Despite the benefits of applying methods of geographic information science (GIScience), the use of such methods in health service planning and provision remains greatly underutilized. Spread of epidemic diseases is a constant threat to mankind and the globalization of the world increases the risk for global attacks from multi-resistant bacteria or deadly virus strains. Therefore, research is needed to better understand how GIScience could be used in epidemiologic analyses and other health applications. This thesis is divided into two parts; one for epidemiologic analyses and one for neighbourhood studies. The overall objective of the epidemiologic part of this research is to understand more about the spatial spread of past pandemics and to find out if there are any common patterns. This overall objective is divided into four specific research objectives; 1) to describe the spatial spread of the Russian Influenza in Sweden, 2) to create models of propagation of the Black Death in Sweden, 3) to establish spatiotemporal characteristics common to past pandemics in Sweden and 4) to visualize the spatiotemporal occurrence of salmonella among animal herds in Sweden. This thesis also discusses some other aspects of health related to place. Are differences in neighbourhood deprivation related to the amount of presence of goods and services? Is the way cities are planned affecting the behaviour within the local population regarding spontaneous walking and physical activity? The specific research objectives for this part are to define how deprivation is related to presence of goods and services in Sweden and to create walkability indices over the city of Stockholm including a quality test of these indices. Case data reported by physicians were used for the epidemiologic studies. The pandemics discussed covered the entire world, but our data is from Sweden only and as regards the Black Death there was no case data at all. The data for the goods and services analyses are from all of Sweden, whereas the walkability indices are based on data from the city of Stockholm. Various methods have been used to clean, structure and geocode the data, including hand written reports on case data, maps of poor geometric quality, information from databases on climate, demography, diseases, goods and services, income data and more, to make this data feasible for spatial analysis, modeling and visualization. Network analysis was used to model food transports in the 14th century as well as walking in the city of Stockholm today. Proximity analysis was used to assess the spatio-temporal spread of the Russian Influenza. The impact of climatological factors on the propagation of the Asian Influenza was analyzed and geographically weighted mean (GWM) calculations were used to discover common characteristics in the spatio-temporal spread of three past pandemics. Among the results generated in the epidemiologic study the following should be noted in particular; the local peaking periods of the Asian Influenza were preceded by falling temperature, the total peaking period for the three pandemics (Russian, Asian and A(H1N1)pdm09) was approximately 10 weeks and their weekly GWM followed a path from southwest to northeast (opposite direction for the A(H1N1)pdm09). From the neighborhood studies one can note that compared to the results measured and reported by tested individuals there is a positive (small but significant) association between neighborhood walkability and physical activity outcomes. The main contribution of this work is that it gives epidemiologists and public health specialists new ideas, not only on how to formulate, model, analyze and visualize different health related research questions but also ideas on how new procedures could be implemented in their daily work. Once the data reporting is organized in a suitable manner there is a multitude of options on how to present important and critical information to officials and policy makers. / <p>QC 20140313</p>

Plusieurs études ont démontré l’impact de divers facteurs sur l’espérance de vie, dont les caractéristiques liées à l’environnement dans l’enfance et à l’âge adulte. L’objectif principal de ce mémoire est de déterminer si l’exposition à une épidémie durant la période fœtale ou pendant la première année de vie a un impact sur la survie après 40 ans pour les Québécois nés entre 1885 et 1901. Durant cette période, nous avons relevé des épidémies de variole et de scarlatine, ainsi qu’une pandémie de grippe, la grippe russe. L’influence d’autres facteurs sur l’âge au décès est également étudiée, celle du sexe, de l’année et de la saison de naissance, du lieu de résidence à la naissance (urbain ou rural) et des régions d’habitation dans l’enfance et à l’âge adulte. Les données sur les Canadiens français nés au Québec à la fin du XIXe siècle, soit l’échantillon de 5% des ménages du recensement canadien de 1901 (Sager 2001) recueilli par le Canadian Families Project, jumelées aux dates de décès à partir de l’index des décès de 1926 à 1996 de l’Institut de la statistique du Québec (ISQ) et de la Société de généalogie du Québec (Pilon-Marien et al. 2009; Gagnon et Bohnert 2012) ont été analysées. Plus spécifiquement, nous avons effectué une analyse descriptive de la population étudiée, puis une analyse multivariée à l’aide de modèles de Cox et de modèles de Gompertz. Il en résulte qu’une exposition à une épidémie avant l’âge d’un an augmente significativement le risque de décéder après l’âge de 40 ans. L’exposition pendant la période fœtale a également un effet négatif sur la longévité, toutefois cet effet n’est pas significatif dans les modèles fournissant le meilleur ajustement aux données. Enfin, une naissance pendant une épidémie, donc une exposition in utero et durant la première année de vie n’a pas d’impact négatif significatif sur l’âge au décès pour ceux qui survivent jusqu’à 40 ans. / Numerous studies have shown the effects on longevity of early life and adult conditions. The purpose of our study is to analyze the impact of exposure to an epidemic disease during the fetal stage or the first year of life on survival after age 40 for people born in Quebec between 1885 and 1901. During this period, we identified epidemics of smallpox and scarlet fever, and the Russian influenza pandemic. The effects on age at death of other environmental conditions have been studied such as the sex, the season of birth and the year of birth, the urban-rural status at birth, the region of residence in early life and the region of residence at death. The dataset used in this study is based on the 5 percent sample of the 1901 Canadian Census, gathered by the Canadian Family Project (Sager 2001). Individuals were matched to their deaths records through the Quebec Consolidated Deaths Index from the Société de Généalogie du Québec and the Index des décès from the Institut de la statistique du Québec (Pilon-Marien and al. 2009). A descriptive analysis of the population studied has been done and a statistical analysis with Cox models and Gompertz models was made. We observe that individuals who were exposed to an epidemic disease during their first year of life had an increased mortality after age 40. In utero exposure to an epidemic hints at an increase of mortality after age 40 but the effect is not significant. Also, a birth during a pandemic, and therefore exposure both in utero and in the first year, apparently has no significant negatives impacts on longevity.