Current research projects

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

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

Project aims

The Environment Research Group, in collaboration with SAHSU, has an ongoing work programme to estimate health impacts of air pollution to provide support and evidence to national and local governments.  Health Impact Assessments allow burden calculations which estimate the size of the health impact of air pollution in a particular area, and impact calculations which allow the health benefits of policy proposals to be assessed.  While the health outcomes and air pollutants of interest may differ slightly, the general principles and methods and responsible data handling apply to all health impact assessment projects.  Health Impact Assessments are generally funded ad hoc to address an urgent policy needs and are often short-term projects of approximately 3 months. There is therefore a need to react in a timely manner.

 Geography

England and Wales

 Data

NHS Digital (HES) Inpatient

ONS Live Birth

ONS Death

Contact

Dr Daniela Fecht

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

Professor Marta Blangiardo

Project aims

Wastewater-based epidemiology (WBE) has proven to be a successful tool to monitor infection levels of SARS-CoV-2 in a population. Beyond infections, it is clear that the pandemic has had a profound effect on populations across the world and on their health. The aim of this project is to explore associations between routine WBE measurements for pharmaceuticals, lifestyle markers and chemical toxicants being made in Greater London (and potentially other major cities in England (e.g., Liverpool)) - and specific health outcomes, including mental health. Our hypothesis is that precise WBE data might provide an early-warning system, which could help planning health resource usage. The analysis of pre- and post-pandemic associations might also prepare for future (viral) pandemics.

Geography

England

Data

NHS Digital HES admitted patient care; ONS death registrations

Contact

Dr Fred Piel

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

Project aims

The overarching aim of this project is to develop a general framework for predicting excess mortality at local level in different countries at high temporal resolution (e.g. weeks, months), which can be used as an early warning detection tool. The specific aims are as follows: 1) to develop a model to predict population trends by age, sex, time and spatial region under counterfactual scenarios using historical trends; 2) to link the population prediction to the mortality counts accounting for uncertainty and to estimate the expected deaths during the most recent period (e.g. 1 year) accounting for mortality predictors, historical trends and the population projections from 1); and 3) to examine how covariates contribute to the observed spatio-temporal patterns of excess mortality.

Geograhpy

England

Data

ONS mortality

Contact

Professor Marta Blangiardo

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

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

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

Nitrogen dioxide (NO₂) and fine particulate matter (PM_2.5) are air pollutants that are both emitted from traffic sources.  This means that it can be difficult to distinguish which pollutants are responsible for health effects on high air pollution days since they both build up under certain weather conditions (e.g. when it is cold and still) and are both lower with other weather conditions (e.g. when it is windy and rainy). This means that NO₂, for example, might appear to have health effects but only because PM_2.5 went up at the same time. 

 At the extreme, if NO₂ only appears to have health effects due to its’ correlation with PM_2.5, then if there is all NO₂ and no PM_2.5, then NO₂ will no longer appear to have health effects at all.  That extreme is unlikely, but the same principle applies if the ratio changes to include a lower proportion of PM_2.5compared with NO₂, giving a smaller apparent effect of NO₂.

Project aims

• To analyse the time trends in the ratio of NO₂ to PM_2.5 in around 10 major UK cities (depending on available co-located monitoring data for both pollutants).
• To examine the ratio of NO₂ to PM_2.5 as an effect modifier for the relative risk of each pollutant on health outcomes in time-series analysis.
• To analyse changes in the relative risk of both pollutants on health outcomes in an interrupted time-series analysis, if sufficiently sharp changes in ratio are found.

We will calculate ratios of daily NO₂ to PM_2.5 concentrations at different monitoring sites (separately for background and traffic sites) within each of the ten largest UK cities in terms of population size: Greater London, Birmingham, Glasgow, Liverpool, Bristol, Manchester, Sheffield, Leeds, Edinburgh and Leicester, as well as Cardiff and Belfast as these are the largest cities in Wales and Northern Ireland, respectively. 

