Dementia in Europe: A Spatial Dashboard System for Chronic

Disease Management

Hamish ROBERTSON, Nick NICHOLAS*, Andrew GEORGIOU, Julie JOHNSON, Andrew HAYEN and Joanne TRAVAGLIA

Contents

• Background• Ageing, dementia and chronic in Europe• Dashboards and health informatics• Spatial health informatics• Building a spatial dashboard• Visualisation and engagement• Discussion• Conclusion• References and Resources

Background

• 2013 our paper “A spatial informatics for aged care” setting out a concept for spatial health informatics was presented @ HISA• 2014 we extended this to include papers on “globalising health

informatics” and “virtual aged care systems” – MIE and HISA• The central concept is that health informatics and spatial data

representation need to overlap much more because:• Healthcare is still managed across space regardless of claims to the contrary• Health problems, resources and access vary hugely across space• Visualization is increasingly central to ‘big data’ and related analytical

approaches• Mobile and sensor technologies include integrated GPS i.e. data is already spatial

Ageing is an Increasingly Global PhenomenonSource: HelpAge.org

Life expectancies are high and still rising…Source: Eurostat 2015

Ageing, dementia and chronic disease in Europe• Ageing is highly correlated with multiple health (illness) conditions including the chronic diseases• Dementia is a syndrome associated with neurodegeneration - understood as a cluster of

symptoms which can progress to a disease state/entity• Major diseases associated with dementia -> Alzheimer’s, Vascular dementia, Dementia with

Lewy Bodies and mixed dementias• Rates for these conditions vary considerably across space, time and study methodology - not a

strict linear relationship and variability common• Ageing is therefore an intersectional locus for systemic diseases, chronic diseases,

neurodegenerative diseases and their consequences in society• Physical disability, cognitive impairment, depression, pain syndromes and so on are commonly

seen together• Single-entity disease categories are of finite use in this context but this still characterizes much of

current medical practice• The consequences for ageing societies and older people are substantial

Dashboards and health informatics

• Visual dashboards are increasingly common in hospitals for clinical, management and operational purposes• Health informatics still not fully spatially enabled and health

professionals and management not yet spatially literate• Sub-groups of established users of GIS such as international health,

public health and health inequalities• In Europe the EU is funding a variety of information projects with

major spatial capabilities• Sooner rather than later the majority of health information will be

geocoded automatically e.g. wearable biosensors, mobile phone apps, m-health, t-health and e-health

Interactive Geovisual Analytics applied to Big Statistical Regional Data - Linköping University, Sweden (OECD Funded)

Spatial health informatics: Dementia in EU28Data Sources: OECD 2012 Dementia Prevalence and Eurostat for Population Projections

ID Coloring Country Country Dementia Rate 2015 Popn 60+ Dementia 2015 2020 Popn 60+ Dementia 2020 2030 Popn 60+ Dementia 2030 2040 Popn 60+ Dementia 2040 2050 Popn 60+ Dementia 2050

4153733 2 AT Austria 7.1 2180080 155481 2377353 169551 2937094 209471 3176463 226542 3343594 238462

4153779 1 BE Belgium 7.2 8331533 601073 8711320 628473 9932516 716575 10295971 742797 10281605 741760

11111588 1 BG Bulgaria 5.5 1970210 109267 2010692 111513 2075318 115097 2185254 121194 2239622 124209

3882352 0 HR Croatia 6.2 1817484 113335 1884346 117505 2000162 124727 2101438 131042 2049300 127791

11111560 0 CY Cyprus 6.8 900545 61096 865895 58746 1088055 73818 1198545 81314 1094678 74267

4153760 3 CZ Czech Republic 5.6 2554602 143644 2735362 153808 3002402 168824 3466656 194928 3662600 205946

4726864 1 DK Denmark 6.3 1458007 91479 1567039 98319 1778092 111561 1914583 120125 1940503 121751

11648511 2 EE Estonia 6.7 1147597 76415 1327551 88398 1616461 107636 1323098 88101 1351335 89982

12648303 1 FI Finland 6.5 1444118 94083 1588400 103483 1770853 115369 1826949 119024 1883673 122719

2240256 2 FR France 7.5 15919400 1189143 17410656 1300536 20286753 1515374 21947271 1639411 22285501 1664676

4393040 0 DE Germany 7.0 21808055 1529756 23338019 1637077 27410070 1922717 27984373 1963002 27887307 1956193

10110156 3 GR Greece 6.9 2822336 194759 2950377 203595 3253052 224481 3560572 245702 3553092 245186

11111486 1 HU Hungary 6.2 2361344 145382 2498082 153800 2635042 162233 2967403 182695 3065300 188723

17129843 0 IE Ireland 6.2 796220 49113 895884 55260 1115266 68792 1339015 82593 1398299 86250

