Two-stage Bayesian model to evaluate the effect of air pollution on chronic respiratory diseases using drug prescriptions

Spat Spatiotemporal Epidemiol. 2016 Aug;18:1-12. doi: 10.1016/j.sste.2016.03.001. Epub 2016 Apr 4.


Exposure to high levels of air pollutant concentration is known to be associated with respiratory problems which can translate into higher morbidity and mortality rates. The link between air pollution and population health has mainly been assessed considering air quality and hospitalisation or mortality data. However, this approach limits the analysis to individuals characterised by severe conditions. In this paper we evaluate the link between air pollution and respiratory diseases using general practice drug prescriptions for chronic respiratory diseases, which allow to draw conclusions based on the general population. We propose a two-stage statistical approach: in the first stage we specify a space-time model to estimate the monthly NO2 concentration integrating several data sources characterised by different spatio-temporal resolution; in the second stage we link the concentration to the β2-agonists prescribed monthly by general practices in England and we model the prescription rates through a small area approach.

Keywords: Bayesian model; COSP; General practice; INLA.

Publication types

  • Evaluation Study

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage
  • Adrenergic beta-Antagonists / supply & distribution*
  • Adrenergic beta-Antagonists / therapeutic use
  • Air Pollution / adverse effects
  • Air Pollution / statistics & numerical data*
  • Asthma / drug therapy
  • Asthma / epidemiology*
  • Asthma / etiology
  • Bayes Theorem
  • Databases, Factual
  • Demography
  • England / epidemiology
  • Humans
  • Nitrogen Dioxide / analysis
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Pulmonary Disease, Chronic Obstructive / drug therapy
  • Pulmonary Disease, Chronic Obstructive / epidemiology*
  • Pulmonary Disease, Chronic Obstructive / etiology
  • Risk Factors
  • Sensitivity and Specificity
  • State Medicine


  • Adrenergic beta-Antagonists
  • Nitrogen Dioxide