Torabi Mahmoud
Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Ave,, Winnipeg, Manitoba R3E 0W3, Canada.
BMC Public Health. 2014 Mar 27;14:285. doi: 10.1186/1471-2458-14-285.
Bowel disorders have destructive impacts on the patients social and mental aspects of life and can cause emotional distress. The risk of developing bowel incontinence also increases with age. The rate of incidence of inflammatory bowel disease in Manitoba, Canada, has been unusually raised. Therefore, it is important to identify trends in the incidence of bowel disorders that may suggest further epidemiological studies to identify risk factors and identify any changes in important factors.
An important part of spatial epidemiology is cluster detection as it has the potential to identify possible risk factors associated with disease, which in turn may lead to further investigations into the nature of diseases. To test for potential disease clusters many methods have been proposed. The focused detection methods including the circular spatial scan statistic (CSS), flexible spatial scan statistic (FSS), and Bayesian disease mapping (BYM) are among the most popular disease detection procedures. A frequentist approach based on maximum likelihood estimation (MLE) has been recently used to identify potential focused clusters as well. The aforementioned approaches are studied by analyzing a dataset of bowel disorders in the province of Manitoba, Canada, from 2001 to 2010.
The CSS method identified less regions than the FSS method in the south part of the province as potential clusters. The same regions were identified by the BYM and MLE methods as being potential clusters of bowel disorders with a slightly different order of significance. Most of these regions were also detected by the CSS or FSS methods.
Overall, we recommend using the methods BYM and MLE for cluster detection with the similar population and structure of regions as in Manitoba. The potential clusters of bowel disorders are generally located in the southern part of the province including the eastern part of the city of Winnipeg. These results may represent real increases in bowel disorders or they may be an indication of other covariates that were not adjusted for in the model used here. Further investigation is needed to examine these findings, and also to explore the cause of these increases.
肠道疾病对患者的社交和心理生活方面具有破坏性影响，并可能导致情绪困扰。大便失禁的风险也会随着年龄的增长而增加。加拿大曼尼托巴省炎症性肠病的发病率异常升高。因此，识别肠道疾病发病率的趋势很重要，这可能有助于进一步开展流行病学研究，以确定风险因素并识别重要因素的任何变化。
空间流行病学的一个重要部分是聚类检测，因为它有潜力识别与疾病相关的可能风险因素，进而可能促使对疾病本质进行进一步调查。为了检测潜在的疾病聚类，人们提出了许多方法。聚焦检测方法包括圆形空间扫描统计量（CSS）、灵活空间扫描统计量（FSS）和贝叶斯疾病映射（BYM），是最常用的疾病检测程序。最近也有人使用基于最大似然估计（MLE）的频率主义方法来识别潜在的聚焦聚类。通过分析加拿大曼尼托巴省2001年至2010年的肠道疾病数据集，对上述方法进行了研究。
CSS方法在该省南部识别出的潜在聚类区域比FSS方法少。BYM和MLE方法识别出相同的区域为肠道疾病的潜在聚类，只是显著性顺序略有不同。这些区域中的大多数也被CSS或FSS方法检测到。
总体而言，我们建议在与曼尼托巴省人口和区域结构相似的情况下，使用BYM和MLE方法进行聚类检测。肠道疾病的潜在聚类通常位于该省南部，包括温尼伯市东部。这些结果可能代表肠道疾病的实际增加，也可能表明此处使用的模型中未调整的其他协变量。需要进一步调查以检验这些发现，并探索这些增加的原因。
