Geospatial cryptography: enabling researchers to access private, spatially referenced, human subjects data for cancer control and prevention.

As the volume, accuracy and precision of digital geographic information have increased, concerns regarding individual privacy and confidentiality have come to the forefront. Not only do these challenge a basic tenet underlying the advancement of science by posing substantial obstacles to the sharing of data to validate research results, but they are obstacles to conducting certain research projects in the first place. Geospatial cryptography involves the specification, design, implementation and application of cryptographic techniques to address privacy, confidentiality and security concerns for geographically referenced data. This article defines geospatial cryptography and demonstrates its application in cancer control and surveillance. Four use cases are considered: (1) national-level de-duplication among state or province-based cancer registries; (2) sharing of confidential data across cancer registries to support case aggregation across administrative geographies; (3) secure data linkage; and (4) cancer cluster investigation and surveillance. A secure multi-party system for geospatial cryptography is developed. Solutions under geospatial cryptography are presented and computation time is calculated. As services provided by cancer registries to the research community, de-duplication, case aggregation across administrative geographies and secure data linkage are often time-consuming and in some instances precluded by confidentiality and security concerns. Geospatial cryptography provides secure solutions that hold significant promise for addressing these concerns and for accelerating the pace of research with human subjects data residing in our nation's cancer registries. Pursuit of the research directions posed herein conceivably would lead to a geospatially encrypted geographic information system (GEGIS) designed specifically to promote the sharing and spatial analysis of confidential data. Geospatial cryptography holds substantial promise for accelerating the pace of research with spatially referenced human subjects data.

Identification of a Blue Zone in a Typical Chinese Longevity Region.

Influenced by a special local environment, the proportion of centenarians is particularly high in some places, known as "blue zones". Blue zones are mysterious regions that continue to attract research. This paper explores the spatial distribution of the longevity population in a typical Chinese longevity region. Longevity evaluation indexes are used to analyze the longevity phenomenon in 88 towns between 2011 and 2015. Our research findings show that longevity is more important than birth rate and migration in shaping the degree of deep aging in the research region. Fluctuations in the proportion of centenarians are much higher than for nonagenarians, both in relation to towns and to years. This is because there are so few centenarians that data collected over a short time period cannot accurately represent the overall degree of longevity in a small region; data and statistics must be collected over a longer time period to achieve this. GIS analysis revealed a stable longevity zone located in the center of the research region. This area seems to help people live more easily to 90-99 years old; however, its ability to help nonagenarians live to 100 is a weaker effect.

Genetic GIScience: Toward a Place-Based Synthesis of the Genome, Exposome, and Behavome.

The exposome, defined as the totality of an individual's exposures over the life course, is a seminal concept in the environmental health sciences. Although inherently geographic, the exposome as yet is unfamiliar to many geographers. This article proposes a place-based synthesis, genetic geographic information science (Genetic GISc) that is founded on the exposome, genome+ and behavome. It provides an improved understanding of human health in relation to biology (the genome+), environmental exposures (the exposome), and their social, societal and behavioral determinants (the behavome). Genetic GISc poses three key needs: First, a mathematical foundation for emergent theory; Second, process-based models that bridge biological and geographic scales; Third, biologically plausible estimates of space-time disease lags. Compartmental models are a possible solution; this article develops two models using pancreatic cancer as an exemplar. The first models carcinogenesis based on the cascade of mutations and cellular changes that lead to metastatic cancer. The second models cancer stages by diagnostic criteria. These provide empirical estimates of the distribution of latencies in cellular states and disease stages, and maps of the burden of yet to be diagnosed disease. This approach links our emerging knowledge of genomics to cancer progression at the cellular level, to individuals and their cancer stage at diagnosis, to geographic distributions of cancer in extant populations. These methodological developments and exemplar provide the basis for a new synthesis in health geography: genetic geographic information science.

Investigation of spatio-temporal cancer clusters using residential histories in a case-control study of non-Hodgkin lymphoma in the United States.

