Susan T.

Williams
Geog 597K
March 2013

Lesson 3:
Compiling spatial data for a case-control study of Coronary Heart Disease
Task 1. Take a look at this spreadsheet. Do you consider age, sex and
deprivation to be predisposing, individual, or environmental factors? How do

they affect CHD, according to this table?

Figure 1: A summary of Coronary Heart Disease survey results from a sample of general practices across England
and Wales, compiled from http://www.heartstats.org/datapage.asp?id=1584

Age and sex are generally considered predisposing factors that cannot be
changed. Deprivation is slightly trickier to categorize. Although deprivation
(based on income, work, education, etc) is mainly an individual factor, there is a
possibility that deprivation could be influenced by environmental or even

predisposing factors (ie- a disabled individual who cannot obtain meaningful

income).
According to this table, age seems to be a strong factor in Coronary Heart
Disease (CHD), with those over the age of 65 being at higher risk. Gender also
seems to be a factor, with men experiencing a higher prevalence of CHD.
Deprivation seems to affect CHD as well, with prevalence being higher among
those in higher deprivation quintiles.

Work out expected numbers of cases for CHD by output area

Task 2: Using the field calculator menu option (as weve just done) and the
information in the spreadsheet chd_survey_results, try estimating the number
of CHD cases among those aged under 65 years and over 65 years respectively.
You will need to assume that the national CHD rates in these areas hold true for
each of our small areas. Add the number of cases in each group together to
produce a count of total CHD cases for each of our output areas let us call this
chdcases. Create a map of the result and include this in your report.
This task was accomplished by using the Field Calculator to multiply the Under
65 population count by the 2.38% average of CHD prevalence rates found on
the survey results spreadsheet:
CHDunder65 = [under65] * 0.0238
and similarly multiplying the Over 65 population count by the 17.31% average
prevalence rate:
CHDover65 = [OVER65] * .1731
And then the two groups were added together with the Field Calculator:
TotalCHD = [CHDunder65] + [CHDover65]
A map was generated from these results and is shown on the next page as
Figure 2.

Figure 2: A choropleth map estimating the prevalence of Coronary Heart Disease rates among small areas in Cardiff,
UK during 1994/98 using Natural Breaks classification. Map created with ESRI ArcMap 10.1 and used here for
educational purposes only.

Work out expected numbers of cases for CHD by practice

After finding the practices that are completely within the area of census data, I
worked out the expected number of cases for CHD by practice and developed
the thematic map shown in Figure 3 below.
Figure 3: A choropleth map estimating the expected Coronary Heart Disease rates per practice catchment in
Cardiff, UK during 1994/98 using Natural Breaks classification. Map created with ESRI ArcMap 10.1 and
used here for educational purposes only.

Calculate standardized rates of CHD

4

Task 3: By manipulating the table of attributes of the practice_within map

layer, work out a Standardised Morbidity Rate (SMR) for CHD for each practice.
(Hint To do this, you will need to divide the observed number of CHD cases [i.e.
the actual number of CHD on the practices computer, stored in the field
QOFcases] by the expected number, given each practices population [that you
have just calculated]. Produce a map of the resultant SMRs and include this in
your report.
The Standardized Morbidity Rate is obtained by dividing the observed number of
CHD cases by the expected number of cases and then multiplying by 100. The
results of this calculation are shown in Figure 4 below.

Figure 4: A choropleth map displaying the Standardized Morbidity Rates (SMR) for Coronary
Heart Disease per practice catchment in Cardiff, UK during 1994/98 using Natural Breaks
classification. Map created with ESRI ArcMap 10.1 and used here for educational purposes
only.

Task 4: Assess how well you think the standardisation of CHD disease cases has
worked. What aspects of our data or GIS analysis do you think might have

influenced the final map of standardised rates of CHD? Can you think of any
ways that they might be improved?
It is my opinion that the standardization of CHD cases has been fairly successful
in this instance. When comparing the thematic maps showing the prevalence
and expected cases which were compiled prior to standardization, the map
displaying standardized rates is different enough to appear as though the
calculations had a visible effect on the data. The steps taken during analysis
seemed quite logical and care was taken to prevent skewed data, such as
selecting the practices that are only located completely within the census
boundaries.
Though the data used here was generally of good content and quality, there are
a few possible things that may have influenced the final map, as well as some
things that may improve the analysis. Consideration of other contributing CHD
factors such as diabetes and obesity may affect the final map and would
certainly be worth including. It is uncertain as to how each risk factor might
affect the outcome of the final map, and each should be considered.
Additionally, as mentioned in the lesson, having an idea of the location of the
population within each census boundary would enable us to interpolate
information into practice boundaries. The aggregation affect here is currently
unknown but it is possible that the data might appear differently at lower levels
of aggregation.

References
Economic & Social Research Council (2000). Output Area Demonstrator. Retrieved
March 2013 at http://www.public.geog.soton.ac.uk/research/oa2001/oademon.asp
GIS for the Analysis of Health. University of Southampton. Retrieved March 2013 at
http://www2.geog.soton.ac.uk/users/TrevesR/obs/gah/frame_normal.htm
World Heart Federation (2013). Cardiovascular Disease Risk Factors. Retrieved
March 2013 at http://www.world-heart-federation.org/cardiovascularhealth/cardiovascular-disease-risk-factors/