 We will analyse the data using a standard city-level time-series analysis relating daily NO₂ and PM_2.5 concentrations to health outcomes, controlling for temperature and long-term trend in health outcomes. We will use effect modification analysis to test for a significant interaction of the main coefficient for each pollutant with the NO₂ to PM_2.5 ratio.  Subject to the data, we aim to perform an interrupted time-series analysis in selected cities, looking for changes in the main coefficient before and after a sharp change in ratio.  Consistency across cities will be examined for both types of analysis. 

 The health outcomes we will study include all-cause and cause-specific mortality, and hospital admissions with respiratory and cardiovascular conditions.

Geography

England, Wales, Scotland

Data

NHS Digital HES: Inpatient and A&E

ONS Death

Contact

Dr Daniela Fecht

Project aims

This proposal aims to advance our understanding of the impact of exceptional heat exposures on the health of people living with diabetes and to explore the effects of adaptation/mitigation policies. The key aims are as follows:  

Aim 1. Examine the short-term effect of heat exposure on mortality and hospitalisation for a range of conditions (including cardiovascular and respiratory disease) and explore the role of age, sex and socioeconomic deprivation in patterns observed. 

Aim 2. Assess how the short-term effect of heat exposure on mortality and hospitalisation varies in time (e.g. role of adaptation), space (e.g. urban/rural or other population characteristics) and across different levels of air-pollution.   

Aim 3. Estimate the heat related burden of disease and associated costs in people with diabetes in England and explore the effect of different policies (e.g. future climate scenarios and clean air zones) using synthetic cohorts.  

Geography

England

Data

NHS Digital HES: Admitted patient care and emergency care

ONS mortality data

Contact

Dr Garyfallos Konstantinoudis

Project aims

Build a generalisable modelling framework to evaluate the individual and area level impact of “shocks” (i.e., government policy) on health outcomes (i.e., mental wellbeing) over time. The developed framework will be transferable to any type of policy implementation (e.g. environmental) and health outcomes.

Period and Geography

2000-2022

England

Data

ONS Civil Registration Data - Death

Contact

Professor Marta Blangiardo

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

Project aims

The goal of this project is to evaluate the impact of the UK 2012 suicide prevention strategy. The objectives are:

1. Use negative outcome controls in an interrupted time series design to draw causal inferences about the associations between the strategy and the occurrence of death by suicide.
2. Explore how the impact of the strategy differs by social and environmental factors.

Period and Geography

2000-2023

England

Data

HES-ONS Linked Mortality: Death registrations

Contact

Professor Marta Blangiardo

Project aims

The summer of 2022 in England was one of the warmest in the past 10 years. The heatwaves in the summer of 2022 were more frequent and lasted longer than in previous years. Very high temperatures can increase ill health and increase deaths. The people most at risk include those over 75 years of age, the very young and people with a chronic illness. The UK Health Security Agency provides advice to people in England on sensible precautions to take during a heatwave and the NHS provides guidance for health and social care professionals. The study we would like to undertake will improve our understanding of the impact this summer’s high temperatures had on all-cause mortality and will be useful in guiding future preparedness and resilience activities.

The aim of this project is to quantify the excess all-cause mortality (comparison of number of deaths from all causes during summer 2022 and number of deaths expected had the extended heatwave event not occurred) during the summer 2022. This project builds on Dr Konstantinoudis’ MRC fellowship which focuses on the impact of temperature on respiratory hospital admissions and uses this expertise to address a timely public health need. We will study population groups defined by age group (<40, 40-59, 60-69, 70-79 and 80+), sex and deprivation to assess the impact of the extended heatwave during summer 2022 in Local Authorities in England.

Geography

England

Data

ONS mortality

Contact

Dr Garyfallos Konstantinoudis

Project aims

The goal of this project is to explore the difference in geographic, environmental and social patterns between deaths from intentional and non-intentional suicides in England. We will:

a. Describe trends in deaths by suicide by intentional and non-intentional categories

b. Explore the role of area-level social and environmental factors in these trends, specifically focussing on geographical differences and interactions between exposures. 

Period and geography

2000-2023

England

Data

HES-ONS Linked Mortality: Death registrations

Contact

Professor Marta Blangiardo

Project aims

The goal of this project is to use data from the Small Area Health Statistics Unit (SAHSU) to study the effect of extreme weather in populations experiencing homelessness in England. The two main questions of interest are:

1. How do extreme heat, rainfall and humidity affect the health of populations experiencing homelessness in England?
2. How does the above effect compare with the non-homeless population?

