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Pathak A, Serrer L, Zapata D, King R, Mirel LB, Sukalac T, Srinivasan A, Baier P, Bhalla M, David-Ferdon C, Luxenberg S, Gundlapalli AV. Privacy preserving record linkage for public health action: opportunities and challenges. J Am Med Inform Assoc 2024:ocae196. [PMID: 39047294 DOI: 10.1093/jamia/ocae196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/27/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES To understand the landscape of privacy preserving record linkage (PPRL) applications in public health, assess estimates of PPRL accuracy and privacy, and evaluate factors for PPRL adoption. MATERIALS AND METHODS A literature scan examined the accuracy, data privacy, and scalability of PPRL in public health. Twelve interviews with subject matter experts were conducted and coded using an inductive approach to identify factors related to PPRL adoption. RESULTS PPRL has a high level of linkage quality and accuracy. PPRL linkage quality was comparable to that of clear text linkage methods (requiring direct personally identifiable information [PII]) for linkage across various settings and research questions. Accuracy of PPRL depended on several components, such as PPRL technique, and the proportion of missingness and errors in underlying data. Strategies to increase adoption include increasing understanding of PPRL, improving data owner buy-in, establishing governance structure and oversight, and developing a public health implementation strategy for PPRL. DISCUSSION PPRL protects privacy by eliminating the need to share PII for linkage, but the accuracy and linkage quality depend on factors including the choice of PPRL technique and specific PII used to create encrypted identifiers. Large-scale implementations of PPRL linking millions of observations-including PCORnet, National Institutes for Health N3C, and the Centers for Disease Control and Prevention COVID-19 project have demonstrated the scalability of PPRL for public health applications. CONCLUSIONS Applications of PPRL in public health have demonstrated their value for the public health community. Although gaps must be addressed before wide implementation, PPRL is a promising solution to data linkage challenges faced by the public health ecosystem.
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Affiliation(s)
- Aditi Pathak
- American Institutes for Research, Arlington, VA 22202, United States
| | - Laina Serrer
- American Institutes for Research, Arlington, VA 22202, United States
| | - Daniela Zapata
- American Institutes for Research, Arlington, VA 22202, United States
| | - Raymond King
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Lisa B Mirel
- National Center for Science and Engineering Statistics, National Science Foundation, Alexandria, VA 22314, United States
| | - Thomas Sukalac
- Center for Forecasting and Outbreak Analytics, Centers for Disease Control and Prevention, Atlanta, GA 30333, United States
| | - Arunkumar Srinivasan
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, United States
| | - Patrick Baier
- American Institutes for Research, Arlington, VA 22202, United States
| | - Meera Bhalla
- American Institutes for Research, Arlington, VA 22202, United States
| | - Corinne David-Ferdon
- Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA 30333, United States
| | - Steven Luxenberg
- Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA 30333, United States
| | - Adi V Gundlapalli
- Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA 30333, United States
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Rigby RC, Ferdinand AO, Kum HC, Schmit C. Data Sharing in a Decentralized Public Health System: Lessons From COVID-19 Syndromic Surveillance. JMIR Public Health Surveill 2024; 10:e52587. [PMID: 38546731 PMCID: PMC11009847 DOI: 10.2196/52587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 04/14/2024] Open
Abstract
The COVID-19 pandemic revealed that data sharing challenges persist across public health information systems. We examine the specific challenges in sharing syndromic surveillance data between state, local, and federal partners. These challenges are complicated by US federalism, which decentralizes public health response and creates friction between different government units. The current policies restrict federal access to state and local syndromic surveillance data without each jurisdiction's consent. These policies frustrate legitimate federal governmental interests and are contrary to ethical guidelines for public health data sharing. Nevertheless, state and local public health agencies must continue to play a central role as there are important risks in interpreting syndromic surveillance data without understanding local contexts. Policies establishing a collaborative framework will be needed to support data sharing between federal, state, and local partners. A collaborative framework would be enhanced by a governance group with robust state and local involvement and policy guardrails to ensure the use of data is appropriate. These policy and relational challenges must be addressed to actualize a truly national public health information system.
