Regression models for disease prevalence with diagnostic tests on pools of serum samples
Regression models for disease prevalence with diagnostic tests on pools of serum samples
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DOI：
10.1111/j.0006-341x.2000.01126.x
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发表时间：
2000-12-01
期刊：
影响因子：
1.9
通讯作者：
Verstraeten, T
中科院分区：
文献类型：
--
作者：
Vansteelandt, S;Goetghebeur, E;Verstraeten, T
无论目的是诊断个体还是估计患病率，许多流行病学研究都证明了对剥离血清的测试的成功应用。这些测试检测池中至少一个样本是否呈阳性。尽管检测池最初是为了降低诊断成本而设计的，但它也可以降低低流行率环境中的假阳性和阴性率，并产生更精确的流行率估计。目前的方法旨在通过对池的诊断测试来估计平均群体风险。在本文中，我们扩展了原始风险估计器类别，以调整单个池成员记录的协变量。最大似然理论提供了一种灵活的估计方法，可以处理池中不同的协变量值、不同的池大小以及测试结果中的错误。在特殊情况下，可以使用广义线性模型软件。池设计对精度和成本效率有很大影响，协变量同质池携带最大量的信息。我们使用池中各个贡献者的信息进行联合池和样本量计算，并表明良好的设计可以大大降低成本，同时提高精度。使用肯尼亚艾滋病毒监测研究的数据来说明这些方法。与单独测试相比，年龄同质、平均大小为 7 的最佳大小池可将成本降低至原始价格的 44%，而精度几乎没有损失。
Whether the aim is to diagnose individuals or estimate prevalence, many epidemiological studies have demonstrated the successful use of tests on pealed sera. These tests detect whether at least one sample in the pool is positive. Although originally designed to reduce diagnostic costs, testing pools also lowers false positive and negative rates in low prevalence settings and yields more precise prevalence estimates. Current methods are aimed at estimating the average population risk from diagnostic tests on pools. In this article, we extend the original class of risk estimators to adjust for covariates recorded on individual pool members. Maximum likelihood theory provides a flexible estimation method that handles different covariate values in the pool, different pool sizes, and errors in test results. In special cases, software for generalized linear models can be used. Pool design has a strong impact on precision and cost efficiency, with covariate-homogeneous pools carrying the largest amount of information. We perform joint pool and sample size calculations using information from individual contributors to the pool and show that a good design can severely reduce cost and yet increase precision. The methods are illustrated using data from a Kenyan surveillance study of HIV. Compared to individual testing, age-homogeneous, optimal-sized pools of average size seven reduce cost to 44% of the original price with virtually no loss in precision.