Period and geography

2002-2022

England

Data

NHS Digital HES England; Inpatient and A&E; HES-ONS Linked Mortality; Death registrations

Contact

Dr Garyfallos Konstantinoudis

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

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

Project aims

Approximately two thirds of annual deaths in England are among individuals aged 75 years and over. This proportion is projected to increase as life expectancy increases.

Trends in the causes of death in older adults and those with dementia are also changing. It is unclear, however, how the causes of death in these groups vary geographically and across levels of deprivation.

The aim of this project is to explore the changing patterns in causes of death among older adults (≥75 years) in England from 2012 to 2024 and examine their associations with area-level deprivation and other social and environmental determinants of health. This analysis will be undertaken for all deaths; deaths with dementia recorded as the underlying cause; and deaths with dementia recorded on the death certificate.

Period and geography

2012-2024

England and Wales

Data

HES-ONS Linked Mortality; Death registrations

Contact

Dr Bethan Davies

Dr Angela Pinot de Moira

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

Project aims

This project is part of the “Emerging Environmental Issues Prepareness” theme of the NIHR HPRU in Environmental Exposures & Health.

The UK is shifting electricity generation towards “renewable” energy sources including biomass. DEFRA (2017)
advise that burning biomass “could have adverse air quality impacts”, particularly through PM and NO2 associated
health outcomes, including acute exacerbations of asthma and COPD. Based on modelled ground-based
exposures to air pollutants, we will investigate potential health impacts near biomass electricity generating installations in England and Wales using spatio-temporal epidemiological methods applied to SAHSU data.

The aims of this project are: i) to assess the health impacts of living near biomass electricity generating installations; ii) to undertake a literature review and, if appropriate, a meta-analyse on the health impact of biomass-burning and health, in particular respiratory disease; iii) to identify existing data on air pollution modelling of emissions from power stations fuelled by biomass burning for use in epidemiological models; iv) to quantify health risks around selected biomass-burning facilities; and v) to feed results into policy for the management and control of installations carrying out biomass burning for power generation.

Geography

England and Wales

Data

NHS Digital HES England; Inpatient and A&E

Contact

Dr Fred Piel

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

Project aims

The aim is to conduct an updated small-area study using national routine health data from ONS, PHE and NHS Digital covering a period of nearly 20 years to investigate risks of cancer incidence, mortality rates and respiratory hospital admissions in the area exposed to the plume from a fire at the Cleansing Service Group (CSG) site in Sandhurst in October 2000.

Period and geography

2000 - 2022

SW England

Data

NHS Digital HES England Inpatient data; ONS Civil Registration Data - Death; Cancer data from Public Health England and the Office for National Statistics historical data

Contact

Dr Fred Piel

Project Aims

Housing quality is a key socio-economic determinant of health and its link with poor health are well-established. This project focuses on one component of housing quality: thermal comfort. Thermal comfort is the condition of being satisfied with the thermal environment inside the home, which is neither too hot or too cold. This study will explore the relationship between the proportion of homes with poor thermal comfort in London with the rate of poor health outcomes, including cardiovascular and respiratory disease related hospital admissions and mortality. Socio-demographic factors including age, sex, and socioeconomic status will be taken into account in the analysis. The study will be conducted in London. The findings will provide the evidence needed to create effective and targeted housing policies related to housing quality.

Period and geography

2009-2020, London

Data

NHS Digital (HES) Inpatient

ONS Death

Contact

 Dr Daniela Fecht

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

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

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

Project aims

This Master’s project is linked to the SAHSU project ‘The impact of brownfield sites on health’ and will be supervised by Daniela Fecht and Weiyi Wang.  

 This project aims to investigate small area-level associations between brownfield land and hospital admissions in England using data from the Brownfield Land Register and hospital episode statistics.

Geography

England

Data

NHS Digital HES admitted patient care

Contact

Dr Daniela Fecht

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. hypertension, chronic obstructive pulmonary disease), which are known to increase COVID-19 mortality. Thus, the effect we reported can be attributed to certain comorbidities.

