The Health Insurance Portability and Accountability Act (HIPAA) was an important milestone in protecting the privacy of patient data; however, the HIPAA provisions specific to geographic data remain vague and hinder the ways in which epidemiologists and geographers use and share spatial health data. The literature on spatial health and select legal and official guidance documents present scholars with ambiguous guidelines that have led to the use and propagation of multiple interpretations of a single HIPAA safe harbor provision specific to geographic data. Misinterpretation of this standard has resulted in many entities sharing data at overly conservative levels, whereas others offer definitions of safe harbors that potentially put patient data at risk. To promote understanding of, and adherence to, the safe harbor rule, this paper reviews the HIPAA law from its creation to the present day, elucidating common misconceptions and presenting straightforward guidance to scholars. We focus on the 20,000-person population threshold and the 3-digit zip code stipulation of safe harbors, which are central to the confusion surrounding how patient location data can be shared. A comprehensive examination of these 2 stipulations, which integrates various expert perspectives and relevant studies, reveals how alternative methods for safe harbors can offer researchers better data and better data protection. Much has changed in the 20 years since the introduction of the safe harbor provision; however, it continues to be the primary source of guidance (and frustration) for researchers trying to share maps, leaving many waiting for these rules to be revised in accordance with the times.

This article addresses the challenge of sharing finer scale protected health information (PHI) while maintaining patient privacy by using regionalization to create higher resolution Health Insurance Portability and Accountability Act (HIPAA)-compliant geographical aggregations. We compare four regionalization approaches in terms of their fitness for analysis and display: max-p-regions, regionalization with dynamically constrained agglomerative clustering and partitioning (REDCAP), and self-organizing map (SOM) variants of each. Each method is used to create a configuration of regions that aligns with census boundaries, optimizes intraunit homogeneity, and maximizes the number of spatial units while meeting the minimum population threshold required for sharing PHI under HIPAA guidelines. The relative utility of each configuration was assessed with measures of model fit, compactness, homogeneity, and resolution. Adding the SOM procedure to max-p-regions resulted in statistically significant improvements for nearly all assessment measures, whereas the addition of SOM to REDCAP primarily degraded these measures. These differences can be attributed to the different impacts of SOM on top-down and bottom-up regionalization procedures. Overall, we recommend REDCAP, which outperformed on most measures. The SOM variant of max-p-regions (MSOM) could also be recommended, because it provided the highest resolution while maintaining suitable performance on all other measures.

The spatial university foregrounds the spatiotemporal nature of people, places, and processes in meeting its core missions of scholarship, teaching, and service. The university works across scales by advancing macro efforts that capture the imagination of people on...

We describe the use of network modeling to capture the shifting spatiotemporal nature of the COVID-19 pandemic. The most common approach to tracking COVID-19 cases over time and space is to examine a series of maps that provide snapshots of the pandemic. A series of snapshots can convey the spatial nature of cases but often rely on subjective interpretation to assess how the pandemic is shifting in severity through time and space. We present a novel application of network optimization to a standard series of snapshots to better reveal how the spatial centres of the pandemic shifted spatially over time in the mainland United States under a mix of interventions. We find a global spatial shifting pattern with stable pandemic centres and both local and long-range interactions. Metrics derived from the daily nature of spatial shifts are introduced to help evaluate the pandemic situation at regional scales. We also highlight the value of reviewing pandemics through local spatial shifts to uncover dynamic relationships among and within regions, such as spillover and concentration among states. This new way of examining the COVID-19 pandemic in terms of network-based spatial shifts offers new story lines in understanding how the pandemic spread in geography.

Although many loci have been associated with height in European ancestry populations, very few have been identified in African ancestry individuals. Furthermore, many of the known loci have yet to be generalized to and fine-mapped within a large-scale African ancestry sample. We performed sex-combined and sex-stratified meta-analyses in up to 52,764 individuals with height and genome-wide genotyping data from the African Ancestry Anthropometry Genetics Consortium (AAAGC). We additionally combined our African ancestry meta-analysis results with published European genome-wide association study (GWAS) data. In the African ancestry analyses, we identified three novel loci (SLC4A3, NCOA2, ECD/FAM149B1) in sex-combined results and two loci (CRB1, KLF6) in women only. In the African plus European sex-combined GWAS, we identified an additional three novel loci (RCCD1, G6PC3, CEP95) which were equally driven by AAAGC and European results. Among 39 genome-wide significant signals at known loci, conditioning index SNPs from European studies identified 20 secondary signals. Two of the 20 new secondary signals and none of the 8 novel loci had minor allele frequencies (MAF) < 5%. Of 802 known European height signals, 643 displayed directionally consistent associations with height, of which 205 were nominally significant (p < 0.05) in the African ancestry sex-combined sample. Furthermore, 148 of 241 loci contained ≤20 variants in the credible sets that jointly account for 99% of the posterior probability of driving the associations. In summary, trans-ethnic meta-analyses revealed novel signals and further improved fine-mapping of putative causal variants in loci shared between African and European ancestry populations.

