acknowledgements epidemiologic query & mapping system patrick o’carroll clark johnson richard...
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Acknowledgements
Epidemiologic Query & Mapping System
Patrick O’Carroll
Clark Johnson
Richard HoskinsCathy O’Connor
Sherrilynn Fuller Principal Investigator
Public Health System Linkages – Bench to Bedside and Beyond
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Components• WWW based - high speed access by local health
• Three user levels (public, practitioner, need-to-know)
• Rates with statistical measures
• Charts & graphs, time trends
• Deals with small numbers (empirical Bayes spatial modeling)
• Static, dynamic and full GIS mapping
• Multiple geographies
• Queries a dynamic database (no or little on-line calculation)
• Allows central Q&A (software & data & statistical measures)
• Comprehensive security model
• Individual id protection (available dimensions)
• Only aggregated data
• Tutorials
Components
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Datasets for EpiQMS ABORTIONS 1991-1999BIRTHS CERTIFICATE 1980-1999CANCER RegistryCENSUS DATA 1980 1990 – 1998 2000(state, county, census tract, legislative district, school district, Zip Code, SES cluster zones, climate zones, rural areas)
COMMUNICABLE DISEASE 1980-1997 DEATHS 1980-2000 ICD9 – ICD10 HOSPITALIZATIONS 1990 -1999 HOSPITALIZATIONS (EPI FILE) 1990-1999 INFANT DEATHS 1981-1999 STD 1993-1999 TUBERCULOSIS 1992-1999 HIV 1992 – 1999 Health of Washington State Youth Violence Crime , housing
Available now
In preparation
Requested
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• Original and still primary objective: Communicable disease tracking
• Geographically oriented (maps) • Small numbers• Ease of use and access • Low cost for users
Why do this?
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Objectives
• Ease of access to public health data by all citizens while paying strict attention to individual privacy. • Allow medical practitioners routine access to support assessment and surveillance in local health departments, communities, WA DOH, and public health research. • Get people who use public health data to think geographically. Many geographies, some non-standard.
• Uniformity of epidemiologic measures. • Offer on-line instruction in how to use and intrepret public health data. • Software burden is on DOH not users. • Allow down loading of information – tables, charts, maps.
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DiagramDOH databases
PreProcessingSAS
EpiQMS database
EpiQMS: Data Server
Population data
Static Maps
Aggregated data
EpiQMS Internet Engine
Dynamic mappingengine
Web server
Data formating
Full GIS
SASpreprosessing
Geocoded data
WWW users citizen users practitioners
need-to-know
How it works …
No identifiers !
DOH:Secure Data Server
SQL server
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Indexing - primary key
Disease
Race
Age
Year
Geography
SexNo
Yes
NoNo
OOXOX15Generates Index:
15XOXOO
Aggregating events by:
Breast cancer
Yes
Yes
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Cancer Registry security model level I
Available selected selected 5 or 10 yearUser class Dimensions Disease Geography Year Age group Race Sex
Public 3 11 County 1990-99 10 year A M
Zip Code all B F
legislative district I T
W
all
Practitioner 4 all County 1990-99 10 year A M
Zipcode all B F
legislative district I T
census tract W
all
Need-to-Know all all County 1990-99 5 year A M
Zipcode all 10 year B Flegislative district I T
census tract Wblock group allSES clusters
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Concurrent dimensions security model level II Available selected selected 5 or 10 year
User class Dimensions Disease Geography Year Age group Race Sex
3 11 3 out of 6 all 10 year all all
Public x x xx x x
x x x4 all 4 out of 6 10 year all all
Practitioner x x x xx x x xx x x x
x x x xx x x
all all all all 5, 10 year all all
Need-to-Know x x x x xx x x xx x x
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Who decides which users get various levels of access?
Available selected selected 5 or 10 yearUser class Dimensions Disease Geography Year Age group Race Sex
3 11 3 out of 6 all 10 year all all
Public x x xx x x
x x x4 all 4 out of 6 10 year all all
Practitioner x x x xx x x xx x x x
x x x xx x x
all all all all 5, 10 year all all
Need-to-Know x x x x xx x x xx x x
• Data “owners”• Not EpiQMS team
Tools to help data owners decide:• Probability studies• Count suppression
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Thematic Maps
Trivial pursuitword: choropleth
Beginningto think geographically ...
Map
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MapIssues in thematic mapping
Different conclusionscan be drawn from
maps of thesame data.
Natural break
Equal ranges
Equal counts
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MAUPThe Modifiable ArealUnit Problem (MAUP)
A form of ecological fallacy associated
with the aggregation of data into
areal units for geographical analysis.
There are two effects:
Scale effect: The larger the unit of aggregation, the larger, on
average, is the correlation between two variables.
Aggregation effect: By aggregating data into different blocks, you
can get different correlations.
1960 election:
+0.44 correlation between rural non-farm voting for Nixon in
using Census nine-region division
-0. 22 correlation using the Census four-region division.
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Empirical Bayes estimation
• Smoothing to reflect confidence of local estimation of risk
• Prior knowledge of about rates and the observed data are used to develop a prior distribution posterior likelihood prior distribution of data distribution
• previous data• intuition• good guess (or even a bad one)• the data itself - Empirical Bayes
Mean (smoothed rates)std error (Bayesian confidence intervals)
How to estimate disease rates in “small” areas?
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Deaths from breast cancer in age 35-44 women
Breast Cancer
0 9030 60
Miles
Bayesian Rate Ratio0.00 to 0.750.75 to 1.251.25 to 2.252.25 to 12.00Other
No Bayes
Bayes
Zipcodes
Blank areas indicate no deaths
Map
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What does it take to run EpiQMS?
User
• Internet Explorer• Internet connection 56k or > • Two plug-ins which are easy to deal with. (SVG for maps, ChartFX for charts)
DOH
• SQL server• ChartFX – charting software• SAS for the prep of data • Visual Interdev – standard Internet site development tool. • RoboHelp – help system development package
http://198.187.0.45/EpiQMS/
Fast!