title: Spatial variation of heart failure and air pollution in Warwickshire, UK: an investigation of small scale variation at the ward-level.
abstract: OBJECTIVE
  To map using geospatial modelling techniques the morbidity and mortality caused by heart failure within Warwickshire to characterise and quantify any influence of air pollution on these risks.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Warwickshire, UK.
  
  
  METHODS
  Data from all of the 105 current Warwickshire County wards were collected on hospital admissions and deaths due to heart failure.
  
  
  RESULTS
  In multivariate analyses, the presence of higher mono-nitrogen oxide (NOx) in a ward (3.35:1.89, 4.99), benzene (Ben) (31.9:8.36, 55.85) and index of multiple deprivation (IMD; 0.02: 0.01, 0.03), were consistently associated with a higher risk of heart failure morbidity. Particulate matter (Pm; -12.93: -20.41, -6.54) was negatively associated with the risk of heart failure morbidity. No association was found between sulfur dioxide (SO2) and heart failure morbidity. The risk of heart failure mortality was higher in wards with a higher NOx (4.30: 1.68, 7.37) and wards with more inhabitants 50+ years old (1.60: 0.47, 2.92). Pm was negatively associated (-14.69: -23.46, -6.50) with heart failure mortality. SO2, Ben and IMD scores were not associated with heart failure mortality. There was a prominent variation in heart failure morbidity and mortality risk across wards, the highest risk being in the regions around Nuneaton and Bedworth.
  
  
  CONCLUSIONS
  This study showed distinct spatial patterns in heart failure morbidity and mortality, suggesting the potential role of environmental factors beyond individual-level risk factors. Air pollution levels should therefore be taken into account when considering the wider determinants of public health and the impact that changes in air pollution might have on the health of a population.
authors.affiliation: Public Health Warwickshire, Communities Group, Warwickshire County Council, Warwick, UK.
authors.forename: Oscar
authors.identifier: http://orcid.org/0000-0003-4546-1807
authors.initials: O
authors.lastname: Bennett
authors.affiliation: Division of Health Sciences, University of Warwick Medical School, Coventry, UK Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Ngianga-Bakwin
authors.initials: NB
authors.lastname: Kandala
authors.affiliation: Division of Health Sciences, University of Warwick Medical School, Coventry, UK.
authors.forename: Chen
authors.initials: C
authors.lastname: Ji
authors.affiliation: Public Health Warwickshire, Communities Group, Warwickshire County Council, Warwick, UK.
authors.forename: John
authors.initials: J
authors.lastname: Linnane
authors.affiliation: Division of Health Sciences, University of Warwick Medical School, Coventry, UK.
authors.forename: Aileen
authors.initials: A
authors.lastname: Clarke
mesh_terms: D000397:Air Pollution / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D009017:Morbidity / Q000639:trends; D010343:Patient Admission / Q000639:trends*; D010362:Patients' Rooms / Q000706:statistics & numerical data*; D011634:Public Health; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology
keywords: EPIDEMIOLOGY; SOCIAL MEDICINE