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Spatial lifecourse epidemiology is an interdisciplinary field that utilizes advanced spatial, location-based, and artificial intelligence technologies to investigate the long-term effects of environmental, behavioural, psychosocial, and biological factors on health-related states and events and the underlying mechanisms. With the growing number of studies reporting findings from this field and the critical need for public health and policy decisions to be based on the strongest science possible, transparency and clarity in reporting in spatial lifecourse epidemiologic studies is essential. A task force supported by the International Initiative on Spatial Lifecourse Epidemiology (ISLE) identified a need for guidance in this area and developed a Spatial Lifecourse Epidemiology Reporting Standards (ISLE-ReSt) Statement. The aim is to provide a checklist of recommendations to improve and make more consistent reporting of spatial lifecourse epidemiologic studies. The STrengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement for cohort studies was identified as an appropriate starting point to provide initial items to consider for inclusion. Reporting standards for spatial data and methods were then integrated to form a single comprehensive checklist of reporting recommendations. The strength of our approach has been our international and multidisciplinary team of content experts and contributors who represent a wide range of relevant scientific conventions, and our adherence to international norms for the development of reporting guidelines. As spatial, location-based, and artificial intelligence technologies used in spatial lifecourse epidemiology continue to evolve at a rapid pace, it will be necessary to revisit and adapt the ISLE-ReSt at least every 2-3 years from its release., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This article explores the spatio-temporal variation of mood and anxiety treatments in the context of a severe earthquake sequence. The aim was to examine a possible earthquake exposure effect, identify populations at risk and areas with particularly large mood and anxiety treatment rate increases or decreases in the affected Christchurch urban area. A significantly stronger increase of mood and anxiety treatments among residents in Christchurch compared to others in New Zealand have been found, as well as children and elderly identified as especially vulnerable. Spatio-temporal cluster analysis and Bayesian spatio-temporal modelling revealed little changes in mood and anxiety treatment patterns for most parts of the city, whereas areas in the less affected north and northwest showed the strongest increases in risk. This effect may be linked to inner-city mobility activity as a consequence of the earthquakes, but also different levels of community cohesion after the disaster, which merit further research., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

This study investigates the effects of disruptions to different community environments, community resilience and cumulated felt earthquake intensities on yearly mood and anxiety symptom treatments from the New Zealand Ministry of Health's administrative databases between September 2009 and August 2012. The sample includes 172,284 long-term residents from different Christchurch communities. Living in a better physical environment was associated with lower mood and anxiety treatment rates after the beginning of the Canterbury earthquake sequence whereas an inverse effect could be found for social community environment and community resilience. These results may be confounded by pre-existing patterns, as well as intensified treatment-seeking behaviour and intervention programmes in severely affected areas. Nevertheless, the findings indicate that adverse mental health outcomes can be found in communities with worse physical but stronger social environments or community resilience post-disaster. Also, they do not necessarily follow felt intensities since cumulative earthquake intensity did not show a significant effect., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: Since 2012, all community care recipients in New Zealand have undergone a standardised needs assessment using the Home Care International Residential Assessment Instrument (interRAI-HC). This study describes the national interRAI-HC population, assesses its data quality and evaluates its ability to be matched., Methods: The interRAI-HC instrument elicits information on 236 questions over 20 domains; conducted by 1,800+ trained health professionals. Assessments between 1 July 2012 and 30 June 2014 are reported here. Stratified by age, demographic characteristics were compared to 2013 Census estimates and selected health profiles described. Deterministic matching to the Ministry of Health's mortality database was undertaken., Results: Overall, 51,232 interRAI-HC assessments were conducted, with 47,714 (93.1%) research consent from 47,236 unique individuals; including 2,675 Māori and 1,609 Pacific people. Apart from height and weight, data validity and reliability were high. A 99.8% match to mortality data was achieved., Conclusions: The interRAI-HC research database is large and ethnically diverse, with high consent rates. Its generally good psychometric properties and ability to be matched enhances its research utility., Implications: This national database provides a remarkable opportunity for researchers to better understand older persons' health and health care, so as to better sustain older people in their own homes., (© 2016 Public Health Association of Australia.)

