Choropleth map legend design for visualizing community health disparities

<p>Abstract</p> <p>Background</p> <p>Disparities in health outcomes across communities are a central concern in public health and epidemiology. Health disparities research often links differences in health outcomes to other social factors like income. Choropleth maps of health outcome rates show the geographical distribution of health outcomes. This paper illustrates the use of cumulative frequency map legends for visualizing how the health events are distributed in relation to social characteristics of community populations. The approach uses two graphs in the cumulative frequency legend to highlight the difference between the raw count of the health events and the raw count of the social characteristic like low income in the geographical areas of the map. The approach is applied to mapping publicly available data on low birth weight by town in Connecticut and Lyme disease incidence by town in Connecticut in relation to income. The steps involved in creating these legends are described in detail so that health analysts can adopt this approach.</p> <p>Results</p> <p>The different health problems, low birth weight and Lyme disease, have different cumulative frequency signatures. Graphing poverty population on the cumulative frequency legends revealed that the poverty population is distributed differently with respect to the two different health problems mapped here.</p> <p>Conclusion</p> <p>Cumulative frequency legends can be useful supplements for choropleth maps. These legends can be constructed using readily available software. They contain all of the information found in standard choropleth map legends, and they can be used with any choropleth map classification scheme. Cumulative frequency legends effectively communicate the proportion of areas, the proportion of health events, and/or the proportion of the denominator population in which the health events occurred that falls within each class interval. They illuminate the context of disease through graphing associations with other variables.</p

Virtual and actual: Relative accuracy of on-site and web-based instruments in auditing the environment for physical activity

Objectives: To assess the relative accuracy and usefulness of web tools in evaluating and measuring street-scale built environment characteristics. Methods: A well-known audit tool was used to evaluate 84 street segments at the urban edge of metropolitan Boston, Massachusetts, using on-site visits and three web-based tools. The assessments were compared to evaluate their relative accuracy and usefulness. Results: Web-based audits, based-on Google Maps, Google Street View, and MS Visual Oblique, tend to strongly agree with on-site audits on land-use and transportation characteristics (e.g., types of buildings, commercial destinations, and streets). However, the two approaches to conducting audits (web versus on-site) tend to agree only weakly on fine-grain, temporal, and qualitative environmental elements. Among the web tools used, auditors rated MS Visual Oblique as the most valuable. Yet Street View tends to be rated as the most useful in measuring fine-grain features, such as levelness and condition of sidewalks. Conclusion: While web-based tools do not offer a perfect substitute for on-site audits, they allow for preliminary audits to be performed accurately from remote locations, potentially saving time and cost and increasing the effectiveness of subsequent on-site visits

Relationships Between the Built Environment and Walking and Weight Status Among Older Women in Three U.S. States

There are few studies of built environment associations with physical activity and weight status among older women in large geographic areas that use individual residential buffers to define environmental exposures. Among 23,434 women (70.0±6.9 years; range = 57-85) in 3 states, relationships between objective built environment variables and meeting physical activity recommendations via walking and weight status were examined. Differences in associations by population density and state were explored in stratified models. Population density (odds ratio (OR)=1.04 [1.02,1.07]), intersection density (ORs=1.18-1.28), and facility density (ORs=1.01-1.53) were positively associated with walking. Density of physical activity facilities was inversely associated with overweight/obesity (OR=0.69 [0.49, 0.96]). The strongest associations between facility density variables and both outcomes were found among women from higher population density areas. There was no clear pattern of differences in associations across states. Among older women, relationships between accessible facilities and walking may be most important in more densely populated settings

BioMed Central Methodology

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: Disparities in health outcomes across communities are a central concern in public health and epidemiology. Health disparities research often links differences in health outcomes to other social factors like income. Choropleth maps of health outcome rates show the geographical distribution of health outcomes. This paper illustrates the use of cumulative frequency map legends for visualizing how the health events are distributed in relation to social characteristics of community populations. The approach uses two graphs in the cumulative frequency legend to highlight the difference between the raw count of the health events and the raw count of the social characteristic like low income in the geographical areas of the map. The approach is applied to mapping publicly available data on low birth weight by town in Connecticut and Lyme disease incidence by town in Connecticut in relation to income. The steps involved in creating these legends are described in detail so that health analysts can adopt this approach. Results: The different health problems, low birth weight and Lyme disease, have different cumulative frequency signatures. Graphing poverty population on the cumulative frequency legend

Pharmacy patronage among the elderly: Selected racial and geographical patterns

In the United States the number of elderly and their percentage of the total population continues to increase. The large majority will never require care in an institution, yet they are faced with increasing health problems and decreased mobility, and almost half require prescription drugs to pursue activities of daily living. In this paper selected patterns of pharmacy patronage among a sample of elderly are presented. Overall, the percentage of elderly requiring prescriptions reflects national estimates and no significant difference is found in the expressed need for prescriptions between black and respondents. 'Neighborhood' pharmacies are perceived as being very important, but relatively few use the most geographically convenient. Nevertheless, the large majority of elderly are satisfied with distances they presently have to travel to purchase prescriptions. The observed travel patterns for prescription purchases suggest that conventional wisdom pertaining to the nature of the pharmacy journey, the notion of convenience and the traditional concept of neighborhood among the elderly should be reexamined.