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Affiliation(s)
- Ryan C Rigby
- Program in Health, Law, and Policy, Department of Health Policy and Management, Texas A&M University School of Public Health, College Station, TX, United States
| | - Alva O Ferdinand
- Department of Health Policy and Management, Texas A&M University School of Public Health, College Station, TX, United States
| | - Hye-Chung Kum
- Population Informatics Lab, Department of Health Policy and Management, Texas A&M University School of Public Health, College Station, TX, United States
| | - Cason Schmit
- Program in Health, Law, and Policy, Department of Health Policy and Management, Texas A&M University School of Public Health, College Station, TX, United States
- Population Informatics Lab, Department of Health Policy and Management, Texas A&M University School of Public Health, College Station, TX, United States
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3
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Das P, Igoe M, Lacy A, Farthing T, Timsina A, Lanzas C, Lenhart S, Odoi A, Lloyd AL. Modeling county level COVID-19 transmission in the greater St. Louis area: Challenges of uncertainty and identifiability when fitting mechanistic models to time-varying processes. Math Biosci 2024; 371:109181. [PMID: 38537734 DOI: 10.1016/j.mbs.2024.109181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/13/2024] [Indexed: 04/12/2024]
Abstract
We use a compartmental model with a time-varying transmission parameter to describe county level COVID-19 transmission in the greater St. Louis area of Missouri and investigate the challenges in fitting such a model to time-varying processes. We fit this model to synthetic and real confirmed case and hospital discharge data from May to December 2020 and calculate uncertainties in the resulting parameter estimates. We also explore non-identifiability within the estimated parameter set. We find that the death rate of infectious non-hospitalized individuals, the testing parameter and the initial number of exposed individuals are not identifiable based on an investigation of correlation coefficients between pairs of parameter estimates. We also explore how this non-identifiability ties back into uncertainties in the estimated parameters and find that it inflates uncertainty in the estimates of our time-varying transmission parameter. However, we do find that R0 is not highly affected by non-identifiability of its constituent components and the uncertainties associated with the quantity are smaller than those of the estimated parameters. Parameter values estimated from data will always be associated with some uncertainty and our work highlights the importance of conducting these analyses when fitting such models to real data. Exploring identifiability and uncertainty is crucial in revealing how much we can trust the parameter estimates.
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Affiliation(s)
- Praachi Das
- Biomathematics Graduate Program, Department of Mathematics, North Carolina State University, Raleigh, NC, USA
| | - Morganne Igoe
- Department of Mathematics, University of Tennessee, Knoxville, TN, USA
| | - Alexanderia Lacy
- Department of Mathematics, University of Tennessee, Knoxville, TN, USA
| | - Trevor Farthing
- Department of Population Health and Pathobiology and Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
| | - Archana Timsina
- Department of Population Health and Pathobiology and Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
| | - Cristina Lanzas
- Department of Population Health and Pathobiology and Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
| | - Suzanne Lenhart
- Department of Mathematics, University of Tennessee, Knoxville, TN, USA
| | - Agricola Odoi
- Department of Biomedical and Diagnostics Sciences, University of Tennessee, Knoxville, TN, USA
| | - Alun L Lloyd
- Biomathematics Graduate Program, Department of Mathematics, North Carolina State University, Raleigh, NC, USA.
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4
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Neupane SN, Ruel E. Association between Racial Residential Segregation and COVID-19 Mortality. J Urban Health 2023; 100:937-949. [PMID: 37715049 PMCID: PMC10618147 DOI: 10.1007/s11524-023-00780-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/17/2023]
Abstract
This study investigates the impact of racial residential segregation on COVID-19 mortality during the first year of the US epidemic. Data comes from the Center for Disease Control and Prevention (CDC), and the Robert Wood Johnson Foundation's and the University of Wisconsin's joint county health rankings project. The observation includes a record of 8,670,781 individuals in 1488 counties. We regressed COVID-19 deaths, using hierarchical logistic regression models, on individual and county-level predictors. We found that as racial residential segregation increased, mortality rates increased. Controlling for segregation, Blacks and Asians had a greater risk of mortality, while Hispanics and other racial groups had a lower risk of mortality, compared to Whites. The impact of racial residential segregation on COVID-19 mortality did not vary by racial group.