As urbanisation escalates globally, urban neighbourhood features which may improve physical and mental health are of growing importance. Using a cross-sectional survey of adults and the application of novel geospatial techniques, this study investigated whether increased visibility of nature (green and blue space) was associated with lower psychological distress (K10 scores), in the capital city of Wellington, New Zealand. To validate, we also tested whether visibility of blue space was associated missing teeth in the same sample. Cluster robust, linear regression models were fitted to test the association between visibility of nature and K10 scores, adjusted for age, sex, personal income, neighbourhood population density, housing quality, crime and deprivation. Higher levels of blue space visibility were associated with lower psychological distress (β=-0.28, p<0.001). Importantly, blue space visibility was not significantly associated with tooth loss. Further research is needed to confirm whether increased visibility of blue space could promote mental well-being and reduce distress in other cities., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The closure of the Manawatu Gorge in New Zealand in August 2011 caused a change in the travel time for patients living in the east of the MidCentral Health District to their health services located in Palmerston North. This presented an opportunity to study the effect a change in spatial access had on a population before and after such an event. We used a retrospective cohort design with routinely collected data from general practice and hospital services. Realised accessibility was calculated for 101,456 patients over 3.5 years. General practice utilization appeared to be the only service affected negatively during the gorge closure (rate ratio 1.106). Outpatient attendances had an increase in use by those with increased travel time (rate ratio 0.922). There was evidence of other unidentified factors that impacted the use of services across both intervention and control groups between the gorge open and closed periods. These results were more conservative than those produced by a traditional uncontrolled travel time category analysis which suggested a correlation in non-urgent ED attendance and general practice and boundary effects in all ED attendances and hospital admissions., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

This study investigated variations in perceptions of air quality as a function of residential proximity to busy highways, across two suburbs of South Auckland, New Zealand. While plenty is known about the spatial gradients of highway emissions, very little is known about variation of lay understanding at the fine spatial scale and whether there are gradients in severity of concerns. One-hundred and four near-highway residents agreed to participate in a semi-structured interview on their knowledge and attitudes towards highway traffic emissions. Proximity to the highway edge varied within 5-380 m at the predominantly downwind side of the highway and 13-483 m at the upwind side. Likert-type ordered response questions were analysed using multivariate regression. Inverse linear relationships were identified for distance from highway and measures of concern for health impacts, as well as for noise (p<0.05). Positive linear relationships were identified for distance from highway and ratings of both outdoor and indoor air quality (p<0.05). Measures of level of income had no conclusive statistically significant effect on perceptions. Additional discussion was made surrounding participant's open-ended responses, within the context of limited international research. Findings indicate that there may be quantifiable psychological benefits of separating residents just a short distance (40 m+) from highways and that living within such close proximity can be detrimental to wellbeing by restricting local outdoor activity. This work lends additional rationale for a residential separation buffer of ~100 m alongside major highways in the interests of protecting human health., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The 22nd February 2011 Christchurch earthquake killed 185 people, injured over 8000, damaged over 100,000 buildings and on-going aftershocks maintained high anxiety levels. This paper examines the dose of exposure effect of earthquake damage assessments, earthquake intensity measures, liquefaction and lateral spreading on mood and anxiety disorders in Christchurch after this event. We hypothesise that such disorders are more likely to develop in people who have experienced greater exposure to these impacts within their neighborhood than others who have been less exposed, but also live in the city. For this purpose, almost all clinically diagnosed incident and relapsed cases in Christchurch in a 12 months period after the 2011 earthquake were analysed. Spatio-temporal cluster analysis shows that people living in the widely affected central and eastern parts after the 2010/11 earthquakes have a 23% higher risk of developing a mood or anxiety disorder than people living in other parts of the city. Generally, mood and anxiety-related disorders increase with closer proximity to damage from liquefaction and moderate to major lateral spreading, as well as areas that are more likely to suffer from damage in future earthquakes., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The etiology of pneumococcal pneumonia (PP) is well-known. Yet, some events may increase its incidence. Natural disasters may worsen air quality, a risk factor for PP. We investigated spatial/spatio-temporal clustering of PP pre- and post-earthquakes in Christchurch, New Zealand. The earthquakes resulted in deaths, widespread damage and liquefaction ejecta (a source of air-borne dust). We tested for clusters and associations with ejecta, using 97 cases (diagnosed 10/2008-12/2011), adjusted for age and area-level deprivation. The strongest evidence to support the potential role of ejecta in clusters of PP cases was the: (1) geographic shift in the spatio-temporal cluster after deprivation adjustment to match the post-earthquake clusters and; (2) increased relative risk in the fully-adjusted post-earthquake compared to the pre-earthquake cluster. The application of spatial statistics to study PP and ejecta are novel. Further studies to assess the long-term impacts of ejecta inhalation are recommended particularly in Christchurch, where seismic activity continues., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

