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Title: Bayesian spatial modelling for quasi-experimental designs: An interrupted time series study of the opening of Municipal Waste Incinerators in relation to infant mortality and sex ratio.
Authors: Freni-Sterrantino, A
Ghosh, RE
Fecht, D
Toledano, MB
Elliott, P
Hansell, AL
Blangiardo, M
First Published: 3-May-2019
Publisher: Elsevier for Pergamon
Citation: Environment International, 2019, 128, pp. 109-115
Abstract: BACKGROUND: There is limited evidence on potential health risks from Municipal Waste Incinerators (MWIs), and previous studies on birth outcomes show inconsistent results. Here, we evaluate whether the opening of MWIs is associated with infant mortality and sex ratio in the surrounding areas, extending the Interrupted Time Series (ITS) methodological approach to account for spatial dependencies at the small area level. METHODS: We specified a Bayesian hierarchical model to investigate the annual risks of infant mortality and sex-ratio (female relative to male) within 10 km of eight MWIs in England and Wales, during the period 1996-2012. We included comparative areas matched one-to-one of similar size and area characteristics. RESULTS: During the study period, infant mortality rates decreased overall by 2.5% per year in England. The opening of an incinerator in the MWI area was associated with -8 deaths per 100,000 infants (95% CI -62, 40) and with a difference in sex ratio of -0.004 (95% CI -0.02, 0.01), comparing the period after opening with that before, corrected for before-after trends in the comparator areas. CONCLUSION: Our method is suitable for the analysis of quasi-experimental time series studies in the presence of spatial structure and when there are global time trends in the outcome variable. Based on our approach, we do not find evidence of an association of MWI opening with changes in risks of infant mortality or sex ratio in comparison with control areas.
DOI Link: 10.1016/j.envint.2019.04.009
eISSN: 1873-6750
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © the authors, 2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Description: Births and deaths data were obtained from the Office for National Statistics (ONS) National Mortality, Births and Stillbirth registers for England and Wales. 2011 Census aggregate data came from the Office for National Statistics (for England and Wales): UK Data Service (Edition: June 2016). Health data are available from the data providers on application with appropriate ethics and governance permissions, but we do not hold data provider, ethics, or governance permissions to share these datasets with third parties. The computing code is available upon request to the corresponding author. Supplementary data to this article can be found online at
Appears in Collections:Published Articles, Dept. of Health Sciences

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