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Affiliation(s)
- Suresh Nath Neupane
- Urban Studies Institute, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA.
| | - Erin Ruel
- Department of Sociology, Georgia State University, Atlanta, GA, USA
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5
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Taylor CL, Madans JH, Chapman NN, Woteki CE, Briefel RR, Dwyer JT, Merkel JM, Rothwell CJ, Klurfeld DM, Seres DS, Coates PM. Critical data at the crossroads: the National Health and Nutrition Examination Survey faces growing challenges. Am J Clin Nutr 2023; 117:847-858. [PMID: 36907514 PMCID: PMC10316367 DOI: 10.1016/j.ajcnut.2023.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023] Open
Abstract
NHANES needs urgent attention to ensure its future, which is facing emerging challenges associated with data collection, stagnant funding that has undercut innovation, and the increased call for granular data for subpopulations and groups at risk. The concerns do not rest merely on securing more funding but focus on the need for a constructive review of the survey to explore new approaches and identify appropriate change. This white paper, developed under the auspices of the ASN's Committee on Advocacy and Science Policy (CASP), is a call to the nutrition community to advocate for and support activities to prepare NHANES for future success in a changing nutrition world. Furthermore, because NHANES is much more than a nutrition survey and serves the needs of many in health fields and even commercial arenas, effective advocacy must be grounded in alliances among the survey's diverse stakeholders so that the full range of expertise and interests can engage. This article highlights the complicated nature of the survey along with key overarching challenges to underscore the importance of a measured, thoughtful, comprehensive, and collaborative approach to considering the future of NHANES. Starting-point questions are identified for the purposes of focusing dialog, discussion forums, and research. In particular, the CASP calls for a National Academies of Sciences, Engineering, and Medicine study on NHANES to articulate an actionable framework for NHANES going forward. With a well-informed and integrated set of goals and recommendations that could be provided by such a study, a secure future for NHANES is more readily achievable.
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Affiliation(s)
- Christine L Taylor
- Retired, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA and Chair, Committee on Advocacy and Science Policy, American Society for Nutrition, USA.
| | - Jennifer H Madans
- Retired, National Center for Health Statistics, Hyattsville, MD, USA
| | | | - Catherine E Woteki
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, USA
| | | | - Johanna T Dwyer
- Tufts University School of Medicine and Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | | | | | - David M Klurfeld
- Retired, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, MD, USA and Indiana University School of Public Health, Bloomington, IN, USA
| | - David S Seres
- Institute of Human Nutrition and Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Paul M Coates
- Retired, Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA and Indiana University School of Public Health, Bloomington, IN, USA
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6
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Christen P, Schnell R. Thirty-three myths and misconceptions about population data: from data capture and processing to linkage. Int J Popul Data Sci 2023; 8:2115. [PMID: 37636835 PMCID: PMC10454001 DOI: 10.23889/ijpds.v8i1.2115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Databases covering all individuals of a population are increasingly used for research and decision-making. The massive size of such databases is often mistaken as a guarantee for valid inferences. However, population data have characteristics that make them challenging to use. Various assumptions on population coverage and data quality are commonly made, including how such data were captured and what types of processing have been applied to them. Furthermore, the full potential of population data can often only be unlocked when such data are linked to other databases. Record linkage often implies subtle technical problems, which are easily missed. We discuss a diverse range of myths and misconceptions relevant for anybody capturing, processing, linking, or analysing population data. Remarkably, many of these myths and misconceptions are due to the social nature of data collections and are therefore missed by purely technical accounts of data processing. Many are also not well documented in scientific publications. We conclude with a set of recommendations for using population data.