The study will use the General Practice Extraction Service (GPES)  for Pandemic Planning and Research (GDPPR) data to look at long-term exposure to air-pollution and COVID-19 mortality and to quantify the effect of pre-existing conditions on COVID-19 mortality, as follows:

1.  Identify which comorbidities increase COVID-19 mortality.
2.  Re-assess the effect of air-pollution after accounting for the comorbidities identified.
3.  Adjust for a series of confounders, such as age, sex, ethnicity, access to healthcare, deprivation and the spread of the disease.

Period and geography

England

Data

NHS Digital HES and General Practice Extraction Service (GPES) for Pandemic Planning and Research (GDPPR) data

ONS Mortality

Contact

Dr Garyfallos Konstantinoudis

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

Project aims

In England it is estimated that around 1 in 14 older adults have dementia. The UK Committee on the Medical Effects of Air Pollution (COMEAP) has recently reported that it is likely that air pollution contributes to cognitive decline and dementia, probably through the effects of particulate pollution on the blood vessels and brain. The aim of this project is to map hospital admissions rates for dementia-associated healthcare and mortality in England and explore associations with air pollution and other social and environmental factors.

Data

NHS Digital HES data

Mortality data from ONS

Contact

Dr Bethan Davies

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

Project aims

We will explore differences in both types of food pipe cancer incidence and mortality by geography (level will be decided by case numbers) by mapping longitudinal trends in incidence and mortality rates in England over a 30 year period (or as long as possible in the data).

We will also describe rates of each type of cancer by population subgroup. We will use a case-control design to explore the variation in risk of each cancer type by environmental factors comparing to cancers not influenced by these factors. 

Period and geography

1981 - 2019

England

Data

ONS Cancer registrations - oesophageal cancer

Contact

Dr Gwen Murphy

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

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 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

Project aims

The Greater London Authority launched an Ultra Low Emission Zone (ULEZ) in central London in April 2019. This flagship public health intervention is intended to improve air quality (by lowering NO2 and PM), reduce congestion and deliver health benefits. The ULEZ has been extended to Inner London in 2021 and will be further extended to Greater London in 2023. The behavioural changes enforced by the COVID-19 lockdowns and wider responses to the pandemic had major impacts on traffic patterns, air quality and healthcare utilisation since the introduction of the ULEZ. This research will evaluate the health impacts of the ULEZ and the effect of COVID  on the ULEZ associated impacts. This project is part of a larger programme of research into the impacts of clean air zones. The proposed epidemiological analysis will:

• describe inequalities in healthcare utilisation during the COVID pandemic in communities within and outside the ULEZ;
• examine trends in non-communicable diseases, pre-and post-ULEZ implementation, using routinely collected health data;
• evaluate exposure-response functions at a very fine geographical resolution, focusing on multimorbidity and deprivation at different time intervals (pre-post pandemic; pre-post ULEZ etc.)

 The goal of this research is to provide a comprehensive assessment of the impact of the London ULEZ on health. The results will be disseminated via a range of methods including public events, blogs, presentations, journal articles and direct engagement with practitioners and policy makers.

Geography

England

Data

NHS Digital HES England; Inpatient and A&E; HES-ONS Linked Mortality; Birth and death registrations

Contact

Dr Bethan Davies

Project Aims

The overall objective of this project is to assess the potential of a public health intervention to reduce geographic and socioeconomic inequalities in dementia incidence in England. This project will focus on herpes zoster vaccination as a case study. The aim of this project is, therefore, to estimate the extent to which geographic and socioeconomic inequalities in dementia incidence in England could be reduced through herpes zoster vaccination.

Data

NHS Digital HES: Admitted patient care and emergency care

ONS mortality data

Contact

Dr Bethan Davies

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

Project aims

The objectives of this project are as follows:  

1. To develop a spatio-temporal modelling framework for detecting miscarriages using observational data, and assess whether miscarriage rates can be predicted using expected live birth counts and temperature;
2. To assess whether extreme temperatures affect miscarriage rates, and detect the presence of a critical window in which the pregnancy is most vulnerable to non-optimal temperatures; 
3. To investigate whether the relationship between temperature and miscarriages is modified by characteristics of the built environment or changes in magnitude through the long-term trend, suggesting adaptation to exposure.

