Department of Chemical and Environmental Engineering, Yale University, New Haven, Connecticut; School of Public Health, Yale University, New Haven, Connecticut.
Am J Trop Med Hyg. 2013 Nov;89(5):884-91. doi: 10.4269/ajtmh.12-0540. Epub 2013 Sep 9.
We present an innovative approach for analyzing diarrheal prevalence data that uses latent variables to model the relationships between multiple, interdependent environmental risk factors, and socioeconomic mediators. This strategy was applied to elucidate diarrheal longitudinal prevalence risk factors in children 1-4 years of age in low-income areas of Jakarta, Indonesia. Through a prospective cohort study, we identified 257 children who had at least one episode of diarrhea. At the onset of the study, we collected responses to 44 indicators, covering a wide range of previously identified diarrhea risk factors, including demographic and socioeconomic factors. We used exploratory factor analysis to uncover four latent categories of risk factors and their respective indicators from the initial pool of 44 indicators. Thereafter, we used structural equation modeling to model the relationships between the four risk categories and diarrheal longitudinal prevalence, controlling for socioeconomic and demographic covariates. Our final model elucidated several pathways to longitudinal diarrheal prevalence. Most notably, poverty exerts its effect on increased diarrheal prevalence via dual pathways: poor household hygiene and food quality, controlling for covariates. Implications of this and other findings for disease control in Jakarta are discussed.
我们提出了一种分析腹泻流行率数据的创新方法，该方法使用潜在变量来模拟多个相互依存的环境风险因素与社会经济中介因素之间的关系。该策略应用于阐明印度尼西亚雅加达低收入地区 1-4 岁儿童的腹泻纵向流行率风险因素。通过前瞻性队列研究，我们确定了 257 名至少有一次腹泻发作的儿童。在研究开始时，我们收集了对 44 个指标的回应，涵盖了先前确定的腹泻风险因素的广泛范围，包括人口统计学和社会经济因素。我们使用探索性因素分析从最初的 44 个指标中发现了四个潜在的风险因素类别及其各自的指标。之后，我们使用结构方程模型来模拟四个风险类别与腹泻纵向流行率之间的关系，控制了社会经济和人口统计学协变量。我们的最终模型阐明了通向纵向腹泻流行率的几种途径。最值得注意的是，贫困通过两条途径对增加的腹泻流行率产生影响：贫困家庭的卫生和食品质量，控制了协变量。讨论了这一发现和其他发现对雅加达疾病控制的意义。
