Progress of application and dissemination of the RIF in Hungary

1. Progress of application anddissemination of the RIFin Hungary Attila Juhász*, Csilla Nagy*, Anna Páldy** *Central Hungarian Regional Institute of the National Public Health and Medical Officer’s Service, Budapest, Hungary **National Institute of Environmental Health, Budapest, Hungary EUROHEIS2 workshop „Environmental health assessment and disease mapping: the Dutch approach” 5 - 6 March 2009, The Netherlands

2. Objectives • implementation of RIF in Hungary, • the feasibility testing of the program by using the available Hungarian datasets, • incorporate country specific exposure data, and data on potential confounders from external databases • socio-economic status

3. most deprived DI least deprived Socioeconomic status The Hungarian RIF team constructed a multi-dimensional SES index. This is the first complex index able to give information of socio-economic deprivation at the settlement and district (in case of Budapest) level in Hungary. Selected SES factors: • INCOME (gross income serving basis of the personal income tax per permanent population) • LOW QUALIFICATION (Proportion of population with basic education and illiterate in the total population older than 15 years) • UNEMPLOYMENT (proportion of total population of productive age) • ONE-PARENT FAMILIES (lone females with children, in proportion of families) • LARGE FAMILIES (Parents with three or more children, in proportion of families) • DENSITY OF HOUSING (person per room) • CAR (Passenger cars per 100 inhabitants) Transformations • log-transformation, • standardization (Z-score) Weighting • factor analysis

4. SmoothedSM min - 0.6 0.61 - 0.8 0.81 - 1 1.01 - 1.2 1.21 - 1.6 1.61 - max Association between deprivation and mortality due to the malignant diseases of the trachea, bronchi and lung (ICD-10:C33-C34) in the age group of 35-64 years old population in Hungary, 1994-2004. males females

5. Association between deprivation and premature (15-64 years) mortalitydue to diseases of circulatory system (ICD-10:I00-I99) in Central Hungarian Region, 1996-2005 Males Females

6. Association between premature (30-64 years) mortalitydue to alcoholic liver disease (ICD-10:K70) anddeprivation in Budapest, 1998-2004 Males Females

7. Association between estimated NO2 air pollution and SES adjusted premature (15-64 years) mortality due to diseases of respiratory system (ICD-10:J00-J99) in Budapest,1996-2005. Males Females

8. Smoothed Relative Risk SmRR min - 0.6 0.61 - 0.8 0.81 - 1 1.01 - 1.2 1.21 - 1.6 1.61 - max The risk of premature (15-64 years) mortality due to diseases of respiratory system (ICD-10:J00-J99) in Western Transdanubia, at micro-regional level in Hungary, 2000-2005. Males Females RR=3.84 [2.66;5.36], 34 SmRR=3.38 SmoothedSM=3.47 [2.38;4.78], PP=1 RR=2.92 [1.46;5.22], 11 SmRR=2.27 SmoothedSM=3.13 [1.01;3.76], PP=0.99

9. Smoothed Relative Risk SmRR min - 0.6 0.61 - 0.8 0.81 - 1 1.01 - 1.2 1.21 - 1.6 1.61 - max Death place clusters of premature (15-64 years) mortality due to diseases of respiratory system (ICD-10:J00-J99) in Western Transdanubia, in Hungary, 2000-2005. Males Females Szentgothárd maximum spatial cluster size 2.5 % of the population at risk

10. Dissemination Regional Institutes of the National Public Health and Medical Officer’s Service: • Central Hungarian Region • Southern Great Plain Region • Western Transdanubian Region • Northern Hungarian Region • Public Health Reports Plans, investigations in progress: • Cancer morbidity • Congenital anomalies • Environmental database

11. Thank you for your attention!