Using a GIS implementation to examine
Epidemiology of Autism in
New York, New Jersey and Florida
Rehab Uosef
Brooklyn College
Dr. Rebecca Boger
Thesis Research Report
Spring 2013
Table of Contents
Table of Contents
Figures/Tables
Introduction
Background
Overview
GIS: What and Why Use
GIS applications in epidemiology
Case studies: GIS and epidemiology
Study areas
GIS and Autism
Prevalence
Methods
Autism GIS Prototype
Web based map development
Results and discussion
Autism GIS Prototype results
Conclusion and future work
References
Figures/Tables
Figure 1: “Infection Watch live” areal map
Figure 2: Easy-to-use interface
Figure 3: Easy-to-use interface
Figure 4: Link -
Table 1: 'Autism GIS Data Layers' ………………………………………………………………………………………………………… 20
Introduction
This thesis shows a web-based Autism GIS prototype that displays the epidemiology of children with Autism using an online Geographic Information System (GIS). Autism, along with Autism spectrum disorder (ASD), is a term used to define a particular group of disorders associated with the brain. These disorders are recognized as developmental disabilities diagnosed early on in childhood that may affect children’s social, communicative and behavioral attributes. It is estimated that 1.5 million children in the US have Autism. Prevalence of Autism is steadily on the rise[1].
The Autism GIS prototype examines various layers in a unified GIS system called “GIS Epidemiology - Infectious Disease”. This Autism GIS prototype and associated research are available at This map is also embedded into the web site ( for this Autism GIS prototype. The Autism GIS prototype allows the user to extract data, query data, and construct tables. Relationships within and among data layers can be examined, which can lead to further investigations. This Autism GIS prototype is designed to be used by a variety of users including GIS professionals or by families who are interested in viewing information visually. As a web-based tool, it can reach a wide audience. The goal is to provide for an alternative way of viewing research, data and statistics in a web-based GIS system where visualization is an important factor.
In future iterations of this Autism GIS prototype, statistical tools can be applied such as ‘Google Trends’ which can help in further analyzing the data a user is exploring. Further details on ‘Google Trends’ and other technologies that can be useful in future iterations will be discussed in more detail belowin the “GIS applications in epidemiology” section of this report. Other iterations can include the ability for users to upload to the Autism GIS prototype site their own map version; allowing multiple users to view and cross-reference maps with one another.
Background
Overview
This thesis shows a web-based geographic information system (GIS) Autism prototype that displays the epidemiology of children with Autism using an online technology known as ArcGIS. The ArcGIS technology is produced by a company called ESRI; ESRI works with maps and geographic information to create a geographic information system known as ArcGIS. For the purpose of this project ArcGIS was used and embedded in a website that includes other relevant information on Autism. Autism, along with Autism spectrum disorder (ASD), is a term used as a broad definition to generalize a particular group of disorders associated with the brain. They are recognized as developmental disabilities diagnosed early on in childhood that may affect children’s social, communicative and behavioral attributes. It is estimated that 1.5 million children in the United States (US) have Autism. Prevalence of Autism is steadily on the rise[2]. After an examination of existing websites it was found that there is a lack of information and tools that track the epidemiology of children with Autism in the United States while integrating disease prevalence with socioeconomic and environmental factors such as income, urbanization, population, hospital access, among others(see ‘GIS AND AUTISM’ section). For this reason alone, the development of a tool like the one in this project is extremely valuable. This GIS Autism GIS prototype can help to spread awareness and information about this steadily growing disease.
This Autism GIS prototypefocuses on three geographic areas in the United States – the states of Florida, New Jersey and New York. Florida was chosen since it has low prevalence of Autism, New Jersey has high and New York is in the middle. The datasets chosen and the data mining techniques are discussed in the methods section. Some of the datasets are contextual in that they enable the user to easily understand where the data are located; other datasets are used to explore patterns and relationships within and among datasets. Output products (e.g., maps, tables and reports) can be used for many purposes such as exploratory research to develop hypothesis for causal relationships pertaining to Autism, development of strategies to lessen and eventually eradicate the disease, and general education.
The intention of this project is to enable a wide range of users online to have access to information that may assist them in better understanding the epidemiology of Autism. The design of the GIS tool and website is meant to be simple and easy to use by diverse audiences. Both the Autism GIS prototype built for this project as well as the GIS tool case study both protect the privacy of the patients by not displaying their identity. Instead,the Autism GIS prototype displays each patient or position of data as a “point” or “area” of reference on the map. It does not represent an address or specific location but rather an area or region.
