Introduction to GIS course and health data sets

GIS systems
A geographical information system (GIS) is a computer based tool which stores,
integrates, analyses, models and displays information using maps. Part of the power of a
GIS system, is in the ability of spatial analysis to reveal health patterns of which
managers were not previously aware. Spatial analysis offers an alternative 'picture' to
that of a spreadsheet, chart or report summary. A GIS system may assist Health
Authorities, PCT's, Trusts and healthcare commissioners, for example, to better
understand issues surrounding access to, and the delivery of health services. It can help
improve the understanding of the spatial incidence of disease or ill health. It can help
make better and more informed use of existing data sources and knowledge. A wide
range of analysis may be carried out using a GIS approach. Typical areas in which a GIS
can be of benefit include the point mapping of patients, aggregated analyses within
different geographical areas, and the modelling of potential service delivery options.
Recent 'windows' based GIS, or mapping packages, are in many ways very similar to
other PC packages such as word processors, spreadsheets, databases and presentation
packages. Such desktop GIS have a similar feel and look, with pull down menus, tool
bars, buttons to press and varied menu options. Windows GIS are intuitive and relatively
easy to use.
The main difference in a GIS is in its geographical or mapping functionality. In
technical terms, a GIS can be used to store, create, manipulate and analyse information
that is spatially linked to a local area, and then show this information on an output map.

A GIS may be defined in a number of ways :

A system for storing, checking, manipulating, analysing and

displaying data which are spatially referenced
A GIS is an information system where the data has a geographical
dimension (you could ignore the G, hence an IS)
A Management Information System (MIS) which enables map
displays of information
Spatial analysis systems concerned with quantitative procedures
applied to locational problems
An integrated system distinguished by high levels of mapping
capability and spatial analysis
Data storage, input, retrieval, mapping and spatial analysis to
support the decision making activities of an organisation (A GIS
integrates data from a variety of sources and presents information
to decision makers). A GIS may become a spatial decision
support system (SDSS).

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GIS have the potential to benefit Public Health analysis and decision making in a number
of ways. For example, GIS can help in the following areas :

Better understanding local populations

Measuring the equality of access to and use of particular services
Informing the Health Improvement Programmes and Local Modernisation Reviews
that Health Authorities, Primary Care Trusts, other health professionals and Local
Authorities are required to develop to help address issues of health promotion and ill
health prevention locally
Supporting issues of clinical governance at both Trust and primary care level using a
range of mortality, secondary care and morbidity data.
Exploring the effect Primary Care Groups and Trusts are having on services.
Assisting in service planning and development
Conducting environmental impact assessments
Providing an epidemiology tool

A health service GIS works by linking data to maps, via a geographical or spatial link.
This spatial link could comprise of a point on a map, derived by linking a patient
postcode to a grid reference. Alternatively, the spatial link could be a summary of data,
aggregated to a geographical area, such as a census or electoral ward. Summary data for
each ward can then be linked to the appropriate ward on a map.
The following illustration shows typically used health service geographical areas.
These comprise of :

North West Health Authorities (2001)

North West Local Authorities (2001)
Census wards within a Health Authority (1991)
Point location of postcodes within a Health Authority (2001)

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Requirements for using GIS within Public Health work

In order to use a GIS within Public Health analysis, we need to consider the requirements
for hardware, software, data and training.
A. Hardware

In order to make the best use of a GIS system and its functionality, an up to date PC is
recommended. For example, in 2002, a desktop tower PC with a Pentium IV processor,
128 MB of SDRAM, large hard disc, CD ROM drive, and as large a monitor as possible 19 would be ideal. This is likely to cost around 1,500.
Additionally, access to a quality colour printer is required for paper printouts.
Competitively priced A3 deskjet's are now on the market, and offer high print quality.
HA's, though not PCT's, may well have available colour laser A4 printers.
B. GIS software

There are a number of windows based GIS systems on the market. Major market leaders
include MapInfo and ArcView. Whilst many North West Health Authorities initially used
Atlas GIS in the early 1990's, this product is no longer supported within the UK.
Which package you use is up to personal choice. However, if you have close links with a
local University which uses Arc Info as a GIS, you may decide to standardise on Arc
View, the PC version. If you have close links with say a City Council which uses
MapInfo, you may wish to standardise on this package. Recent research has indicated
that MapInfo has been chosen by 90% of Health Service users by 2001.
These Windows GIS packages come boxed, and do not include health service data or
local maps. It is up to the user to specify what they include within the local system being
developed. Whilst ready to use GIS are advertised within the health service, these
packages are both expensive and limited in flexibility.
MapInfo and ArcView cost approximately 1,000 for the base software package. Other
add on software modules which may be considered would include a postcode converter
such as MapInfos Quick Address and a drive time analysis module or thematic mapper
module. However, each add on piece of software typically costs another 1,000.
C. Training requirements

This training course aims to guide you through the range of Health Service based data
sets available for use within a windows GIS package, and to demonstrate the use of
MapInfo.
D. Health and mapping data sets

A vast range of health service and other data sets are readily available which can be
presented and analysed using GIS software.

