Integrating open-source technologies to build low-cost information systems for improved access to public health data.

Effective public health practice relies on the availability of public health data sources and assessment tools to convey information to investigators, practitioners, policy makers, and the general public. Emerging communication technologies on the Internet can deliver all components of the "who, what, when, and where" quartet more quickly than ever with a potentially higher level of quality and assurance, using new analysis and visualization tools. Open-source software provides the opportunity to build low-cost information systems allowing health departments with modest resources access to modern data analysis and visualization tools. In this paper, we integrate open-source technologies and public health data to create a web information system which is accessible to a wide audience through the Internet. Our web application, "EpiVue," was tested using two public health datasets from the Washington State Cancer Registry and Washington State Center for Health Statistics. A third dataset shows the extensibility and scalability of EpiVue in displaying gender-based longevity statistics over a twenty-year interval for 3,143 United States counties. In addition to providing an integrated visualization framework, EpiVue's highly interactive web environment empowers users by allowing them to upload their own geospatial public health data in either comma-separated text files or MS Excel spreadsheet files and visualize the geospatial datasets with Google Maps.

Association of the built environment with physical activity and obesity in older persons.

OBJECTIVE: We examined whether older persons who live in areas that are conducive to walking are more active or less obese than those living in areas where walking is more difficult. METHODS: We used data from the Adult Changes in Thought cohort study for a cross-sectional analysis of 936 participants aged 65 to 97 years. The Walkable and Bikable Communities Project previously formulated a walkability score to predict the probability of walking in King County, Washington. Data from the cohort study were linked to the walkability score at the participant level using a geographic information system. Analyses tested for associations between walkability score and activity and body mass index. RESULTS: Higher walkability scores were associated with significantly more walking for exercise across buffers (circular zones around each respondent's home) of varying radii (for men, odds ratio [OR]=5.86; 95% confidence interval [CI]=1.01, 34.17 to OR=9.14; CI=1.23, 68.11; for women, OR=1.63; CI=0.94, 2.83 to OR=1.77; CI=1.03, 3.04). A trend toward lower body mass index in men living in more walkable neighborhoods did not reach statistical significance. CONCLUSIONS: Findings suggest that neighborhood characteristics are associated with the frequency of walking for physical activity in older people. Whether frequency of walking reduces obesity prevalence is less clear.

Current practices in spatial analysis of cancer data: mapping health statistics to inform policymakers and the public.

BACKGROUND: To communicate population-based cancer statistics, cancer researchers have a long tradition of presenting data in a spatial representation, or map. Historically, health data were presented in printed atlases in which the map producer selected the content and format. The availability of geographic information systems (GIS) with comprehensive mapping and spatial analysis capability for desktop and Internet mapping has greatly expanded the number of producers and consumers of health maps, including policymakers and the public.Because health maps, particularly ones that show elevated cancer rates, historically have raised public concerns, it is essential that these maps be designed to be accurate, clear, and interpretable for the broad range of users who may view them. This article focuses on designing maps to communicate effectively. It is based on years of research into the use of health maps for communicating among public health researchers. RESULTS: The basics for designing maps that communicate effectively are similar to the basics for any mode of communication. Tasks include deciding on the purpose, knowing the audience and its characteristics, choosing a media suitable for both the purpose and the audience, and finally testing the map design to ensure that it suits the purpose with the intended audience, and communicates accurately and effectively. Special considerations for health maps include ensuring confidentiality and reflecting the uncertainty of small area statistics. Statistical maps need to be based on sound practices and principles developed by the statistical and cartographic communities. CONCLUSION: The biggest challenge is to ensure that maps of health statistics inform without misinforming. Advances in the sciences of cartography, statistics, and visualization of spatial data are constantly expanding the toolkit available to mapmakers to meet this challenge. Asking potential users to answer questions or to talk about what they see is still the best way to evaluate the effectiveness of a specific map design.

Distance from home when death occurs: a population-based study of Washington State, 1989-2002.

OBJECTIVE: For patients who die in hospitals, the regionalization of tertiary health care services may be increasing the home-to-hospital distance, particularly for younger patients whose care is especially regionalized and for whom access to and use of home hospice services remains limited. The objective of this study was to test the hypotheses that the distance from home at the time of death in a hospital has increased over time and is inversely related to the age of the dying patient. METHODS: A population-based case series was conducted in Washington State of all deaths of state residents from 1989 to 2002. The main outcome measure was driving distance between home residence and location at the time of death. RESULTS: The overall mean distance from home to the hospital where death occurred has increased by 1% annually. Children who died in hospitals were much farther from home than their adult counterparts: the mean distance was 37.4 km for neonates and 50.9 km for children who were aged 1 to 9 years, compared with 19.9 km for adults who were aged 60 to 79 years and 14.0 km for patients who were older than 79 years. Disparities of distance were even greater among patients who were at the 90th percentile for distance (85.6 km for neonates compared with 30.8 for patient who were older than 79 years). CONCLUSIONS: The distance between home residence and the hospital where death occurs is greatest for children and has increased over time. Both of these findings have implications for the design of local and regional pediatric end-of-life supportive care services.

EpiQMS: an Internet application for access to public health data for citizens, providers, and public health investigators.

Access to epidemiologic data is critical to public health practice. Unfortunately, most published data are out of date and live databases are inaccessible because of issues of confidentiality, varying user needs, cost, security concerns, and other reasons. EpiQMS is a Web-based application that allows exploratory, statistical, and geographic analysis of public health data. Tables, graphs, and maps with adjustments for small areas are available at three levels: (1) the general public, (2) public health and medical practitioners, and (3) epidemiologists and health officers. The difference in each level is with respect to the presentation of small cell sizes and small geographies as set by the data set custodians.