3446370 0 IT Italy 7.7 15995248 1233182 17094728 1317948 20106540 1550149 22529769 1736972 23216182 1789893

11111870 1 LV Latvia 6.9 490664 33773 503243 34639 511328 35196 508326 34989 506159 34840

11111847 2 LT Lithuania 6.4 706957 45372 727451 46687 755477 48486 725782 46580 645532 41430

2430042 3 LU Luxembourg 6.7 130802 8797 152061 10226 203439 13682 239032 16075 271749 18276

2430175 0 MT Malta 5.1 215378 11045 236733 12140 225259 11551 261076 13388 261370 13403

4153834 3 NL Netherlands 6.3 3836242 239883 4310409 269533 5217229 326237 5499698 343900 5503402 344132

11111820 1 PL Poland 6.2 8206055 505713 9267907 571151 10246282 631445 11416453 703559 12502826 770509

15975092 1 PT Portugal 6.9 3046893 210531 3294437 227635 3588317 247942 3958200 273499 4018981 277699

11111529 0 RO Romania 5.7 4614008 263823 4868559 278378 5275379 301639 5863575 335271 6127605 350368

11111509 0 SK Slovakia 5.5 1079058 59106 1220584 66859 1425356 78075 1666078 91261 1840684 100825

3498815 3 SI Slovenia 6.5 683946 44520 784316 51053 814996 53050 941813 61305 933158 60742

16512072 0 ES Spain 7.5 10722418 800988 11626015 868489 14085843 1052243 16778380 1253382 17136414 1280128

6019577 0 SE Sweden 7.1 2429771 171903 2594518 183559 2964804 209756 3177482 224803 3458441 244681

23673283 1 GB United Kingdom 7.0 14284208 1001253 15611237 1094271 18652264 1307432 20429047 1431976 22151411 1552705

EU (28 countries) 7.0 131953179 9236723 142453174 9971722 164973649 11548155 179282302 12549761 184610323 12922723

Dementia Estimate for EU28 Countries 2015 and 2050

MaltaLuxembourg

LatviaLithuaniaSlovenia

CyprusIrelandEstonia

SlovakiaDenmark

FinlandBulgariaCroatia

HungaryCzech Republic

AustriaSwedenGreece

PortugalNetherlands

RomaniaBelgiumPoland

SpainUnited Kingdom

FranceItaly

Germany

-500000 0 500000 1000000 1500000 2000000 2500000Population

Total Dementia Change 2015-2050 in EU28

Treemap for Dementia by EU28 in 2050

Building a dashboard

Visualisation and engagement

• Visual dashboards linked to health data warehouse systems, direct data feeds and personal sensors, for example, to support real-time collection, analysis, reporting and responses (emergency, chronic, preventive?)

• Soon they will support interventional strategies e.g. why is this pattern occurring in this place but not this one? Why is this strategy working here but not there?

• Scale factors can be better integrated with time and spatial indexation of data (micro to macro in the same environment)

• Prevalence and incidence data can be mapped in the same system and visual environment as healthcare providers – medical, nursing, emergency, pharmacy etc

• Health informatics can support multidisciplinary teams (health and other) in programmed responses as happens with e.g. crisis responses

• Health informatics systems will be increasingly spatial - push and pull factors such as personal health systems for home monitoring

Virtual earth environments

• Data silos, policy separation and professional sub-domains are common in health systems globally• Integration is getting better but even then complexity remains an issue• Most systems, even tele-health, stop at nominal boundaries (administrative, payment,

regulatory etc)• Most systems will need to interact with more dynamic phenomena e.g. climate

change and consequences (flood, fire, heat, disease vectors)• Virtual earth environments as a totalising of the health environment – people, health

status, built environment, natural environment etc• Engagement processes and system interconnections will improve with time e.g. Excel

can now map, Tableau can map and similar convergence of x,y data plus spatial dimension (z), temporal (t) and scalar (s)

Discussion

• Dashboards are already common in health systems and will become more so with time• Information software environments and ‘big data’ strategies are driving many of

these applications• Visualisation methods are becoming more sophisticated and more accessible – not

just expert users now, many include basic mapping• Health informatics involves complex and varied information types – visualization is

useful for a broad audience of users• Health system problems and resources vary across space – adding a spatial element

to visualization is beneficial• Integration of spatial tools and visuals support existing tasks and build numeracy

and spatial literacy within healthcare

Conclusion

• Spatial variability is a major issue for disease management• Ageing is clearly associated with multiple, complex, intersecting health

problems and their sequelae – cascading clinical consequences• Visual models and methods have the capacity to plan for, monitor and

respond to these issues across a complex jurisdictional domain like the EU• Integration of (a) incidence data and (b) patient data will emerge soon • Spatially enabled dashboard systems can support prevention and intervention

in ways that usefully extend the science of applied health informatics• Next comes the need for spatial skills in policy, clinical, administrative and

information management environments