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Affiliation(s)
- Peter Christen
- School of Computing, The Australian National University, Canberra, ACT 2600, Australia
- Scottish Centre for Administrative Data Research (SCADR), University of Edinburgh. UK
| | - Rainer Schnell
- Methodology Research Group, University Duisburg-Essen, Germany
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7
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Bhatia R, Sledge I, Baral S. Missing science: A scoping study of COVID-19 epidemiological data in the United States. PLoS One 2022; 17:e0248793. [PMID: 36223335 PMCID: PMC9555641 DOI: 10.1371/journal.pone.0248793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Systematic approaches to epidemiologic data collection are critical for informing pandemic responses, providing information for the targeting and timing of mitigations, for judging the efficacy and efficiency of alternative response strategies, and for conducting real-world impact assessments. Here, we report on a scoping study to assess the completeness of epidemiological data available for COVID-19 pandemic management in the United States, enumerating authoritative US government estimates of parameters of infectious transmission, infection severity, and disease burden and characterizing the extent and scope of US public health affiliated epidemiological investigations published through November 2021. While we found authoritative estimates for most expected transmission and disease severity parameters, some were lacking, and others had significant uncertainties. Moreover, most transmission parameters were not validated domestically or re-assessed over the course of the pandemic. Publicly available disease surveillance measures did grow appreciably in scope and resolution over time; however, their resolution with regards to specific populations and exposure settings remained limited. We identified 283 published epidemiological reports authored by investigators affiliated with U.S. governmental public health entities. Most reported on descriptive studies. Published analytic studies did not appear to fully respond to knowledge gaps or to provide systematic evidence to support, evaluate or tailor community mitigation strategies. The existence of epidemiological data gaps 18 months after the declaration of the COVID-19 pandemic underscores the need for more timely standardization of data collection practices and for anticipatory research priorities and protocols for emerging infectious disease epidemics.
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Affiliation(s)
- Rajiv Bhatia
- Primary Care and Population Health, Stanford University, Stanford, CA, United States of America
- * E-mail:
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
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8
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Biddell CB, Johnson KT, Patel MD, Smith RL, Hecht HK, Swann JL, Mayorga ME, Hassmiller Lich K. Cross-sector decision landscape in response to COVID-19: A qualitative network mapping analysis of North Carolina decision-makers. Front Public Health 2022; 10:906602. [PMID: 36052008 PMCID: PMC9424900 DOI: 10.3389/fpubh.2022.906602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/29/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction The COVID-19 pandemic response has demonstrated the interconnectedness of individuals, organizations, and other entities jointly contributing to the production of community health. This response has involved stakeholders from numerous sectors who have been faced with new decisions, objectives, and constraints. We examined the cross-sector organizational decision landscape that formed in response to the COVID-19 pandemic in North Carolina. Methods We conducted virtual semi-structured interviews with 44 organizational decision-makers representing nine sectors in North Carolina between October 2020 and January 2021 to understand the decision-making landscape within the first year of the COVID-19 pandemic. In line with a complexity/systems thinking lens, we defined the decision landscape as including decision-maker roles, key decisions, and interrelationships involved in producing community health. We used network mapping and conventional content analysis to analyze transcribed interviews, identifying relationships between stakeholders and synthesizing key themes. Results Decision-maker roles were characterized by underlying tensions between balancing organizational mission with employee/community health and navigating organizational vs. individual responsibility for reducing transmission. Decision-makers' roles informed their perspectives and goals, which influenced decision outcomes. Key decisions fell into several broad categories, including how to translate public health guidance into practice; when to institute, and subsequently loosen, public health restrictions; and how to address downstream social and economic impacts of public health restrictions. Lastly, given limited and changing information, as well as limited resources and expertise, the COVID-19 response required cross-sector collaboration, which was commonly coordinated by local health departments who had the most connections of all organization types in the resulting network map. Conclusions By documenting the local, cross-sector decision landscape that formed in response to COVID-19, we illuminate the impacts different organizations may have on information/misinformation, prevention behaviors, and, ultimately, health. Public health researchers and practitioners must understand, and work within, this complex decision landscape when responding to COVID-19 and future community health challenges.
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Affiliation(s)
- Caitlin B. Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,*Correspondence: Caitlin B. Biddell
| | - Karl T. Johnson
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mehul D. Patel
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Raymond L. Smith
- Department of Engineering, East Carolina University, Greenville, NC, United States
| | - Hillary K. Hecht
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Julie L. Swann
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, United States
| | - Maria E. Mayorga
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, United States
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Ioannides KLH, Dekker AM, Shin ME, Schriger DL. Ambulances Required to Relieve Overcapacity Hospitals: A Novel Measure of Hospital Strain During the COVID-19 Pandemic in the United States. Ann Emerg Med 2022; 80:301-313.e3. [PMID: 35940995 PMCID: PMC9356618 DOI: 10.1016/j.annemergmed.2022.05.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/10/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022]
Abstract
Study objective Methods Results Conclusion
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Affiliation(s)
- Kimon L H Ioannides
- Department of Emergency Medicine, University of California, San Francisco-Fresno Medical Education Program, Fresno, CA; Department of Emergency Medicine, University of California, Los Angeles, CA.