Geography

England

Data

NHS Digital (HES) Inpatient, HES Accident and Emergency Attendances

HES-ONS Linked Mortality: Live birth registrations; Still birth registrations

Contact

Professor Marta Blangiardo

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

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

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

Project aims

Air pollution is a major public health concern. It is linked to common non-communicable diseases, including asthma, lung cancer, heart attacks and strokes. Our study will help us understand more about which sources of air pollution are the most harmful to the health of children and the elderly in London. This information will support the design of strategies to control and reduce air pollution that target the most harmful sources.

Air pollution is made up of many different types of substances. In this study will we be focussing on particulate matter, or PM. Particulate matter is a complex mixture of chemically and physically diverse substances that are suspended in the air. Particulates come from man-made and natural sources, for example vehicles, factories, and plants. The mixture of particulate matter that is present in the air, and the concentrations that the particulates are found in, varies across place and time. What is in the mixture depends on the sources of the particulates and factors like weather conditions and other chemicals or biological agents in the air that act on the particles.

In this research project, we will use real-world data on particulate concentrations in the air and advanced statistical modelling techniques to explain how each source of air pollution is contributing to air quality in London. We will then use real-world data from daily hospital admissions for children and elderly residents in London to find out which air pollution sources are having the biggest effect on health. Finally, we will use statistical models to predict how health might change if hypothetical policies are introduced to reduce air pollution from different sources.

The output of our research will support public health decision making on air quality management.

Period and geography

2010 - 2019 London

Data

NHS Digital (HES) Inpatient

Contact

Professor Marta Blangiardo

Project aims

Sickle cell disease (SCD) is the most common genetic disease in the UK, affecting about 18,000 people. The health impacts of SCD are driven in large part by inflammation. Complications often include significant impact to the lungs in both children and adults. Evidence of both the short-term and long-term health impact of air pollution on respiratory complications in SCD is currently lacking in the UK. The aim of this project is to address this evidence gap by conducting an analysis of hospital admission data, combined with high resolution ambient air quality modelled surfaces for common air pollutants. A better understanding of the impact of air quality on SCD could guide policies to prevent complications.

Period and geography

2014-2024

England

Data

NHS Digital HES England; Inpatient; HES-ONS Linked Mortality; Death registrations

Contact

Dr Fred Piel

Project Aims

The UK seeks to reduce carbon emissions to zero by 2050 in line with the Paris Climate Agreement. This project will study the air quality, health and economic benefits of various future climate policy scenarios which would meet this goal and that have support from the public.

The main objectives of the NIHR project from the SAHSU perspective are:

To estimate the UK’s public health and economic burden from air pollution in 2030/40 and 2050 under different 2050 net-zero climate policies.

To quantify to what extent the additional health benefits of UK climate action change the benefit/cost.

To assess how potential benefits vary across the socioeconomic spectrum.

Geography

England Scotland and Wales

Data

PHE Cancer Registrations

WICSU Cancer Registrations

NHS Digital HES: admitted patient care; HES-ONS Linked mortality

ONS Live birth

Contact

Dr Daniela Fecht

Project aims

Brownfield land is increasingly being targeted for housing redevelopment by local government to address the country-wide housing shortage and avoid building on green land to protect the countryside. Brownfield sites refer to land that has been previously used for industrial or commercial purposes but has subsequently become vacant or derelict. Brownfield sites are potentially, but not necessarily, contaminated depending on their previous uses, and might pose potential risks to the health of residents in housing developments either on or in the vicinity of redeveloped sites. Most of the literature on brownfield sites and health focuses on health impact assessments, but epidemiological evidence that investigates the link between brownfield sites and the health of local residents is sparse. In this research project, we will study the potential impacts of living near brownfield sites on health using administrative health data such as information on birth outcomes, hospital admissions and mortality from the Office for National Statistics and NHS Digital. The results of the study will add to the scientific evidence used to inform future housing and public health planning.

The aim of this project is to assess and quantify the associations of living near brownfield sites and adverse health effects.

Geography

England

Data

NHS Digital HES: admitted patient care; ONS Civil Registration Data - Births and Deaths

Contact

Dr Daniela Fecht

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

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

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