BACKGROUND: Non-Hodgkin lymphoma (NHL) is an enigmatic disease with few known risk factors. Spatio-temporal epidemiologic analyses have the potential to reveal patterns that may give clues to new risk factors worthy of investigation. We sought to investigate clusters of NHL through space and time based on life course residential histories. METHODS: We used residential histories from a population-based NHL case-control study of 1300 cases and 1044 controls with recruitment centers in Iowa, Detroit, Seattle, and Los Angeles, and diagnosed in 1998-2000. Novel methods for cluster detection allowing for residential mobility, called Q-statistics, were used to quantify nearest neighbor relationships through space and time over the life course to identify cancer clusters. Analyses were performed on all cases together and on two subgroups of NHL: Diffuse large B-cell lymphoma and follicular lymphoma. These more homogenous subgroups of cases might have a more common etiology that could potentially be detected in cluster analysis. Based on simulation studies designed to help account for multiple testing across space and through time, we required at least four significant cases nearby one another to declare a region a potential cluster, along with confirmatory analyses using spatial-only scanning windows (SaTScan). RESULTS: Evidence of a small cluster in southeastern Oakland County, MI was suggested using residences 10-18 years prior to diagnosis, and confirmed by SaTScan in a time-slice analysis 20 years prior to diagnosis, when all cases were included in the analysis. Consistent evidence of clusters was not seen in the two histologic subgroups. CONCLUSIONS: Suggestive evidence of a small space-time cluster in southeastern Oakland County, MI was detected in this NHL case-control study in the USA.

Local bladder cancer clusters in southeastern Michigan accounting for risk factors, covariates and residential mobility.

BACKGROUND: In case control studies disease risk not explained by the significant risk factors is the unexplained risk. Considering unexplained risk for specific populations, places and times can reveal the signature of unidentified risk factors and risk factors not fully accounted for in the case-control study. This potentially can lead to new hypotheses regarding disease causation. METHODS: Global, local and focused Q-statistics are applied to data from a population-based case-control study of 11 southeast Michigan counties. Analyses were conducted using both year- and age-based measures of time. The analyses were adjusted for arsenic exposure, education, smoking, family history of bladder cancer, occupational exposure to bladder cancer carcinogens, age, gender, and race. RESULTS: Significant global clustering of cases was not found. Such a finding would indicate large-scale clustering of cases relative to controls through time. However, highly significant local clusters were found in Ingham County near Lansing, in Oakland County, and in the City of Jackson, Michigan. The Jackson City cluster was observed in working-ages and is thus consistent with occupational causes. The Ingham County cluster persists over time, suggesting a broad-based geographically defined exposure. Focused clusters were found for 20 industrial sites engaged in manufacturing activities associated with known or suspected bladder cancer carcinogens. Set-based tests that adjusted for multiple testing were not significant, although local clusters persisted through time and temporal trends in probability of local tests were observed. CONCLUSION: Q analyses provide a powerful tool for unpacking unexplained disease risk from case-control studies. This is particularly useful when the effect of risk factors varies spatially, through time, or through both space and time. For bladder cancer in Michigan, the next step is to investigate causal hypotheses that may explain the excess bladder cancer risk localized to areas of Oakland and Ingham counties, and to the City of Jackson.

Space-time analysis of testicular cancer clusters using residential histories: a case-control study in Denmark.

Though the etiology is largely unknown, testicular cancer incidence has seen recent significant increases in northern Europe and throughout many Western regions. The most common cancer in males under age 40, age period cohort models have posited exposures in the in utero environment or in early childhood as possible causes of increased risk of testicular cancer. Some of these factors may be tied to geography through being associated with behavioral, cultural, sociodemographic or built environment characteristics. If so, this could result in detectable geographic clusters of cases that could lead to hypotheses regarding environmental targets for intervention. Given a latency period between exposure to an environmental carcinogen and testicular cancer diagnosis, mobility histories are beneficial for spatial cluster analyses. Nearest-neighbor based Q-statistics allow for the incorporation of changes in residency in spatial disease cluster detection. Using these methods, a space-time cluster analysis was conducted on a population-wide case-control population selected from the Danish Cancer Registry with mobility histories since 1971 extracted from the Danish Civil Registration System. Cases (N=3297) were diagnosed between 1991 and 2003, and two sets of controls (N=3297 for each set) matched on sex and date of birth were included in the study. We also examined spatial patterns in maternal residential history for those cases and controls born in 1971 or later (N= 589 case-control pairs). Several small clusters were detected when aligning individuals by year prior to diagnosis, age at diagnosis and calendar year of diagnosis. However, the largest of these clusters contained only 2 statistically significant individuals at their center, and were not replicated in SaTScan spatial-only analyses which are less susceptible to multiple testing bias. We found little evidence of local clusters in residential histories of testicular cancer cases in this Danish population.

