Using GIS to Evaluate the Social Determinants of Health (Text Version)

On September 19, 2011, Mike Dulin made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (6.8 MB). Plugin Software Help.

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Using Geographic Information Systems (GIS) to Evaluate the Social Determinants of Health

Michael Dulin

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Disclosures

• I have no relationships to disclose.
• I will not discuss off label use and/or investigational use in my presentation.
• Funding from:
  • National Institutes of Health (NIH) (R01 MD006127).
  • The Robert Wood Johnson Foundation.
  • NIH (R24 MD004930).

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Background

Image: Two maps labeled "Percent Hispanic by Census Tract" shows the growth of the Hispanic population in a sample county of North Carolina from 1990 to 2005.

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Goal

• Examine the relationship between social determinants and health outcomes.
• Design and validate GIS models that can identify areas within our community in need of health resources.
• Implement community-based interventions to improve appropriate healthcare utilization.

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Community-Based Participatory Research

Community Advisory Board (CAB)

Image: Venn diagram showing the structure of the CAB: The Research Team is entirely inside the CAB; the Latino Community and Healthcare Providers overlap slightly with both.

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Community Advisory Board (CAB)

• Healthcare System (Providers, Administrators).
• School Board.
• City/County Management.
• Parks Department.
• Law Enforcement.
• Community.
• Academic (Social Sciences, Statistical Support, GIS).
• Health Department.

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Variables

• Race / Ethnicity.
• Income.
• Access to Grocery Stores.
• Distance to Green Space.
• Access to Public Transportation.
• Access to Healthcare.
• Social Network.
• Hospitalizations.
• ED Visits.
• Primary care Treatable ED Visits.
• Utilization of Primary care.
• Quality of Life.

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Variable Selection Process

Image: A flow diagram labeled "Variable Selection Process" is shown.

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Themes Identified / Data Elements Selected

• Education—Hispanic Population Speaking Spanish at Home and Not Proficient in English.
• Economic Status—Hispanic/Latino Families below the Poverty Line.
• Acculturation—Time of Arrival/Latin American-born Population who Entered U.S. in 2000 or Later and are Not U.S. Citizens.
• Safety—Violent Crime Rate.

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Percent Hispanic (2010)

Image: A map labeled "Percent Hispanic (2010)" shows the Hispanic population in a sample county.

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Access to Public Transportation

Image: A map labeled "Access to Public Transportation" shows data for a sample county.

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Violent Crime Rate

Image: A map labeled "Violent Crime Rate" shows data for a sample county.

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Emergency Department for Primary Care

Image: A map labeled "Emergency Department for Primary Care" shows data for a sample county.

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Latin American Born Population Who Entered the U.S. After 2000 and Not U.S. Citizens

Image: A map labeled "Latin American Born Population who Entered the U.S. after 2000 and not US Citizens" shows data for a sample county.

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Hispanic Renter-Occupied Housing

Image: A map labeled "Hispanic Renter-Occupied Housing" shows data for a sample county.

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Hispanic Hospitalization Rate

Image: A map labeled "Hispanic Hospitalization Rate" shows data for a sample county.

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Median Household Income

Image: A map labeled "Median Household Income" shows data for a sample county.

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Hispanic Children Speaking Spanish at Home—Not Proficient in English

Image: A map labeled "Hispanic Children Speaking Spanish at Home—Not Proficient in English" shows data for a sample county.

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Hispanic Families Below the Poverty Line

Image: A map labeled "Hispanic Families below the Poverty Line" shows data for a sample county.

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Hispanic Patients Using a Safety Net Clinic

Image: A map labeled "Hispanic Patients Using a Safety Net Clinic" shows data for a sample county.

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Hispanic Families

Image: A map labeled "Hispanic Families" shows data for a sample county.

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Hispanic High School Graduation Rate

Image: A map labeled "Hispanic High School Graduation Rate" shows data for a sample county.

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Hispanic Population That Moved from Abroad in the Past Year

Image: A map labeled "Hispanic Population that Moved from Abroad in the Past Year" shows data for a sample county.

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Hispanic Single Mother Families

Image: A map labeled "Hispanic Single Mother Families" shows data for a sample county.

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Hispanic Unemployment Rate

Image: A map labeled "Hispanic Unemployment Rate" shows data for a sample county.

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Latin American-Born Population

Image: A map labeled "Latin American-Born Population" shows data for a sample county.

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Latin American-Born Population That Entered the U.S. in 2000 or Later

Image: A map labeled "Latin American-Born Population that Entered the U.S. in 2000 or Later" shows data for a sample county.

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Latin American-Born Population Who Are Not U.S. Citizens

Image: A map labeled "Latin American-Born Population" who are not U.S. Citizens shows data for a sample county.

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Combining Variables

• Variables Identified are Normalized.
• CAB asked to Weigh Each Variable.
• Variables are combined.
• CAB Adds Exclusion Criteria.
• Composite Map Created.

Dulin MF, et. al. Geographic Information Systems (GIS) demonstrating primary care needs for a transitioning Hispanic community. J Am Board Fam Med. 2010 Jan-Feb;23(1):109-20.

Dulin MF, et. al. Using Geographic Information Systems (GIS) to understand a community’s primary care needs. J Am Board Fam Med. 2010 Jan-Feb;23(1):13-21

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Composite Map

Image: A map labeled "Composite Map" shows data for a sample county.

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Neighborhood Evaluation / Ground Truthing

• Drill Down to the Neighborhood Level.
• Validation Process Started:
  • Qualitative / Photovoice.
  • Quantitative.
• Begin to Build Intervention Team.

Slide 32

Image: A street map of Tract 1702 in the sample county shows Hispanic/Latino Population by Block.

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Image: A table labeled "Census Tract Profile" shows demographic data for the sample county.

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Image: A street map of Tract 1918 in the sample county shows Hispanic/Latino Population by Block.