It is not always possible to apply such associations from a popul

It is not always possible to apply such associations from a population level down to the individuals within selleck that population. In summary, this study has provided a number

of interesting results. First, it has helped to quantify and map the inequality that exists across different parts of Warwickshire with regard to heart failure risk. It has also provided some interesting circumstantial evidence of a link between heart failure morbidity and air pollution. Finally, it has also given a suggestion of a possible link between living in urban environments and a higher risk of cardiovascular disease and a corresponding lower risk from living in rural environments. More work will need to be carried out to look into this particular possibility. It would be informative to run this type of analysis while factoring in the influence of a person’s distance from their nearest urban centre. This urban/rural factor should be further

explored and mined for additional information as it could be an indication of hitherto unconsidered factors influencing the health status of the population of Warwickshire and possibly further afield. In order to determine the validity of our conclusions at the individual level, further work would need to be carried out analysing the available data from individual patients (risks and outcomes). Such work could help to characterise the true effect of different components of air pollution at the individual level. It would also be interesting to determine if the different components of air pollution act as effect modifiers on each other. It would be possible to look at the effects of air pollution variation in the shorter term as well. For example, looking at how local ‘spikes’ in

air pollution affect the rates of hospital admissions locally immediately following it. This could be carried out in Leamington Spa where there is an air quality monitoring station constantly measuring the levels of air pollutants. Other health problems, such as ischaemic heart disease and respiratory diseases, have been linked with air pollution as well and it could be informative to also look into these links locally. Supplementary Material Author’s manuscript: Click here to view.(3.9M, pdf) Reviewer comments: Click here to view.(259K, pdf) Footnotes Contributors: OB conceived the idea, analysed the data, contributed to formulating the results and Brefeldin_A wrote the first draft. N-B K analysed the data, advised on statistical aspects, contributed to formulating the results and wrote the second draft. CJ analysed the data. JL helped coordinate the project and cowrote the final draft. AC coordinated the project, advised on all aspects and cowrote the final draft. Funding: This paper presents independent research supported by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands.

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