Coventry University DOCTOR OF PHILOSOPHY An Environmental Health Information System Model for the Spatiotemporal Analysis of the Effects of Air Pollution on Cardiovascular Diseases in Bangalore, India Chinnaswamy, Anitha Award date: 2015 Awarding institution: Coventry University Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of this thesis for personal non-commercial research or study • This thesis cannot be reproduced or quoted extensively from without first obtaining permission from the copyright holder(s) • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Download date: 11. Oct. 2021 An Environmental Health Information System Model for the Spatiotemporal Analysis of the Effects of Air Pollution on Cardiovascular Diseases in Bangalore, India Anitha Chinnaswamy A thesis submitted in partial fulfilment of the University’s requirements for the Degree of Doctor of Philosophy August 2015 COVENTRY UNIVERSITY Abstract This study attempts to answer the research question ‘Can a novel model of health information system strengthen process for conducting research to understand the effects of air pollution on CVD in developing countries?’ There is limited research output from Asia and in particular, from India on studies of the deleterious effects of air pollution on CVD. This research aimed to investigate the barriers in developing countries and proposed the use of a spatiotemporal methodology to assess the effects of air pollution on CVD by developing an application based on a GIS platform. Choosing Bangalore as a case study area, secondary data from various governmental departments that included demographic data, air pollution data and mortality data were obtained. An Environmental Health Information system application based on GIS platform was developed specifically for Bangalore and with the characteristics of the datasets available. Data quality assessment was carried out on these datasets that resulted in the recommendation of a generalisable data quality framework to enable better data collection that will aid in strengthening health development policies. The data was analysed using spatial and non-spatial techniques. Results showed that levels of PM10 were of concern to the city with all areas having either high or critical levels of pollution. CVD deaths also were of concern contributing to almost 40% of total mortality. The potential years of life lost (PYLL), which is an estimate of the average years a person would have lived if he or she had not died prematurely was calculated for the years from 2010 to 2013; this revealed that 2.1 million person years were lost in Bangalore due to CVD alone. These potential years lost is an important factor to consider, as preventive measures taken by the Government will result in a significant economic impact on the city. The limitations of few monitoring stations were overcome by using spatial interpolation techniques such as Inverse Distance Weighted interpolation technique. The performance of the interpolation was tested using cross-validation techniques and the results revealed that Bangalore city would benefit from increased measuring stations for PM10. The logistic regression conducted showed that pollution especially PM10 was a likely predictor of CVD in the city. Spatial analysis was conducted and included buffering, overlay maps, queries and Hotspot analysis highlighting the zone hotspots. The results from the research guided the development of the novel 5-I model that would assist other similar developing cities to assess the effects of air pollution on CVD. The impetus is that based on evidence, intervention policies and programs may be implemented to inform research and practice which will ultimately have social, economic and health impact on the population. On implementation of the model, hotspots will be identified in order to roll out interventions to priority areas and populations most at risk that will ultimately prevent millions of deaths and enhance overall quality of life. i Dedication To Mum and Dad I am who I am today only because of your love, encouragement and your incessant belief in me. I immensely appreciate your sacrifices – I wouldn’t have gotten this far without you. To Kumar For your unending support, relentless positivity and boundless inspiration: You are my rock. To Karthik and Vignesh For your patience, sacrifice, selfless-love, cuddles and kisses; mostly for being such wonderful, lovely boys – you are a true blessing. ii Acknowledgments Firstly, I would like to thank my Director of Studies Prof. Ian Marshall: Thank you for your continued support, guidance and advice throughout this research. I have gained immense knowledge whilst under your supervision and I sincerely appreciate your time, patience and kindness. I shall remain indebted to Prof. Raouf Naguib: Thank You for your mentoring, advice and support throughout this research. I extend my deepest gratitude and thanks, I shall treasure all that I learnt from you forever. I would like to express my gratitude to the rest of my supervisory team Dr. Nigel Trodd and Dr. Norlaily Yaacob for their guidance. I am also very grateful to Dr. Gill Cooke and Dr. Alexeis Garcia-Perez for their continued support and encouragement. I would also like to acknowledge all the colleagues and staff at Coventry University who have helped in formal or informal ways during this research. I would like to extend my gratitude to Dr. Srinivas Reddy for extending his invaluable support and help towards the data collection and feedback from the stakeholders. Finally, I would like to Thank all my family and friends, Viju for being such a wonderful sister, my lovely brother Shiva, my in-laws and all those who have continued to motivate me in more ways than they can imagine. iii Contents Abstract .............................................................................................................................................. i Dedication ............................................................................................................................................. ii Acknowledgments ................................................................................................................................ iii Contents ............................................................................................................................................ iv List of Figures ....................................................................................................................................... ix List of Tables ........................................................................................................................................ xi List of Abbreviations .......................................................................................................................... xii List of Publications ............................................................................................................................ xiii Chapter 1: Introduction ....................................................................................................................... 1 1.1 Overview ................................................................................................................................. 1 1.2 Problem Statement .................................................................................................................. 2 1.3 Research Question .................................................................................................................. 4 1.4 Research Aim and Objectives ................................................................................................. 4 1.5 General Methodology ............................................................................................................. 5 1.5.1 Background ..................................................................................................................... 5 1.5.2 Spatiotemporal Methodology .......................................................................................... 5 1.6 Overview of Research Activities ............................................................................................ 6 1.6.1 Phase 1: Investigation ..................................................................................................... 7 1.6.2 Phase 2: System Development and Analysis .................................................................. 8 1.6.3 Phase 3: Data Management and Analysis ....................................................................... 8 1.6.4 Phase 4: Model Development and Validation ................................................................ 9 1.7 Ethical Considerations .......................................................................................................... 11 1.8 Structure of the Thesis .........................................................................................................