Kleinman Ken P, Abrams Allyson M
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
Stat Med. 2008 Sep 10;27(20):4057-68. doi: 10.1002/sim.3269.
In modern surveillance of public health, data may be reported in a timely fashion and include spatial data on cases in addition to the time of their occurrence. This has lead to many recent developments in statistical methods to detect events of public health importance. However, there has been relatively little work about how to compare such methods. One powerful rationale for performing surveillance is earlier detection of events of public health significance; previous evaluation tools have focused on metrics that include the timeliness of detection in addition to sensitivity and specificity. However, such metrics have not accounted for the number of persons affected by the events. We re-examine the rationale for this surveillance and conclude that earlier detection is preferred because it can prevent additional morbidity and mortality. On the basis this observation, we propose evaluating the number of cases prevented by each detection method, and include this information in assessing the value of different detection methods. Using this approach incorporates more information about the events and the detection and provides a sound basis for making decisions about which detection methods to employ.
在现代公共卫生监测中，数据可能会及时上报，除了事件发生时间外，还包括病例的空间数据。这促使了统计方法在检测具有公共卫生重要性的事件方面取得了许多最新进展。然而，关于如何比较这些方法的研究相对较少。进行监测的一个有力理由是更早地发现具有公共卫生意义的事件；以前的评估工具关注的指标除了敏感性和特异性外，还包括检测的及时性。然而，这些指标没有考虑受事件影响的人数。我们重新审视了这种监测的理由，并得出结论，更早发现是可取的，因为它可以预防额外的发病和死亡。基于这一观察结果，我们建议评估每种检测方法预防的病例数，并将此信息纳入评估不同检测方法的价值中。使用这种方法可以纳入更多关于事件和检测的信息，并为决定采用哪种检测方法提供合理依据。
