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Spat Spatiotemporal Epidemiol. 2016 Aug;18:1-12. doi: 10.1016/j.sste.2016.03.001. Epub 2016 Apr 4.

Two-stage Bayesian model to evaluate the effect of air pollution on chronic respiratory diseases using drug prescriptions.

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Epidemiology and Biostatistics Department, Imperial College London Norfolk Place, Paddington London W2 1PG United Kingdom. Electronic address:
University of Bergamo via dei Caniana 2 Bergamo 24127 BG, Italia.


Exposure to high levels of air pollutant concentration is known to be associated with respiratory problems which can translate into higher morbidity and mortality rates. The link between air pollution and population health has mainly been assessed considering air quality and hospitalisation or mortality data. However, this approach limits the analysis to individuals characterised by severe conditions. In this paper we evaluate the link between air pollution and respiratory diseases using general practice drug prescriptions for chronic respiratory diseases, which allow to draw conclusions based on the general population. We propose a two-stage statistical approach: in the first stage we specify a space-time model to estimate the monthly NO2 concentration integrating several data sources characterised by different spatio-temporal resolution; in the second stage we link the concentration to the β2-agonists prescribed monthly by general practices in England and we model the prescription rates through a small area approach.


Bayesian model; COSP; General practice; INLA

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