This project includes the Autism GIS prototype, a website ( that includes the Autism GIS prototype available at a PowerPoint explaining how to use the GIS tool data analysis that can be accessed via the website and the report presented here. This thesis beginswith a background on GIS thatexplains what GIS is and how it is implemented, as well as how it makes an existing system such as a Management Information System(MIS) or database more effective. Additionally, this section covers study areas that examine the success of GIS in various other projects. Following the background, the prevalence of Autism and statistics on its rate are discussed as well as connecting the use of a GIS tool with the study of infectious disease; particularly Autism. This is followed by a review of case studies, in particular, a study known as ‘Infection Watch Live’ which influenced the development of this (Autism) Autism GIS prototype. The methods section discussesof the techniques used to develop the Autism GIS prototype, including the code used to build the web site, the application used to build the map and the datasets that were incorporated. The analysis and outcomes of the Autism GIS prototype are discussed in the results and discussion section. Lastly, the last section presents final conclusions and future work for the next iteration of the Autism GIS prototype.
GIS: What and Why Use
Management information systems (MIS) is a method of gathering and analyzing datathat provides statistics, analyzes functions, and produces useful reports from its data.It can be used to explore the epidemiology of a particular event or occurrence. Epidemiology looks at patterns and characteristics of health related “events” that occur in particular populations and analyzes what their causes might be, and what influences the society, environment, or other surroundings may have on these “events”. Although MIS produces valuable information, this method lacks the ability of capturing and displaying the information visually on a map so that important information such as location, environmental conditions and population can be better understood. This is where the success of implementing geographic information system (GIS) comes into play.
GIS is used to capture, store and manipulate spatial data. Almost all types of data can contain a geo-reference, which enables the data to be defined in physical space, and therefore be used and integrated with other datasets in a GIS. These datasets can be reported, analyzed and leveraged in almost all areas of study. These systems are interactive and easily interfaced with other systems. In fact, the power of GIS is heightened because the existing implementation of MIS can remain within the GIS. In other words, GIS can co-exist and interface with other useful systems. GIS can also have built in MIS characteristics, eliminating the need for two or more separate systems.
The GIS framework provides tools for data analysis not available in other types of systems, and canenable the user to better interpret the data. It can search and bring together multiple types of data in different formats. The map data can be filtered and queried, as well as manipulated to produce outputs such as reports, charts, graphs, and tables. These different data outputs show the versatility of a GIS system to integrate different types of systems, such as MIS systems, expert systems,and reporting systems into one system with added features of spatial visibility. This versatility provides for a better rate of success when analyzing data and creating hypothesis.
The ability of a GIS to incorporate both tables of data (attributes) and spatial data enables GIS to become a very useful tool when making critical decisions. It is useful in answering questions such as “What is the geographical pattern of the disease rate of x in this region and tell me why I should be confident there is no reason to be concerned about the high rate here?” Gattrell and Loytonen (1995) explain that the public is more interested in the onset and early stages of diseases, and in understanding patterns of disease spread. GIS is useful for providing the public with an exploratory spatial analysis of a how a disease spreads and its trends (Bailey and Gatrell, 1995).
A brief examination of how South Carolina Department of Health and Environmental Control implemented a GIS illustrates how GIS can be used in health related applications. After understanding their needs, this health organization implemented an ESRI GIS tool into a website that would provide for more efficient distribution of health information for various audiences. This implementation showed extremely positive results, Jared Shoultz, Informatics Manager, Division of Biostatistics and Health GIS, PHSIS, SC DHEC shared that, “ESRI software has helped us keep data current and accessible. Instead of doing this annually, we are able to save a considerable amount of time and man-hours with GIS.”[3]
GIS is used for management and basic and applied research.[4]It is used to improve the rate at which health outbreaks and diseases are identified, tracked, and ultimately controlled. The implementation of GIS to help improve the rate at which health outbreaks and diseases are identified and controlled is more of a technological solution rather than a research based solution.[5] The technology can be leveraged for research purposes by gathering and integrating data for analysis. It has helped in many areas where resources are limited for research and disease outbreaks are at a rise.[6]
GIS provides several advantages when used as an infectious disease management system:[7] These include:
- Since GIS is a subset of MIS, GIS inherits the functions of MIS tools such as data mining, saving, processing, and analyzing of data.
- GIS makes it easier to monitor and control an epidemic event. Data of the population on a map help to better understand trends more quickly and efficiently.