Space-time clusters of breast cancer using residential histories: a Danish case-control study.

BACKGROUND: A large proportion of breast cancer cases are thought related to environmental factors. Identification of specific geographical areas with high risk (clusters) may give clues to potential environmental risk factors. The aim of this study was to investigate whether clusters of breast cancer existed in space and time in Denmark, using 33 years of residential histories. METHODS: We conducted a population-based case-control study of 3138 female cases from the Danish Cancer Registry, diagnosed with breast cancer in 2003 and two independent control groups of 3138 women each, randomly selected from the Civil Registration System. Residential addresses of cases and controls from 1971 to 2003 were collected from the Civil Registration System and geo-coded. Q-statistics were used to identify space-time clusters of breast cancer. All analyses were carried out with both control groups, and for 66% of the study population we also conducted analyses adjusted for individual reproductive factors and area-level socioeconomic indicators. RESULTS: In the crude analyses a cluster in the northern suburbs of Copenhagen was consistently found throughout the study period (1971-2003) with both control groups. When analyses were adjusted for individual reproductive factors and area-level socioeconomic indicators, the cluster area became smaller and less evident. CONCLUSIONS: The breast cancer cluster area that persisted after adjustment might be explained by factors that were not accounted for such as alcohol consumption and use of hormone replacement therapy. However, we cannot exclude environmental pollutants as a contributing cause, but no pollutants specific to this area seem obvious.

Residential mobility and breast cancer in Marin County, California, USA.

Marin County (California, USA) has among the highest incidences of breast cancer in the U.S. A previously conducted case-control study found eight significant risk factors in participants enrolled from 1997-1999. These included being premenopausal, never using birth control pills, lower highest lifetime body mass index, having four or more mammograms from 1990-1994, beginning drinking alcohol after age 21, drinking an average two or more alcoholic drinks per day, being in the highest quartile of pack-years of cigarette smoking, and being raised in an organized religion. Previously conducted surveys provided residential histories; while statistic accounted for participants' residential mobility, and assessed clustering of breast cancer cases relative to controls based on the known risk factors. These identified specific cases, places, and times of excess breast cancer risk. Analysis found significant global clustering of cases localized to specific residential histories and times. Much of the observed clustering occurred among participants who immigrated to Marin County. However, persistent case-clustering of greater than fifteen years duration was also detected. Significant case-clustering among long-term residents may indicate geographically localized risk factors not accounted for in the study design, as well as uncertainty and incompleteness in the acquired addresses. Other plausible explanations include environmental risk factors and cases tending to settle in specific areas. A biologically plausible exposure or risk factor has yet to be identified.

Space-time clustering of non-hodgkin lymphoma using residential histories in a Danish case-control study.

Non-Hodgkin lymphoma (NHL) is a frequent cancer and incidence rates have increased markedly during the second half of the 20(th) century; however, the few established risk factors cannot explain this rise and still little is known about the aetiology of NHL. Spatial analyses have been applied in an attempt to identify environmental risk factors, but most studies do not take human mobility into account. The aim of this study was to identify clustering of NHL in space and time in Denmark, using 33 years of residential addresses. We utilised the nation-wide Danish registers and unique personal identification number that all Danish citizens have to conduct a register-based case-control study of 3210 NHL cases and two independent control groups of 3210 each. Cases were identified in the Danish Cancer Registry and controls were matched by age and sex and randomly selected from the Civil Registration System. Residential addresses of cases and controls from 1971 to 2003 were collected from the Civil Registration System and geocoded. Data on pervious hospital diagnoses and operations were obtained from the National Patient Register. We applied the methods of the newly developed Q-statistics to identify space-time clustering of NHL. All analyses were conducted with each of the two control groups, and we adjusted for previous history of autoimmune disease, HIV/AIDS or organ transplantation. Some areas with statistically significant clustering were identified; however, results were not consistent across the two control groups; thus we interpret the results as chance findings. We found no evidence for clustering of NHL in space and time using 33 years of residential histories, suggesting that if the rise in incidence of NHL is a result of risk factors that vary across space and time, the spatio-temporal variation of such factors in Denmark is too small to be detected with the applied method.

