Understanding how urban environment affects Non-Communicable Diseases (NCDs) is essential to help shift investment decision-making so that future urban planning considers far more comprehensively the prevention of risks causing NCDs.
This project will first focus on evaluating already existing interventions to improve urban development such as the introduction of Clean Air Zones in London. It will then also examine the impact of noise and major railway developments across England. We will look at changes in NCDs and consequently prescriptions as a result of urban planning interventions across different Strategic Health Authorities (SHAs) while controlling for several area-level characteristics. These analyses will allow us to measure changes in health outcomes and prescriptions, thus estimating the potential costs of unhealthy urban development.
Evaluating the impact of different urban planning measures can benefit taxpayers and central government over the long term due to decreased health burden on the NHS and increased levels of productivity, which is the primary focus of the current Industrial Strategy. It can also benefit the public as it provides evidence on which interventions may help the environment and hence population health.
The aims of this study are to examine the impact of urban development on health and wellbeing and investigate its related inequalities.
We will look at changes in diagnosis of NCDs and prescriptions for patients registered in practice areas with relatively low and high Index of Multiple Deprivation (IMD) (e.g. based on the domains “living environment” and “barriers to housing & services”) before and after urban planning interventions are introduced in different SHAs. We will use a difference in differences method comparing "treated" and "untreated" SHAs by components of IMD, before and after interventions have occurred. In investigating different "treated" and "untreated" SHAs, we will focus on those with trends in diagnosis and prescriptions prior to the start of urban development interventions that are similar to one another. We will control for a variety of area-level characteristics, as well as patient characteristics.
We will then look at how these changes in outcomes vary by other IMD domains and location. There are stark differences in health and urban infrastructure across England, it is therefore important to examine whether changes in urban development further exacerbate these inequalities and if so, for which groups this is likely to happen.
An early, high level understanding of the benefits and costs of urban development on health will inform policy in how best to invest in our cities in a way that benefits health, reducing potential costs to the health sector and society in the future.
The outcomes variables will be related to physical health (e.g. NCDs) and primary health care utilisation (e.g. prescriptions and consultation rates). Specifically, onset or presence of pre-existing long-term condition: Cancer, Diabetes, Heart Failure, Coronary Heart Disease, Atrial Fibrillation, Asthma, Chronic Obstructive Pulmonary Disorder, Stroke, Chronic Kidney Disease, Chronic Liver Disease, Depression, Anxiety, Dementia, Allergies; and reasons for consultation or diagnosis; consultation type; outcome of consultation (e.g. referral, prescribing).
With regards to drug prescriptions, we will focus on groups of drugs to treat respiratory problems such as bronchodilators including beta-adrenergic drugs, anticholinergics and methylxanthines and cancer medications such as alkylating agents, nitrosoureas, antimetabolites, fluticasone, budesonide and prednisolone. We will consider groups of drugs for diabetes (metformin, sulfonylureas, thiazolidinediones, meglitinides, dopamine-2 agonists, alpha-glucosidase inhibitors, sodium-glucose transporter 2 (SGLT2), dipeptidyl peptidase-4 (DPP-4) inhibitors, and bile acid sequestrants). Groups of drugs for heart diseases include beta blockers, ACE inhibitors and angiotensin II receptor blockers, aspirin, cholesterol modifying medications, ranolazine and calcium channel blockers. Drugs for liver and kidney diseases include dehydroemetine, entecavir, lamivudine, metaxodine, methionine, tenofovir and ursodeoxycholic acid. In addition to aspirin (mentioned above), for stroke common prescriptions include clopidogrel and ticagrelor. The group of drugs for depression and anxiety are the selective serotonin reuptake inhibitors (SSRIs) (e.g. fluoxetine (Prozac), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Cipralex) and sertraline (Zoloft)) and for dementia there are acetylcholinesterase (AChE) inhibitors. Prescriptions for allergies will include steroid medications, antihistamines and decongestants.
We will adjust for key variables such as age; sex; practice staff role; practice-level Index of Multiple Deprivation (without its specific domains), smoking status, alcohol drinking status and body mass index (BMI). Other covariates of interest will include significant comorbidities unrelated to pollution and area-level socioeconomic characteristics, including employment rates and type of employment, house prices (sources of which have been detailed above).
Eleonora Fichera - Chief Investigator - University of Bath
Eleonora Fichera - Corresponding Applicant - University of Bath
Anita McGrogan - Collaborator - University of Bath
Arpana Verma - Collaborator - University of Manchester
Habtamu Beshir - Collaborator - University of Bath
Julia Snowball - Collaborator - University of Bath
Practice Level Index of Multiple Deprivation;Rural-Urban Classification