| | - Annette M Dekker
- Department of Emergency Medicine, University of California, Los Angeles, CA
| | - Michael E Shin
- Department of Geography, University of California, Los Angeles, CA
| | - David L Schriger
- Department of Emergency Medicine, University of California, Los Angeles, CA
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Freeman K, Monestime JP. Associations between Florida counties' COVID-19 case and death rates and meaningful use among Medicaid providers: Cross-sectional ecologic study. PLOS DIGITAL HEALTH 2022; 1:e0000047. [PMID: 36812551 PMCID: PMC9931361 DOI: 10.1371/journal.pdig.0000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/20/2022] [Indexed: 06/18/2023]
Abstract
Although the Health Information Technology for Economic and Clinical Health (HITECH) Act has accelerated adoption of Electronic Health Records (EHRs) among Medicaid providers, only half achieved Meaningful Use. Furthermore, Meaningful Use' impact on reporting and/or clinical outcomes remains unknown. To address this deficit, we assessed the difference between Medicaid providers who did and did not achieve Meaningful Use regarding Florida county-level cumulative COVID-19 death, case and case fatality rates (CFR), accounting for county-level demographics, socioeconomic and clinical markers, and healthcare environment. We found that cumulative incidence rates of COVID-19 deaths and CFRs were significantly different between the 5025 Medicaid providers not achieving Meaningful Use and the 3723 achieving Meaningful Use (mean 0.8334/1000 population; SD = 0.3489 vs. mean = 0.8216/1000; SD = 0.3227, respectively) (P = .01). CFRs were .01797 and .01781, respectively, P = .04. County-level characteristics independently associated with increased COVID-19 death rates and CFRs include greater concentrations of persons of African American or Black race, lower median household income, higher unemployment, and higher concentrations of those living in poverty and without health insurance (all P < .001). In accordance with other studies, social determinants of health were independently associated with clinical outcomes. Our findings also suggest that the association between Florida counties' public health outcomes and Meaningful Use achievement may have had less to do with using EHRs for reporting of clinical outcomes and more to do with using EHRs for coordination of care-a key measure of quality. The Florida Medicaid Promoting Interoperability Program which incentivized Medicaid providers towards achieving Meaningful Use, has demonstrated success regarding both rates of adoption and clinical outcomes. Because the Program ends in 2021, we support programs such as HealthyPeople 2030 Health IT which address the remaining half of Florida Medicaid providers who have not yet achieved Meaningful Use.
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Affiliation(s)
- Katherine Freeman
- Division of Biomedical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Judith P. Monestime
- Health Administration Programs, Management Department, College of Business, Florida Atlantic University, Boca Raton, Florida, United States of America
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Paulus D, Fathi R, Fiedrich F, de Walle BV, Comes T. On the Interplay of Data and Cognitive Bias in Crisis Information Management: An Exploratory Study on Epidemic Response. INFORMATION SYSTEMS FRONTIERS : A JOURNAL OF RESEARCH AND INNOVATION 2022:1-25. [PMID: 35342331 PMCID: PMC8938164 DOI: 10.1007/s10796-022-10241-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
Humanitarian crises, such as the 2014 West Africa Ebola epidemic, challenge information management and thereby threaten the digital resilience of the responding organizations. Crisis information management (CIM) is characterised by the urgency to respond despite the uncertainty of the situation. Coupled with high stakes, limited resources and a high cognitive load, crises are prone to induce biases in the data and the cognitive processes of analysts and decision-makers. When biases remain undetected and untreated in CIM, they may lead to decisions based on biased information, increasing the risk of an inefficient response. Literature suggests that crisis response needs to address the initial uncertainty and possible biases by adapting to new and better information as it becomes available. However, we know little about whether adaptive approaches mitigate the interplay of data and cognitive biases. We investigated this question in an exploratory, three-stage experiment on epidemic response. Our participants were experienced practitioners in the fields of crisis decision-making and information analysis. We found that analysts fail to successfully debias data, even when biases are detected, and that this failure can be attributed to undervaluing debiasing efforts in favor of rapid results. This failure leads to the development of biased information products that are conveyed to decision-makers, who consequently make decisions based on biased information. Confirmation bias reinforces the reliance on conclusions reached with biased data, leading to a vicious cycle, in which biased assumptions remain uncorrected. We suggest mindful debiasing as a possible counter-strategy against these bias effects in CIM.
