Landscape-epidemiological study design to investigate an environmentally based disease

Abstract

Cost-effective approaches for identifying and enrolling subjects in community-based epidemiological studies face many challenges. Additional challenges arise when a neighborhood scale of analysis is required to distinguish between individual-and group-level risk factors with strong environmental determinants. A stratified, two-stage, cross-sectional, address-based telephone survey of Greater Tucson, Arizona, was conducted in [2002][2003]. Subjects were recruited from direct marketing data at neighborhood resolution using a geographic information system (GIS). Three geomorphic strata were divided into two demographic units. Households were randomly selected within census block groups, selected using the probability proportional to size technique. Purchased direct marketing lists represented 45.2% of Census 2000 households in the surveyed block groups. Survey design effect (1.6) on coccidioidomycosis prevalence (88 per 100,000 per year) was substantially reduced in four of the six strata (0.3-0.9). Race-ethnicity was more robust than age and gender to compensate for significant selection bias using poststratification. Clustered, address-based telephone surveys provide a costeffective, valid method for recruiting populations from address-based lists using a GIS to design surveys and population survey statistical methods for analysis. Landscape ecology provides effective methods for identifying scales of analysis and units for stratification that will improve sampling efficiency when environmental variables of interest are strong predictors.

Coccidioidomycosis: epidemiology

“…The other ethnic groups were not linked with either elevated rates of severe pulmonary disease or extrapulmonary dissemination, though the low numbers of Filipinos or Asians in the study limited the analysis. Others have confirmed these findings using geomorphic and demographic strata to control for differences in group-level exposure – making the results more externally valid than prior epidemiologic studies conducted solely on military personnel, clinic or hospitalized patients, or student population 70,71…”

Coccidioidomycosis in African Americans

“…39 Location of residence within the greater metropolitan area of Tucson, AZ, did not affect the risk of coccidioidomycosis in African Americans. 40 More recently, population-based studies of coccidioidomycosis in Kern County, California, in 1991 32 and in 1995 to 1996 41 showed that blacks had a disproportionate percentage of disseminated infection (31% of all disseminated cases were in blacks, but blacks accounted for only 6.7% of all coccidioidal infections 32 ) and an increased rate of dissemination (22%), whereas a similar increase in dissemination was not noted for Hispanic or Asian patients. 32,41 Among 223 patients at Naval Medical Center San Diego (1994-2002), 44% of African American patients with coccidioidomycosis had extrapulmonary infection, and the risk of disseminated disease was 42 times higher in African Americans than in whites (the risk of disseminated disease in Filipinos and Hispanics was also significantly higher).…”

Use of Market Research Data by State Chronic Disease Programs, Illinois, 2012–2014

“…Community-based prevention marketing was also used to develop and implement physical activity interventions for middle-aged women (6) and for children and adolescents (7), but investigators in both of these studies conducted their own market research surveys. Another study used geographic information systems (GIS) data and marketing data to investigate an environmentally based disease in a neighborhood in greater Tucson, Arizona (8). …”

“…Segmentation is “a process of looking at the audience or ‘market’ and seeking to identify distinct, manageable subgroups (segments) that may have similar needs, attitudes, or behaviors” (8). The goal of segmentation is to create population subgroups in which all members are as similar to one another and as different from others as possible.…”