) families living in separate dwellings, iv) one parent, and v) parent families with children less than fifteen years of age. Results also show that the distribution of building fires varies markedly across the SEQ region, with some of the Brisbane inner suburbs, areas of high socio‐economic disadvantage, and parts of inland SEQ associated with relatively high fire rates.

Regional and Temporal Trends in Migration among People Living with HIV/AIDS in British Columbia, 1993-2005

Objectives: To examine regional and temporal trends in migration among patients receiving HIV treatment in British Columbia (BC). Methods: Patients initiating antiretroviral therapy in BC between January 1993 and November 2004 were followed until November 2005. Migration was calculated as the cumulative number of times a patient’s residential address changed during their course of treatment. Analyses were performed at the provincial and at the regional health authority (HA) and local health area levels. Demographic methods were used to estimate the in- and out-migration rates, indices of dissimilarity and concentration across regions over time. Results: A total of 3,588 participants were followed during the study period. Individuals who migrated most often migrated to the Vancouver Coastal HA (from the Interior: 30%, Fraser: 41%, Vancouver Island: 28%, and Northern: 19%), specifically the city of Vancouver, which has been treating the most patients with HIV since the early stages of the epidemic. We also showed that this movement intensified as more contemporary HAART regimens became available (p-value for trend Discussion: Our results demonstrate that migration among people with HIV in BC is not homogeneous, with areas around large urban centres having the highest influx of patients. It is thus important that health authorities in BC work in partnership to monitor and evaluate accessibility of HIV-related health care services to ensure universal access for all patients. Furthermore, enhanced HIV care and support services need to be developed, on a province-wide basis, and funding allocation needs to be adjusted to reflect patient migration in BC. Key words: HIV/AIDS; migration; regional analysis; trend; British Columbia; Canada

Regional and temporal trends in migration among people living with HIV/AIDS in British Columbia, 1993-2005.

To examine regional and temporal trends in migration among patients receiving HIV treatment in British Columbia (BC). Patients initiating antiretroviral therapy in BC between January 1993 and November 2004 were followed until November 2005. Migration was calculated as the cumulative number of times a patient's residential address changed during their course of treatment. Analyses were performed at the provincial and at the regional health authority (HA) and local health area levels. Demographic methods were used to estimate the in- and out-migration rates, indices of dissimilarity and concentration across regions over time. A total of 3,588 participants were followed during the study period. Individuals who migrated most often migrated to the Vancouver Coastal HA (from the Interior: 30%, Fraser: 41%, Vancouver Island: 28%, and Northern: 19%), specifically the city of Vancouver, which has been treating the most patients with HIV since the early stages of the epidemic. We also showed that this movement intensified as more contemporary HAART regimens became available (p-value for trend < 0.01). Our results demonstrate that migration among people with HIV in BC is not homogeneous, with areas around large urban centres having the highest influx of patients. It is thus important that health authorities in BC work in partnership to monitor and evaluate accessibility of HIV-related health care services to ensure universal access for all patients. Furthermore, enhanced HIV care and support services need to be developed, on a province-wide basis, and funding allocation needs to be adjusted to reflect patient migration in BC.

Long-term exposure to gaseous air pollutants and cardio-respiratory mortality in Brisbane, Australia

This study examines the association of long-term exposure to gaseous air pollution with cardio-respiratory mortality in Brisbane, Australia, in the period 1996-2004. The pollutant concentrations were estimated using geographical information system (GIS) techniques at the statistical local area (SLA) level. The generalized estimating equations model was used to investigate the impact of nitrogen dioxide (NO2), ozone (O3) and sulphur dioxide (SO2) on mortality due to cardio-respiratory disease after adjusting for a range of potential confounders. An increase of 4.7% (95% confidence interval = 0.7-8.9%) in cardio-respiratory mortality for 1 part per billion (ppb) increment in annual average concentration of SO2 was estimated. However, there was no significant association between long-term exposures to NO2 or O3 and death due to cardio-respiratory disease. The results indicate that the annual average concentration of SO2 is associated with cardio-respiratory mortality at the SLA level and this association appears to vary with the geographical area.

Income inequality and alcohol attributable harm in Australia

BackgroundThere is little research on the relationship between key socioeconomic variables and alcohol related harms in Australia. The aim of this research was to examine the relationship between income inequality and the rates of alcohol-attributable hospitalisation and death at a local-area level in Australia.MethodWe conducted a cross sectional ecological analysis at a Local Government Area (LGA) level of associations between data on alcohol caused harms and income inequality data after adjusting for socioeconomic disadvantage and remoteness of LGAs.The main outcome measures used were matched rate ratios for four measures of alcohol caused harm; acute (primarily related to the short term consequences of drinking) and chronic (primarily related to the long term consequences of drinking) alcohol-attributable hospitalisation and acute and chronic alcohol-attributable death. Matching was undertaken using control conditions (non-alcohol-attributable) at an LGA level.ResultsA total of 885 alcohol-attributable deaths and 19467 alcohol-attributable hospitalisations across all LGAs were available for analysis. After weighting by the total number of cases in each LGA, the matched rate ratios of acute and chronic alcohol-attributable hospitalisation and chronic alcohol-attributable death were associated with the squared centred Gini coefficients of LGAs. This relationship was evident after adjusting for socioeconomic disadvantage and remoteness of LGAs. For both measures of hospitalisation the relationship was curvilinear; increases in income inequality were initially associated with declining rates of hospitalisation followed by large increases as the Gini coefficient increased beyond 0.15. The pattern for chronic alcohol-attributable death was similar, but without the initial decrease. There was no association between income inequality and acute alcohol-attributable death, probably due to the relatively small number of these types of death.ConclusionWe found a curvilinear relationship between income inequality and the rates of some types of alcohol-attributable hospitalisation and death at a local area level in Australia. While alcohol-attributable harms generally increased with increasing income inequality, alcohol-attributable hospitalisations actually showed the reverse relationship at low levels of income inequality. The curvilinear patterns we observed are inconsistent with monotonic trends found in previous research making our findings incompatible with previous explanations of the relationship between income inequality and health related harms.