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Affiliation(s)
- David Paulus
- Department of Multi-Actor Systems, Delft University of Technology, Jaffalaan 5, 2628 BX Delft, The Netherlands
| | - Ramian Fathi
- Institute for Public Safety and Emergency Management, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany
| | - Frank Fiedrich
- Institute for Public Safety and Emergency Management, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany
| | - Bartel Van de Walle
- UNU-MERIT, United Nations University, Boschstraat 24, 6211 AX Maastricht, The Netherlands
| | - Tina Comes
- Faculty of Technolgy, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX Delft, The Netherlands
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Simpson RB, Lauren BN, Schipper KH, McCann JC, Tarnas MC, Naumova EN. Critical Periods, Critical Time Points and Day-of-the-Week Effects in COVID-19 Surveillance Data: An Example in Middlesex County, Massachusetts, USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031321. [PMID: 35162344 PMCID: PMC8835321 DOI: 10.3390/ijerph19031321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 01/14/2023]
Abstract
Critical temporal changes such as weekly fluctuations in surveillance systems often reflect changes in laboratory testing capacity, access to testing or healthcare facilities, or testing preferences. Many studies have noted but few have described day-of-the-week (DoW) effects in SARS-CoV-2 surveillance over the major waves of the novel coronavirus 2019 pandemic (COVID-19). We examined DoW effects by non-pharmaceutical intervention phases adjusting for wave-specific signatures using the John Hopkins University’s (JHU’s) Center for Systems Science and Engineering (CSSE) COVID-19 data repository from 2 March 2020 through 7 November 2021 in Middlesex County, Massachusetts, USA. We cross-referenced JHU’s data with Massachusetts Department of Public Health (MDPH) COVID-19 records to reconcile inconsistent reporting. We created a calendar of statewide non-pharmaceutical intervention phases and defined the critical periods and timepoints of outbreak signatures for reported tests, cases, and deaths using Kolmogorov-Zurbenko adaptive filters. We determined that daily death counts had no DoW effects; tests were twice as likely to be reported on weekdays than weekends with decreasing effect sizes across intervention phases. Cases were also twice as likely to be reported on Tuesdays-Fridays (RR = 1.90–2.69 [95%CI: 1.38–4.08]) in the most stringent phases and half as likely to be reported on Mondays and Tuesdays (RR = 0.51–0.93 [0.44, 0.97]) in less stringent phases compared to Sundays; indicating temporal changes in laboratory testing practices and use of healthcare facilities. Understanding the DoW effects in daily surveillance records is valuable to better anticipate fluctuations in SARS-CoV-2 testing and manage appropriate workflow. We encourage health authorities to establish standardized reporting protocols.
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Rocco P, Rich JAJ, Klasa K, Dubin KA, Béland D. Who Counts Where? COVID-19 Surveillance in Federal Countries. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2021; 46:959-987. [PMID: 34075406 DOI: 10.1215/03616878-9349114] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CONTEXT While the World Health Organization (WHO) has established guidance on COVID-19 surveillance, little is known about implementation of these guidelines in federations, which fragment authority across multiple levels of government. This study examines how subnational governments in federal democracies collect and report data on COVID-19 cases and mortality associated with COVID-19. METHODS We collected data from subnational government websites in 15 federal democracies to construct indices of COVID-19 data quality. Using bivariate and multivariate regression, we analyzed the relationship between these indices and indicators of state capacity, the decentralization of resources and authority, and the quality of democratic institutions. We supplement these quantitative analyses with qualitative case studies of subnational COVID-19 data in Brazil, Spain, and the United States. FINDINGS Subnational governments in federations vary in their collection of data on COVID-19 mortality, testing, hospitalization, and demographics. There are statistically significant associations (p < 0.05) between subnational data quality and key indicators of public health system capacity, fiscal decentralization, and the quality of democratic institutions. Case studies illustrate the importance of both governmental and civil-society institutions that foster accountability. CONCLUSIONS The quality of subnational COVID-19 surveillance data in federations depends in part on public health system capacity, fiscal decentralization, and the quality of democracy.