International debate posits that when groups feel deprived relative to reference groups in society, there may be psychosocial impacts. Deprivation varies geographically and deprived areas may be proximal to advantaged areas. In theory, this leads to chronic stress and poor mental health. This research explored whether socioeconomically isolated deprived areas experience increased levels of anxiety/mental disorder treatment, compared to other deprived areas. We developed a spatial isolation measure to characterise deprived areas surrounded by advantaged areas in Auckland, New Zealand. We found that isolated areas were characterised by fewer Māori and Pacific people, high density and shorter travel time to General Practitioners. We found significantly higher rates of anxiety/mood disorder treatment in highly isolated versus non-isolated areas and a statistically significant relationship with anxiety/mood disorders for each isolation level, both before and after confounder adjustment. This evidence suggests that mental health within small areas may be sensitive to the neighbourhood interactions, through social comparison or discrimination which lead to psychosocial stress., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: To examine the association between geographic access to alcohol outlets and serious violent crime in New Zealand., Methods: A national study of alcohol outlet access and serious violent crime used a cross-sectional ecological analysis. Serious violence offences recorded between 2005 and 2007 were aggregated for 286 police station areas. Using Geographical Information Systems (GIS), 9,320 licensed premises were geocoded and road travel distances to the closest alcohol outlet type/category were calculated for each area. Negative binomial regression models measured the association between the distance to the closest alcohol outlet and the number of serious violent offences in each police station area, controlling for area-level measures of social deprivation, Māori population, young males 15-29 years and population density., Results: There were significant negative associations between distance (access) to licensed outlets and the incidence of serious violent offences with greater levels of violent offending recorded in areas with close access to any licensed premises compared to those areas with least access (IRR 1.5, 95% CI 1.10-2.03); with on-licensed premises (IRR 1.6, 95% CI 1.16-2.08); and off-licensed premises (IRR 1.4, 95% CI 1.05-1.93)., Conclusion: Having greater geographic access to alcohol outlets was associated with increased levels of serious violent offending across study areas., Implications: Alcohol availability and access promoted under the current liberalised licensing regime are important contextual determinants of alcohol-related harm within New Zealand communities., (© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.)

Air pollution can increase mortality risk and may also exacerbate socioeconomic inequalities in health outcomes. This New Zealand study investigated whether exposure to particulate air pollution (PM(10)) was associated with mortality and health inequalities. Annual mean PM(10) estimates for urban Census Area Units (CAUs) were linked to cause-specific mortality data. A dose-response relationship was found between PM(10) and respiratory disease mortality, including at concentrations below the existing annual average guideline value of 20μgm(-3). Establishing and enforcing a lower guideline value is likely to have population health benefits. However, socioeconomic inequalities in respiratory disease mortality were not significantly elevated with PM(10) exposure., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: To refine and revise previous air pollution, climate and health time series analysis in Christchurch, New Zealand, introducing viral identification data (positive identification count and outbreak, defined as two of more positive tests)., Method: The effects on daily respiratory admissions for five years (1998-2002) of air pollution (PM(10) ), climate and virology (incorporating actual counts and outbreaks of influenza A and B (INF), para influenza virus type 3 (PIV) and respiratory syncytial virus (RSV) were examined using generalised additive models (GAMs), which are one of semiparametric models. Results were also compared with a model that included climate and air pollution parameters but without the inclusion of virology data. The data were analysed aggregately and then stratified by age group and season., Results: Different virology data detected various association levels. The highest estimates were a 3.93% (CI: 2.69-5.17) and a 3.88% (CI: 2.65-5.12) rise in respiratory admissions for a rise of 10 µg/m(3) annual PM(10) with outbreak and actual counts of PIV respectively for 0-19 years old with a three-day lag., Conclusion: Refining a statistical model with the addition of virology data gives a similar estimation of the association between PM(10) levels and respiratory admissions to previous research. Use of the indicator of an outbreak of viral infection appears to be similar to actual count of viruses detected., (© 2011 The Authors. ANZJPH © 2011 Public Health Association of Australia.)