Performance of cancer cluster Q-statistics for case-control residential histories.

Few investigations of health event clustering have evaluated residential mobility, though causative exposures for chronic diseases such as cancer often occur long before diagnosis. Recently developed Q-statistics incorporate human mobility into disease cluster investigations by quantifying space- and time-dependent nearest neighbor relationships. Using residential histories from two cancer case-control studies, we created simulated clusters to examine Q-statistic performance. Results suggest the intersection of cases with significant clustering over their life course, Q(i), with cases who are constituents of significant local clusters at given times, Q(it), yielded the best performance, which improved with increasing cluster size. Upon comparison, a larger proportion of true positives were detected with Kulldorf's spatial scan method if the time of clustering was provided. We recommend using Q-statistics to identify when and where clustering may have occurred, followed by the scan method to localize the candidate clusters. Future work should investigate the generalizability of these findings.

A research agenda: does geocoding positional error matter in health GIS studies?

Until recently, little attention has been paid to geocoding positional accuracy and its impacts on accessibility measures; estimates of disease rates; findings of disease clustering; spatial prediction and modeling of health outcomes; and estimates of individual exposures based on geographic proximity to pollutant and pathogen sources. It is now clear that positional errors can result in flawed findings and poor public health decisions. Yet the current state-of-practice is to ignore geocoding positional uncertainty, primarily because of a lack of theory, methods and tools for quantifying, modeling, and adjusting for geocoding positional errors in health analysis. This paper proposes a research agenda to address this need. It summarizes the basics of the geocoding process, its assumptions, and empirical evidence describing the magnitude of geocoding positional error. An overview of the impacts of positional error in health analysis, including accessibility, disease clustering, exposure reconstruction, and spatial weights estimation is presented. The proposed research agenda addresses five key needs: (1) a lack of standardized, open-access geocoding resources for use in health research; (2) a lack of geocoding validation datasets that will allow the evaluation of alternative geocoding engines and procedures; (3) a lack of spatially explicit geocoding positional error models; (4) a lack of resources for assessing the sensitivity of spatial analysis results to geocoding positional error; (5) a lack of demonstration studies that illustrate the sensitivity of health policy decisions to geocoding positional error.

Forecasting the effect of the Amethyst initiative on college drinking.

BACKGROUND: A number of college presidents have endorsed the Amethyst Initiative, a call to consider lowering the minimum legal drinking age (MLDA). Our objective is to forecast the effect of the Amethyst Initiative on college drinking. METHODS: A system model of college drinking simulates MLDA changes through (i) a decrease in heavy episodic drinking (HED) because of the lower likelihood of students drinking in unsupervised settings where they model irresponsible drinking (misperception), and (ii) an increase in overall drinking among currently underage students because of increased social availability of alcohol (wetness). RESULTS: For the proportion of HEDs on campus, effects of large decreases in misperception of responsible drinking behavior were more than offset by modest increases in wetness. CONCLUSIONS: For the effect of lowering the MLDA, it appears that increases in social availability of alcohol have a stronger impact on drinking behavior than decreases in misperceptions.

Spatial clustering of leukemia and type 1 diabetes in children in Denmark.