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Pecoraro F, Luzi D. Open Data Resources on COVID-19 in Six European Countries: Issues and Opportunities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10496. [PMID: 34639796 PMCID: PMC8507931 DOI: 10.3390/ijerph181910496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/28/2022]
Abstract
Since the beginning of the COVID-19 pandemic in March 2020, national and international authorities started to develop and update datasets to provide data to researchers, journalists and health care providers as well as public opinion. These data became one of the most important sources of information, which are updated daily and analysed by scientists in order to investigate and predict the spread of this epidemic. Despite this positive reaction from both national and international authorities in providing aggregated information on the diffusion of COVID-19, different challenges have been underlined in previously published studies. Different papers have discussed strengths and weaknesses of these types of datasets by focusing on different quality perspectives, which include the statistical methods adopted to analyse them; the lack of standards and models in the adoption of data for their management and distribution; and the analysis of different data quality characteristics. These studies have analysed datasets at the general level or by focusing the attention on specific indicators such as the number of cases or deaths. This paper further investigates issues and opportunities in the diffusion of these datasets under two main perspectives. At the general level, it analyses how data are organized and distributed to scientific and non-scientific communities. Moreover, it further explores the indicators adopted to describe the spread of the COVID-19 epidemic while also highlighting the level of detail used to describe them in terms of gender, age ranges and territorial units. The paper focuses on six European countries: Belgium, France, Germany, Italy, Spain and UK.
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Affiliation(s)
- Fabrizio Pecoraro
- Institute for Research on Population and Social Policies, National Research Council, Via Palestro, 32, 00185 Rome, Italy;
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Cegan JC, Trump BD, Cibulsky SM, Collier ZA, Cummings CL, Greer SL, Jarman H, Klasa K, Kleinman G, Surette MA, Wells E, Linkov I. Can Comorbidity Data Explain Cross-State and Cross-National Difference in COVID-19 Death Rates? Risk Manag Healthc Policy 2021; 14:2877-2885. [PMID: 34267565 PMCID: PMC8275866 DOI: 10.2147/rmhp.s313312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022] Open
Abstract
Many efforts to predict the impact of COVID-19 on hospitalization, intensive care unit (ICU) utilization, and mortality rely on age and comorbidities. These predictions are foundational to learning, policymaking, and planning for the pandemic, and therefore understanding the relationship between age, comorbidities, and health outcomes is critical to assessing and managing public health risks. From a US government database of 1.4 million patient records collected in May 2020, we extracted the relationships between age and number of comorbidities at the individual level to predict the likelihood of hospitalization, admission to intensive care, and death. We then applied the relationships to each US state and a selection of different countries in order to see whether they predicted observed outcome rates. We found that age and comorbidity data within these geographical regions do not explain much of the international or within-country variation in hospitalization, ICU admission, or death. Identifying alternative explanations for the limited predictive power of comorbidities and age at the population level should be considered for future research.
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Affiliation(s)
- Jeffrey C Cegan
- US Army Engineer Research and Development Center, US Army Corps of Engineers, Vicksburg, MS, USA
| | - Benjamin D Trump
- US Army Engineer Research and Development Center, US Army Corps of Engineers, Vicksburg, MS, USA
| | - Susan M Cibulsky
- US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Boston, MA, USA
| | - Zachary A Collier
- Radford University, Davis College of Business and Economics, Department of Management, Radford, VA, USA
| | - Christopher L Cummings
- North Carolina State University, Genetic Engineering and Society Center, Raleigh, NC, USA
| | - Scott L Greer
- University of Michigan, School of Public Health, Department of Health Management and Policy, Ann Arbor, MI, USA
| | - Holly Jarman
- University of Michigan, School of Public Health, Department of Health Management and Policy, Ann Arbor, MI, USA
| | - Kasia Klasa
- US Army Engineer Research and Development Center, US Army Corps of Engineers, Vicksburg, MS, USA
- University of Michigan, School of Public Health, Department of Health Management and Policy, Ann Arbor, MI, USA
| | - Gary Kleinman
- US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Boston, MA, USA
| | | | - Emily Wells
- US Army Engineer Research and Development Center, US Army Corps of Engineers, Vicksburg, MS, USA
| | - Igor Linkov
- US Army Engineer Research and Development Center, US Army Corps of Engineers, Vicksburg, MS, USA
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