- GIS makes the analysis of an epidemic event not only more efficient but much safer as well. For instance, Ku and Wu (2010) explain that, “the department of disease control could integrate each kind of infectious disease spread model to analyze the high dangerous area, divide the dangerous area of infectious disease, and notify people of the correct prevent method”.
- GIS can be combined with the Web to create an interactive website. Ku and Wu (2010) explain that, “By the Web GIS technology, we can announce the epidemic situation and related statistical data on web, and then people know the present domestic epidemic situation.”
The development of web-based GIS tools is rapidlyevolving. There are a variety of tools available, such as “OpenMap”[8], that do not charge the user. Environmental Systems Research Institute Inc (Esri©) offers both free-of-charge and purchased tools. Google maps and Google analytics are other tools freely available for users to implement in their project. Google software can be implemented alongside an ESRI project implementation or an OpenMap project. This integration of tools provides powerful web-based applications.
The web-based tool used for the Autism GIS prototype is online ArcGIS created by ESRI. ESRI is an organization that supplies desktop and web-based GIS tools, software and informational documentations and databases. Online ArcGIS was chosen since this is a framework available at Brooklyn College and it has a user-friendly interface and useful built in tools to customize projects.
GIS applications in epidemiology
The ability to track diseases and their outbreaks is extremely important to prevent further spreading while bringing the disease under control. GIS has advanced the surveillance of tracking diseases, and is widely used throughout the world. Mapping diseases can be traced back to 1854 when Dr. John Snow combined geospatial information on paper maps to analyze the cholera deaths and found clusters around water pumps. Over the years, mapping of diseases has expanded tremendously. To illustrate the pervasiveness of GIS in the epidemiology, “s[S]ince 1993, WHO’s Public Health Mapping and GIS program has been leading a global partnership in the promotion and implementation of GIS to support decision making for a wide range of infectious disease and public health programs.”[9]. In their research, Bindu and Janak (2009),[10] explain that GIS provides for better visualization and understanding of relationships between different factors versus the more traditional methods of viewing data in a MIS or other database.
The use of online GIS has been increasing due to the advancement in the tools including ESRI’s ArcGIS, OpenMap’s free software and Google applications such as maps and analytics. This section will explore how different projects have taken advantage of these advancements.
“Google trends”, as previously mentioned, is a technology which can be easily implemented and extremely useful in future iterations of this Autism GIS prototype. For the purpose of this Autism GIS prototype“Google trends” canallow data gathering of Internet searches. This data keeps track of users search terms, phrases, and occurrences of searches terms. This allows “Google trends” users implementing the technology the ability to track trending topics of all kinds based on what users search for in the Google search engine. In tracking what a user searches, the tool also tracks where the user was located when using the search tool (not precise location, but area or region instead). This can provide for greater detail about a trending topic occurring in a particular area. ‘Google trends’ is different from ordinary Google Internet searches in that as mentioned ‘Google trends’ tracks number of occurrences a particular search is entered by the user as well as its location. In using ‘Google trends’ a user has more data available to them such as being able to view a chart or graph of all other users who search for a particular thing. This is different from regular Google searches because all of the additional data available in ‘Google trends’ is hidden from the user and not shown, because the user is using the regular search engine to simply find something they are inquiring about. ‘Google trends’ provides the user with metrics, charts and GIS data visualization. ‘Google trends’ allows the user to use existing tools built elsewhere, similar to plug-in tools, to broaden the types of applications and products produced. For the Autism GIS prototype using “Google trends” in a future iteration will help gather, share and analyze data trends and patterns across a much larger audience that can interact with one another.
Case studies: GIS andepidemiology
This section will review several successful web-based GIS epidemiological applications as well as discussing one, Infection Watch Live ( in greater depth. Through this analysis, elements of the tools have been applied to the Autism GIS prototype. The following implementations were chosen because they are web-based tools which display how the implementation of a GIS tool provides for a more effective outcome.
Engest and Jensen of Geodata AS document a Le gionnaires outbreak in Norway. A hospital alerted Norwegian national authorities about an outbreak of Legionnaires’ disease in over 50 patients scattered over a large area. To identify connections among these spatially dispersed patents, researchers applied ArcGIS software (ESRI). The analysis revealed that a commercial air scrubber released infected water droplets into the air.[11] This project used ESRI products to create a web-based application. An important lesson learned from this research was the inclusion of many different factors that could be connected to the disease outbreak. In this particular project for Autism, uncommon factors such as population and other socio-economic factors were examined. This project examined commercial air scrubbers that were also present at the time the incidents occurred.