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The three main types of data used within health service spatial analyis are :
i. Geographical maps for use within a geographical information system.
ii. Data sets already aggregated and standardised to a set level (e.g. ward, Local
Authority, PCG/PCT or Health Authority).
iii. Data sets detailing individual patients or residents within a Health Authority, PCT or
Trust catchment area, which, through use of the patient postcode, enables data to be
aggregated to any given spatial level (e.g. census or electoral ward, future 2001
census output area, enumeration district (ED), postcode area, PCG, LA, PCT or HA).
Information on data sets available for each of the above groupings follows.

Available NHS spatial data sets

1. Mapping and spatial data sets

A range of maps, boundary files and data sets are available for purchase by NHS
organisations, or can be made available from local partner organisations. These include :
a. Boundary data
1991 census wards are readily available for all wards within the North West. NHSE and
HA data analysis typically makes use of such census wards. 1991 census enumeration
districts (EDs) are also available. EDs nest within wards.
Over time, Local Authorities adapt their ward boundaries, with electoral wards taking
over from census wards. HAs and PCTs may be able to obtain updated electoral wards.
For example, 1997 or 2000 electoral ward boundaries are required to map the IMD2000
deprivation indicators.
2001 census data should include census ward and output area boundaries - available
during 2003.
PCG , PCT and other neighbourhood boundaries may be created locally using head-up
digitising within a GIS. Local sites could include chemical tip sites, sure start estate
borders, and so on.
b. Ordnance Survey (OS) map data
The Ordnance Survey can supply inexpensive 1:10,000 and 1:50,000 colour raster map
tiles for the UK. Major North West route data is also available relatively cheaply in
vector format, although digitised at a far larger scale.
c. ONS postcode converters
The NHS receives a postcode converter file within the NHS organisational codes CD
ROM. This electronic file allocates a grid reference, ward and HA code to a given
postcode. Postcodes can be readily mapped to 100 metre resolution squares.
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However, a new Office of National Statistics (ONS) postcoder gridlink - provides six
digit x and y co-ordinates for postcodes within a given Health Authority, down to a one
metre resolution. An annual gridlink licence will cost approximately 150 per HA area.
d. Aerial photography
Many Local Authorities have available aerial photography, which can be incorporated
within a GIS. LAs are able to pass such data onto key partner organisations for use
within joint project work. Such photographic maps may be useful when looking at very
local sites.

ii. Individual patient data sets

1. Health Authority or Hospital Trust individual patient records
a. Inpatient database patient records
Hospital Trust PAS systems (patient admission systems) contain a variety of datasets of
potential use by Public health and other teams. Trust datasets are catchment based
they summarise activity for all patients attending that hospital, regardless of where the
patient lives. Health Authorities receive copies of some of these data sets, on a resident
basis - namely for residents who live within a set geographical area. PCTs will in the
future receive similar resident based data.
Commissioning or Contract Minimum Data Sets (CMDS) are key building blocks used
to analyse secondary care inpatient and day case Trust activity. Each CMDS is a
(complete) electronic record of an individual patients time in hospital, detailing and
summarising what has happened to a patient during their time in hospital. Each inpatient
record contains data on :

age, sex of patient

referring GP, consultant
Trust(s) where activity undertaken
HA of residence, purchaser
type of admission (e.g. elective inpatient - stay at least one night (booked in
advance) or non-elective (emergency admission), day case, specialty group
diagnosis, subdiagnosis, secondary diagnosis
type of operation and/or procedure undertaken
length of stay, dates within hospital, episode number
outcome, discharge destination
geographical data such as postcode .

Individual projects need to brainstorm and specify exactly what data is required. Data
files may contain raw data for each patient record, or be pre analysed. For example, a
decision could be made to focus on all finished episode patient records, within a time
period for a specific condition and age group. Alternatively, first episodes could be
analysed, or individual patients identified by first date of admission, and so on.

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Raw data can then be tidied, standardised and statistically analysed. For example,
different data sets may be linked using common fields of data, and, data may be
aggregated to a variety of levels (e.g. by Trust, GP, condition, age or geographical area).
Statistical analysis may be undertaken (e.g. counts of activity, crude rates, age
standardised ratios, statistical significance, trend analysis, forecasting). Data may be
geographically mapped through the use of a geographical information system (GIS).
Each stage requires greater levels of analysis input, skills, experience and time.
b. Additional Trust data - A&E Data, Outpatient data etc
Trusts have a range of additional data sets. These include outpatient data, A&E
attendances, specialist clinics, radiology data, CABG/PTCA patient activity, and so on.
2. Public health birth and death tapes data sets
Public Health Teams receive data on every resident within their area who is born or dies
within a given time period. A variety of data is contained within each data set. The
death tapes include information on underlying cause of death, personal details and home
location. The birth tapes provide information such as birth weight, and family details.
Individual postcodes can be aggregated to any geographical level.
3. FHSA patient registers
FHSA teams hold patient registers for every patient registered with GP. Such patient data
includes age, sex, GP, Practice and home address. FHSA data provides an alternative
population structure to other aggregated tables, and are frequently used.
4. Primary care Morbidity data
GP practices hold a wealth of primary care morbidity and other data, which is potentially
available for analysis if downloaded electronically from GP systems. Data includes :

