Anna Hansell | Searcharxiv

arXiv2018

A hierarchical modelling approach to assess multi pollutant effects in time-series studies

When assessing the short term effect of air pollution on health outcomes, it is common practice to consider one pollutant at a time, due to their high correlation. Multi pollutant methods have been recently proposed, mainly consisting of collapsing the different pollutants into air quality indexes or clustering the pollutants and then evaluating the effect of each cluster on the health outcome. A major drawback of such approaches is that it is not possible to evaluate the health impact of each pollutant. In this paper we propose the use of the Bayesian hierarchical framework to deal with multi pollutant concentration in a two-component model: a pollutant model is specified to estimate the `true' concentration values for if your each pollutant and then such concentration is linked to the health outcomes in a time series perspective. Through a simulation study we evaluate the model performance and we apply the modelling framework to investigate the effect of six pollutants on cardiovascular mortality in Greater London in 2011-2012.

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arXiv2017

Using Ecological Propensity Score to Adjust for Missing Confounders in Small Area Studies

Small area ecological studies are commonly used in epidemiology to assess the impact of area level risk factors on health outcomes when data are only available in an aggregated form. However the resulting estimates are often biased due to unmeasured confounders, which typically are not available from the standard administrative registries used for these studies. Extra information on confounders can be provided through external datasets such as surveys or cohorts, where the data are available at the individual level rather than at the area level; however such data typically lack the geographical coverage of administrative registries. We develop a framework of analysis which combines ecological and individual level data from different sources to provide an adjusted estimate of area level risk factors which is less biased. Our method (i) summarises all available individual level confounders into an area level scalar variable, which we call ecological propensity score (EPS), (ii) implements a hierarchical structured approach to predict the values of EPS whenever they are missing, (iii) includes the estimated and predicted EPS into the ecological regression linking the risk factors to the health outcome. Through a simulation study we show that integrating individual level data into small area analyses via EPS is a promising method to reduce the bias intrinsic in ecological studies due to unmeasured confounders; we also apply the method to a real case study to evaluate the effect of air pollution on coronary heart disease hospital admissions in Greater London.

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