Statistical adjustments of sample representation in community-level estimates of COVID-19 transmission and immunity

摘要 在整个新冠肺炎大流行期间，政府政策和医疗保健实施对策 以社区报告的阳性率和疫苗接种率为指导。这些测试的选择偏向 数据质疑它们作为社区实际病毒发病率衡量标准和预测指标的有效性。 临床负担。公众可获得的疫苗接种数据经常被引用为人群免疫力的替代指标，但这 度量法忽略了自然获得性免疫的影响。关于无症状和无症状的健康差异 目前还没有对有症状的患者进行研究。该建议开发了一种有效的衡量标准来估计真实的病毒发病率 和自然/疫苗获得性免疫在社区中的流行率，检查健康差距和社会 不平等，并作为一个可操作的监测系统，随时间监测这一流行病。这种方法收集了 医院系统患者SARS-CoV-2暴露和抗体阳性的常规检测数据 并使用多水平回归和fi后处理对样本表示进行统计调整 (MRP)，它根据测量的样本和总体之间的差异进行调整，并产生稳定的小 面积估计。数据收集和分析程序可以向整个社区提供信息， 可概括性和关注特殊fic人口统计范围内的负担，并密切关注弱势群体 关于健康结果、社会决定因素和行为的差异。特别是，这项研究将产生 无症状和有症状患者之间差异的组别fic估计，以及这些差异如何 差异可能会影响疾病在社会人口统计上的传播及其随后的治疗。 MRP调整将通过网络界面公开，并促进广泛的调查 整合数据来源，以进行全国性研究。

Abstract Throughout the COVID-19 pandemic, government policy and healthcare implementation responses have been guided by reported positivity rates and vaccination rates in the community. The selection bias of these test data questions their validity as measures of the actual viral incidence in the community and as predictors of clinical burden. Publicly available vaccination data are frequently cited as a proxy for population immunity, but this metric ignores the effects of naturally-acquired immunity. The health disparities concerning asymptomatic and symptomatic patients are not yet studied. The proposal develops a valid metric to estimate the true viral incidence and naturally/vaccine-acquired immunity prevalence in the community, examine the health disparities and social inequality, and monitor the epidemic over time as an operational surveillance system. The approach collects routine testing data on SARS-CoV-2 exposure and antibody seropositivity among patients in a hospital system and performs statistical adjustments of sample representation using multilevel regression and poststratification (MRP), which adjusts for measured differences between the sample and population and also yields stable small area estimates. The data collection and analysis procedure can provide information to entire communities with generalizability and focus on burdens within specific demographics, with close attention to vulnerable populations on disparities across health outcomes, social determinants, and behaviors. In particular, the research will yield group-specific estimates of disparities with respect to asymptomatic and symptomatic patients and how these discrepancies may impact the socio-demographically dependent spread of disease and its subsequent treatment. The MRP adjustment will be made publicly accessible via a web interface and promote broad investigations with integrated data sources toward a national study.