Walter S D, Day N E
Am J Epidemiol. 1983 Dec;118(6):865-86. doi: 10.1093/oxfordjournals.aje.a113705.
In this paper, the authors show how data on the observed prevalence of disease at a screen and on the incidence of disease during intervals between screens may be used to estimate jointly the distribution of the length of time during which individuals remain in the pre-clinical state and the sensitivity of the screen. Apart from being of biologic interest, such estimates may be used to evaluate the length of time by which the date of diagnosis could be advanced by screening (the lead time) as well as to predict the relative effectiveness of various alternative screening strategies. The methodology uses only information which should be routinely available in the course of a typical screening program, and makes only rather mild statistical assumptions. The authors illustrate the methods with breast cancer screening data from the Health Insurance Plan of Greater New York (HIP). Although these data have been analyzed by several other authors, the present approach is the first which simultaneously gives estimates of the pre-clinical state duration, the sensitivity of the screening method, and the underlying incidence rate in the screened group, while also taking into account the problem of length-biased sampling.
在本文中，作者展示了如何利用筛查时观察到的疾病患病率数据以及筛查间隔期间的疾病发病率数据，来联合估计个体处于临床前状态的时间长度分布以及筛查的敏感性。除了具有生物学意义外，此类估计可用于评估通过筛查能将诊断日期提前的时间长度（领先时间），以及预测各种替代筛查策略的相对有效性。该方法仅使用在典型筛查项目过程中应常规可得的信息，并且仅做出相当温和的统计假设。作者用来自大纽约健康保险计划（HIP）的乳腺癌筛查数据对这些方法进行了说明。尽管其他几位作者已对这些数据进行过分析，但目前的方法是首个同时给出临床前状态持续时间、筛查方法敏感性以及筛查组潜在发病率估计值的方法，同时还考虑了长度偏倚抽样问题。