It has been proposed that type 1 diabetes (T1D) and leukemia in children may cluster in space and time due to common spatially mediated etiologies. We investigated this hypothesis and clustering of both diseases separately in Danish children aged 0-14 years, using 1,168 leukemia cases diagnosed in the period 1980-2006, 2,443 T1D cases diagnosed 1996-2006, and population-based controls matched on age, gender, and time of diagnosis. Residential histories from birth to diagnosis were collected. For leukemia in ages 0-14 years, we found no evidence of clustering; we did find spatial clustering at time of diagnosis for children aged 2-6 years with acute lymphoblastic leukemia (ALL) (observed/expected [95% confidence interval]: 1.35 [1.15-1.54]). T1D cases showed clustering at birth for ages 0-14 years; for ages 0-4 years at diagnosis, and when the residential history was accounted for. T1D cases clustered near leukemia cases particularly in the age group 2-6 years at diagnosis. Leukemia and T1D in this age group thus may share etiological factors mediated by geographic location. This suggests common environmental risk factors, with exposure to infections as first possible candidate, geographically localized exposure to agents that compromise development and/or response of the immune system being a second, and chance being a third.

Accuracy of commercially available residential histories for epidemiologic studies.

A key problem facing epidemiologists who wish to account for residential mobility in their analyses is the cost and difficulty of obtaining residential histories. Commercial residential history data of acceptable accuracy, cost, and coverage would be of great value. The present research evaluated the accuracy of residential histories from LexisNexis, Inc. The authors chose LexisNexis because the Michigan Cancer Registry has considered using their data, they have excellent procedures for privacy protection, and they make available residential histories at 25 cents per person. Only first and last name and address at last-known residence are required to access the residential history. The authors compared lifetime residential histories collected through the use of written surveys in a case-control study of bladder cancer in Michigan to the 3 residential addresses routinely available in the address history from LexisNexis. The LexisNexis address matches, as a whole, accounted for 71.5% of participants' lifetime addresses. These results provided a level of accuracy that indicates routine use of residential histories from commercial vendors is feasible. More detailed residential histories are available at a higher cost but were not analyzed in this study. Although higher accuracy is desirable, LexisNexis data are a vast improvement over the assumption of immobile individuals currently used in many spatial and spatiotemporal studies.

Heavy episodic drinking on college campuses: does changing the legal drinking age make a difference?

OBJECTIVE: This article extends the compartmental model previously developed by Scribner et al. in the context of college drinking to a mathematical model of the consequences of lowering the legal drinking age. METHOD: Using data available from 32 U.S. campuses, the analyses separate underage and legal age drinking groups into an eight-compartment model with different alcohol availability (wetness) for the underage and legal age groups. The model evaluates the likelihood that underage students will incorrectly perceive normative drinking levels to be higher than they actually are (i.e., misperception) and adjust their drinking accordingly by varying the interaction between underage students in social and heavy episodic drinking compartments. RESULTS: The results evaluate the total heavy episodic drinker population and its dependence on the difference in misperception, as well as its dependence on underage wetness, legal age wetness, and drinking age. CONCLUSIONS: Results suggest that an unrealistically extreme combination of high wetness and low enforcement would be needed for the policies related to lowering the drinking age to be effective.

Incorporating individual-level distributions of exposure error in epidemiologic analyses: an example using arsenic in drinking water and bladder cancer.

PURPOSE: Epidemiologic analyses traditionally rely on point estimates of exposure for assessing risk despite exposure error. We present a strategy that produces a range of risk estimates reflecting distributions of individual-level exposure. METHODS: Quantitative estimates of exposure and its associated error are used to create for each individual a normal distribution of exposure estimates which is then sampled using Monte Carlo simulation. After the exposure estimate is sampled, the relationship between exposure and disease is evaluated; this process is repeated 99 times generating a distribution of risk estimates and confidence intervals. This is demonstrated in a bladder cancer case-control study using individual-level distributions of exposure to arsenic in drinking water. RESULTS: Sensitivity analyses indicate similar performance for categorical or continuous exposure estimates, and that increases in exposure error translate into a wider range of risk estimates. Bladder cancer analyses yield a wide range of possible risk estimates, allowing quantification of exposure error in the association between arsenic and bladder cancer, typically ignored in conventional analyses. CONCLUSIONS: Incorporating distributions of individual-level exposure error results in a more nuanced depiction of epidemiologic findings. This approach can be readily adopted by epidemiologists assuming distributions of individual-level exposure.

