Epidemiological data often include excess zeros. This is particularly the case for data on rare conditions, diseases that are not common in specific areas or specific time periods, and conditions and diseases that are hard to detect or on the rise. In this paper, we provide a review of methods for modeling data with excess zeros with focus on count data, namely hurdle and zero-inflated models, and discuss extensions of these models to data with spatial and spatio-temporal dependence structures. We consider a Bayesian hierarchical framework to implement spatial and spatio-temporal models for data with excess zeros. We further review current implementation methods and computational tools. Finally, we provide a case study on five-year counts of confirmed cases of Lyme disease in Illinois at the county level.
The surveillance of influenza activity is critical to early detection of epidemics and pandemics and the design of disease control strategies. Case reporting through a voluntary network of sentinel physicians is a commonly used method of passive surveillance for monitoring rates of influenza-like illness (ILI) worldwide. Despite its ubiquity, little attention has been given to the processes underlying the observation, collection, and spatial aggregation of sentinel surveillance data, and its subsequent effects on epidemiological understanding. We harnessed the high specificity of diagnosis codes in medical claims from a database that represented 2.5 billion visits from upwards of 120,000 United States healthcare providers each year. Among influenza seasons from 2002-2009 and the 2009 pandemic, we simulated limitations of sentinel surveillance systems such as low coverage and coarse spatial resolution, and performed Bayesian inference to probe the robustness of ecological inference and spatial prediction of disease burden. Our models suggest that a number of socio-environmental factors, in addition to local population interactions, state-specific health policies, as well as sampling effort may be responsible for the spatial patterns in U.S. sentinel ILI surveillance. In addition, we find that biases related to spatial aggregation were accentuated among areas with more heterogeneous disease risk, and sentinel systems designed with fixed reporting locations across seasons provided robust inference and prediction. With the growing availability of health-associated big data worldwide, our results suggest mechanisms for optimizing digital data streams to complement traditional surveillance in developed settings and enhance surveillance opportunities in developing countries.
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