Group-randomized trials of communities often rely on the convenience of pre-existing administrative divisions, such as school district boundaries or census entities, to divide the study area into intervention and control sites. However, these boundaries may include substantial heterogeneity between regions, introducing unmeasured confounding variables. This challenge can be addressed by the creation of exchangeable intervention and control territories that are equally weighted by pertinent socio-demographic characteristics. The present study used territory design software as a novel approach to partitioning study areas for The Minnesota Heart Health Program’s “Ask about Aspirin” Initiative. Twenty-four territories were created to be similar in terms of age, sex, and educational attainment, as factors known to modify aspirin use. To promote ease of intervention administration, the shape and spread of the territories were controlled. Means of the variables used in balancing the territories were assessed as well as other factors that were not used in the balancing process. The analysis demonstrated that demographic characteristics did not differ significantly between the intervention and control territories created by the territory design software. The creation of exchangeable territories diminishes geographically based impact on outcomes following community interventions in group-randomized trials. The method used to identify comparable geographical units may be applied to a wide range of population-based health intervention trials. National Institutes of Health (Clinical Trials.gov), Identifier: NCT02607917 . Registered on 16 November 2015.

There is much interest in using big data for research on rapid social and environmental change. For all the excitement about big data, however, there are “deserts in the deluge” of these data because there is surprisingly little detailed information about human–environment systems for much of the globe, especially for before the year 2000 and for much of the global south. Remotely sensed imagery is a valuable form of big data that promises to fill in some of these gaps and help advance our understanding coupled human–environment systems.

<p>Fine resolution spatial variability in pneumonia hospitalization may identify correlates with socioeconomic, demographic and environmental factors. We performed a retrospective study within the Fairview Health System network of Minnesota. Patients 2 months of age and older hospitalized with pneumonia between 2011 and 2015 were geocoded to their census block group, and pneumonia hospitalization risk was analyzed in relation to socioeconomic, demographic and environmental factors. Spatial analyses were performed using Esri's ArcGIS software, and multivariate Poisson regression was used. Hospital encounters of 17 840 patients were included in the analysis. Multivariate Poisson regression identified several significant associations, including a 40% increased risk of pneumonia hospitalization among census block groups with large, compared with small, populations of ⩾65 years, a 56% increased risk among census block groups in the bottom (first) quartile of median household income compared to the top (fourth) quartile, a 44% higher risk in the fourth quartile of average nitrogen dioxide emissions compared with the first quartile, and a 47% higher risk in the fourth quartile of average annual solar insolation compared to the first quartile. After adjusting for income, moving from the first to the second quartile of the race/ethnic diversity index resulted in a 21% significantly increased risk of pneumonia hospitalization. In conclusion, the risk of pneumonia hospitalization at the census-block level is associated with age, income, race/ethnic diversity index, air quality, and solar insolation, and varies by region-specific factors. Identifying correlates using fine spatial analysis provides opportunities for targeted prevention and control.</p>

We describe a strategy for regionalizing subnational administrative units in conjunction with harmonizing changes in unit boundaries over time that can be applied to provide small-area geographic identifiers for census microdata. The availability of small-area identifiers blends the flexibility of individual microdata with the spatial specificity of aggregate data. Regionalizing microdata by administrative units poses a number of challenges, such as the need to aggregate individual scale data in a way that ensures confidentiality and issues arising from changing spatial boundaries over time. We describe a regionalization and harmonization strategy that creates units that satisfy spatial and other constraints while maximizing the number of units in a way that supports policy and research use. We describe this regionalization strategy for three test cases of Malawi, Brazil, and the United States. We test different algorithms and develop a semi-automated strategy for regionalization that meets data restrictions, computation, and data demands from end users.

Terra Populus, or TerraPop, is a cyberinfrastructure project that integrates, preserves, and disseminates massive data collections describing characteristics of the human population and environment over the last six decades. TerraPop has made a number of GIScience advances in the handling of big spatial data to make information interoperable between formats and across scientific communities. In this paper, we describe challenges of these data, or 'deserts in the deluge' of data, that are common to spatial big data more broadly, and explore computational solutions specific to microdata, raster, and vector data models.

The Terra Populus project (TerraPop) addresses a variety of data management, curation, and preservation challenges with respect to spatiotemporal population and environmental data. In this article, we describe our approaches to these challenges, with a particular focus on geospatial data workflows and associated provenance metadata. The goal of TerraPop is to enable research, learning, and policy analysis by providing integrated spatiotemporal data describing people and their environment. To do so, TerraPop is assembling a globe-spanning and temporally extensive collection of high-quality population and environmental data, ensuring good documentation, and developing a Web-based data access system that enables users to assemble customized integrated data sets drawing on a variety of data sources and formats. We describe TerraPop's collection strategies, detail the geospatial workflows involved in preparing data for ingest into the project database and those used to transform data across formats for dissemination, and discuss the system used to capture and manage provenance metadata throughout the project. A key aspect of the project is the development of global current and historical administrative unit boundaries that can be linked to census data. These boundaries serve as the linchpin of TerraPop's data integration strategy, and constitute an important data set in their own right.