Particulate air pollution is significantly elevated during the winter in Christchurch, New Zealand, largely attributable to use of wood burners for domestic home heating, topography, and meteorological conditions. Polycyclic aromatic hydrocarbons (PAHs) are a key component of airborne particulate matter (PM) and urinary 1-hydroxypyrene (1-OHP) has previously been used to assess exposure of people to PAHs. We examined urinary 1-OHP in Christchurch male non-smoking schoolchildren (12-18 yr) on two occasions after high pollution events (48 and 72 microg PM(10)/m(3) 24-h average) and two occasions during periods of low pollution (19 and 12 microg PM(10)/m(3)). Concentrations of urinary 1-OHP were significantly elevated in the students during high pollution events (median (mean+/-SD) 0.043 (0.051+/-0.032) and 0.042 (0.060+/-0.092) micromol OHP/mol creatinine respectively) compared with low pollution periods (median (mean+/-SD) 0.019 (0.026+/-0.032) and 0.025 (0.028+/-0.018) micromol/mol creatinine respectively). The observed 1-OHP concentrations are at the lower end of those determined in children and non-occupationally exposed adults in international studies and suggest a generally low exposure to PAHs. The increased urinary 1-OHP concentrations following nights of elevated particulate concentrations in ambient air suggest increased exposure to ambient air pollution during winter time, and could potentially be used as a biomarker of exposure in this population.

Numerous studies have noted a strong social gradient in many types of ill health. In particular, people in more deprived areas tend to be less healthy than those in more affluent communities, even once the demographic and socio-economic differences of the people in those areas have been taken into account. The social gradient is evident for many types of health outcomes, including diseases such as cancer. However, this positive relationship is not evident for rates of melanoma incidence and mortality, with rates of the disease tending to decrease with measures of disadvantage. In this study, we assess the relationship between the incidence of melanoma and deprivation in New Zealand, a country with particularly high rates of the disease. In the light of greater public awareness of the risk factors associated with melanoma, through public awareness campaigns such as 'Slip! Slap! Slop' and 'No Suntan is Safe', we analyse small-area data on standardised rates of melanoma for the period 1995-2000. We found that melanoma rates increase with social status, even once other confounding factors are controlled for, but that the relationship is very small. Furthermore, the relationship between melanoma incidence and deprivation is context-dependent. Possible explanations for the relationship between melanoma and deprivation are discussed, including more frequent exposure to intermittent sunshine among less disadvantaged groups and the underreporting of melanoma incidence in the New Zealand cancer registry among individuals in lower social groups.

Epidemiological studies relating air pollution to health effects often utilise one or few central monitoring sites for estimating wider population exposures to outdoor particulate air pollution. These studies often assume that highly correlated particulate concentrations between intraurban sites equate to a uniform concentration field. Several recent studies have questioned the universal validity of this assumption, noting that in some cities, the uniformity assumption may lead to exposure misclassification in health studies. Few studies have compared central fixed site concentrations to intraurban population background sites using actual monitored data in cities with higher levels of pollution. This research examines daily concentration variations in particulate matter less than 10 microm in diameter (PM10) at the neighbourhood scale over two winter months in Christchurch, New Zealand, a city with high winter pollution concentrations. Daily concentrations of PM10 data were collected for two winter months at ten background monitoring sites within 9.3 km of the central fixed monitoring site typically used for estimating exposure in epidemiological studies. Results indicate that while the correlation between PM10 concentrations measured at the central monitoring site and most background sites is strong (r>0.76), absolute daily concentration differences between the central monitoring site and population background sites were substantial (mean 90th percentile absolute difference=17.6 microg m-3). In Christchurch, a central monitoring site does not therefore appear to accurately depict wider area population exposures to PM10. Local intraurban variations in particulates should be well understood before applying central monitoring site concentrations as proxies for population exposure in epidemiological studies.

This paper examines the utility of The Air Pollution Model (TAPM; version 2) in simulating meteorology and dispersion of PM(10) for 1999 over the coastal city of Christchurch, New Zealand. Christchurch usually experiences severe degradation in air quality during austral winter. The formation of a nocturnal inversion layer and the emissions of particulate matter (PM(10)) mainly from solid fuel home heating appliances lead to severe smog episodes on an average of 30 nights during winter. The complex local topography surrounding the city in combination with influences from the urban areas can produce complicated boundary layer winds during quiescent weather. Simulated PM(10) data are used for construction of annual exposure maps for the urban areas in order to assess the health impact of air pollutants due to chronic exposure (presented in an accompanying paper). Meteorology and PM(10) dispersion results are statistically compared with the only permanent air pollution monitoring station available in order to evaluate the model's performance. Statistical measures such as the Index of Agreement (IOA) between modelled and measured data indicate that the model performs well. IOA is greater than 0.6 for meteorological variables, and various calculated skill scores place confidence in the model's performance. However, TAPM has a tendency to overestimate surface wind speed over urban areas during stagnant nocturnal conditions, resulting in quick flushing of pollutants.