Evaluation of the risk of neighbourhood infection of H7N1 Highly Pathogenic Avian Influenza in Italy using Q statistic.

Exposure to the risk of neighbourhood infection was estimated for the H7N1 Highly Pathogenic Avian Influenza (HPAI) epidemic that affected Northern Italy between 1999 and 2000. The two most affected regions (Lombardy and Veneto) were analyzed and the epidemic was divided into three phases. Q statistics were used to evaluate exposure to the risk of neighbourhood infection using two measures. First, a local Q statistic (Qikt) assessed daily exposure for each farm as a function of the number of neighbouring infected farms that were in their infectious period, weighted by the distance between farms. This allowed us to identify the daily time course of risk for each farm and, at any given time, local groups of farms defined by high risk. Second, for each farm a summary statistic of exposure risk within each phase (Qiph) was obtained by summing Qikt over the duration of each phase. This allowed identification of farms defined by persistent, high exposure risk within each phase of the epidemic. Statistical significance was evaluated using conditional Monte Carlo simulation, and significant values of Qiph were mapped to assess the variation of the risk of neighbourhood infection through the phases. Qikt was larger for farms in Lombardy and the reduction of exposed farms was more marked for Veneto. Although the highest value of Qiph was observed in Veneto, in each phase most of the significant values were in Lombardy. In the last phase of the epidemic, a large reduction in the number of farms significantly exposed to the risk of neighbourhood infection was observed in the Veneto region, along with generally low values of Qiph. This may be explained by differences in control measures in the two regions, including pre-emptive slaughtering of farms considered at high risk of infection. The Q statistic allowed us to quantify geographic, time-dynamic variations in exposure to neighbourhood infection, and to generate hypotheses on the efficacy of control measures.

Lifetime exposure to arsenic in drinking water and bladder cancer: a population-based case-control study in Michigan, USA.

OBJECTIVE: Arsenic in drinking water has been linked with the risk of urinary bladder cancer, but the dose-response relationships for arsenic exposures below 100 microg/L remain equivocal. We conducted a population-based case-control study in southeastern Michigan, USA, where approximately 230,000 people were exposed to arsenic concentrations between 10 and 100 microg/L. METHODS: This study included 411 bladder cancer cases diagnosed between 2000 and 2004, and 566 controls recruited during the same period. Individual lifetime exposure profiles were reconstructed, and residential water source histories, water consumption practices, and water arsenic measurements or modeled estimates were determined at all residences. Arsenic exposure was estimated for 99% of participants' person-years. RESULTS: Overall, an increase in bladder cancer risk was not found for time-weighted average lifetime arsenic exposure >10 microg/L when compared with a reference group exposed to <1 microg/L (odds ratio (OR) = 1.10; 95% confidence interval (CI): 0.65, 1.86). Among ever-smokers, risks from arsenic exposure >10 microg/L were similarly not elevated when compared to the reference group (OR = 0.94; 95% CI: 0.50, 1.78). CONCLUSIONS: We did not find persuasive evidence of an association between low-level arsenic exposure and bladder cancer. Selecting the appropriate exposure metric needs to be thoughtfully considered when investigating risk from low-level arsenic exposure.

Geographic boundary analysis in spatial and spatio-temporal epidemiology: perspective and prospects.

Geographic boundary analysis is a relatively new approach that is just beginning to be applied in spatial and spatio-temporal epidemiology to quantify spatial variation in health outcomes, predictors and correlates; generate and test epidemiologic hypotheses; to evaluate health-environment relationships; and to guide sampling design. Geographic boundaries are zones of rapid change in the value of a spatially distributed variable, and mathematically may be defined as those locations with a large second derivative of the spatial response surface. Here we introduce a pattern analysis framework based on Value, Change and Association questions, and boundary analysis is shown to fit logically into Change and Association paradigms. This article addresses fundamental questions regarding what boundary analysis can tell us in public health and epidemiology. It explains why boundaries are of interest, illustrates analysis approaches and limitations, and concludes with prospects and future research directions.