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
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
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
• 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?
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.
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
Indexing - primary key
Disease
Race
Age
Year
Geography
SexNo
Yes
NoNo
OOXOX15Generates Index:
15XOXOO
Aggregating events by:
Breast cancer
Yes
Yes
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
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
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
Thematic Maps
Trivial pursuitword: choropleth
Beginningto think geographically ...
Map
MapIssues in thematic mapping
Different conclusionscan be drawn from
maps of thesame data.
Natural break
Equal ranges
Equal counts
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.
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?
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
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!