Integrating data on health and environment: new spatial modelling approaches to understanding and tackling mental health inequalities in English cities

Overview

There are widespread and persistent health inequalities in England, with wellbeing and length of life depending on wealth, education, occupation and place of residence. Health inequalities are particularly marked in urban areas, where affluent and deprived neighbourhoods are close together. Multiple pollutants and the characteristics of urban environments also impact on both physical and mental health, for example: sympathetic urban design can enhance mood and well-being, whilst poor design can increase stress and feelings of isolation.

Whilst patterns of health inequalities have been well described, the associations between environmental exposures, social factors and health outcomes are still poorly understood due to a lack of datasets linking environmental exposures to the social and health experiences of individual patients. We propose to link the health care records of individual patients to data on both the social characteristics and the physical environment of neighbourhoods. We will use these linked records to measure the impact of environmental exposures on inequalities in mental and physical health.

Findings

Recorded prevalence of adult depression was 12% (SD 0.04%) in urban areas in 2012. Higher prevalence was associated with several population characteristics (‘middle’ aged, lower socio-economic status, poorer general health) and environmental characteristics (greater distance from coastal areas, poorer air quality, less domestic green space). Many relationships were not linear, however. For example: the relationship between prevalence of depression and distance to coast was u-shaped, with the lowest prevalence in areas neither very close to nor very far from the coast.

Quality of care for depression was generally high, with most general practices achieving national quality targets for most eligible patients (mean 80%, SD 10%). The poorest quality of care was found in areas with either very low or very high prevalence of depression. After controlling for socio-economic and environmental factors, there was little association between quality of primary care and patient outcomes such as emergency hospital admissions and deaths. The factor most strongly associated with outcomes was material deprivation, with the poorest outcomes in the most deprived areas.

The project has also contributed spatial datasets to a multi-institution project led by York entitled Co-Motion: Mobility and Wellbeing which is developing a typology of urban areas to spatially characterize their relative benefits in terms of wellbeing and interrelated barriers to mobility.

Outputs

Publications

• Kontopantelis, E, Springate D, Ashworth M, Webb R, Buchan I, Doran T. (2015). Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study. British Medical Journal; 350: h904.