GP practice age/sex registers :

GP practice clinical system data : e.g. patient Read coded data on diagnosis, illness,
drug interventions, lifestyles data.
Disease group registers (e.g. diabetes or IHD registers)

MAAG teams collect some of this data from GP practices. Typically, for reasons of
confidentiality it is not released, or it is not currently postcoded for GIS analysis.
5. Cancer registry data :
Regional Cancer Registries hold data on all individuals registered as having a cancer
within their area.
6. Site location data
HAs have available listings for the location of GP practices, dentists, opticians and
pharmacists. Hospital sites, and other health care bases may equally be mapped.

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iii.

Aggregated patient data sets

1. NHSE North West series of Small Area Databases (SAD)

The NHSE North West has issued a number of Small Area Databases to Health
Authorities through the 1990s. SAD tables provide ward level summaries for key health
indicators for all wards within the North West. Some comparative data may be analysed
over time.
The latest SAD is for 2000. Data is based on 1991 census wards, using updated
estimates for 1991 ward populations.
The small area databases include a variety of information on :

standardised mortality ratios (SMR's) for major causes of death (latest 1997-99), by
set age band, sex and ward
major diagnoses and operations (latest for April 1998 to March 2000)
mid year population estimates
birth weights

Specific additional data has been included within individual year SAD, for example, long
term limiting illness and CACI smoking rates.
2. Government agency data sets
a. ONS Neighbourhood statistics data
During 2000, the Office for National Statistics (ONS) have introduced a number of ward
level and Local authority level data sets data through the internet.
Ward level data is available for the following topic areas (frequently used by our LAs).

Economic deprivation family credit, income support claimants

Education skills and training primary school pupils at stage 2, university admissions
Work jobseekers allowance, incapacity benefits, severe disablement, etc
Indices of deprivation IOLD 2000
Population and vital statistics mid 1998 population estimates
Health attendance allowance claimants, disability living allowance

This data is additionally available at Local Authority level.

b. Indices of local deprivation
In 2000, the DETR produced the latest indices of local deprivation (IOLD 2000) based on
1998 ward boundaries. The 2000 IOLD scores include an overall score and ward
ranking, as well as income, employment, health, education, housing and access scores.
The index supersedes the previous 1998 DofE Index of Local Conditions. In addition to
these ward level data sets, many HAs have a range of deprivation data available,
including Jarman, Townsend, Carstairs and MINI scores.

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c. Teenage conception data

Ward level teenage conception data is available from ONS. This is available for under
18s for 1992-95, 95-97, 98, and for under 16s for 1992-97.
d. Classifications of wards and EDs
Geodemographic Superprofile lifestyle indicators, based on 1991 census enumeration
district areas, were purchased by the NHSE. Superprofiles are available at three levels
including broad lifestyle groupings (have nots, thriving greys, etc) and more specific
target groups (e.g. single mums living mainly in council flats).
In 1996 ONS produced ward classifications for England and Wales. This data set
clusters wards into particular groupings, e.g. suburbia, rural areas, inner city estates,
deprived city area, and so on.
3. 2001 ONS census, & 1991 census
The 2001 census was held in April 2001. Final results, based around new postcode
linked geographical output areas are due by 2003. A wide variety of data will be
available from the 2001 census for use by Health teams. The NHSE plan to disseminate
data to HAs, along with GIS based map boundaries. Data from the 1991 census is still
available.
4. Annual Public Health Common Data Set (now renamed the compendium of
clinical health indicators)
The annual Public Health Common Data Set (PHCDS), now renamed the compendium of
clinical indicators, provides a wide variety of indicators for each Health Authority and
Local Authority in England and Wales. Comparisons may be made within a Region, with
neighbouring HA's or LA's and with similar type areas (e.g. former coal mining
industries).
A wide variety of data is collected within the PHCDS, on Health of the Nation, Public
Health and health outcome indicators. Summaries include district comparisons on
accidents, cancer, CHD, MI, fertility, morbidity and mortality indicators, and so on.
The PHCDS come with their own very extensive guide. The latest version is for 2000.
The HA summaries enable comparisons to be mapped between all districts in E&W,
districts within a Region (e.g. the NW), similar districts (e.g. local rural or urban districts)
and neighbouring districts.
5. Local Authority data :
A variety of additional data is potentially available from Local Authorities, Unitary
Authority or City Council teams. Council Teams provide a valuable source for data on
areas such as housing and homelessness, crime, accidents, education, environmental data,
social services data, Crime and Disorder equity audit data.

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