Katz J, Carey V J, Zeger S L, Sommer A
Dana Center for Preventive Ophthalmology, Wilmer Institute, Johns Hopkins School of Medicine, Baltimore, MD 21287-9019.
Am J Epidemiol. 1993 Dec 1;138(11):994-1006. doi: 10.1093/oxfordjournals.aje.a116820.
The degree to which diarrheal disease clustered within households and within villages among preschool age children was examined using data from four population-based prevalence surveys undertaken in Malawi, Zambia, Indonesia, and Nepal over the past decade. The design effect for each cluster survey was calculated using the diarrhea prevalence, the cluster sizes, and the magnitude of diarrhea clustering within the sampling unit (villages). A recently developed statistical method, alternating logistic regression, was used to estimate disease associations within households of up to nine preschool age children residing within villages of up to 589 such children. Pairwise odds ratios estimating diarrhea clustering within villages ranged from 1.03 (95% confidence interval (CI) 1.01-1.07) in Zambia to 2.19 (95% CI 1.73-2.78) in Indonesia. The design effects ranged from 2.07 (95% CI 1.26-3.19) in Zambia to 7.93 (95% CI 5.16-11.52) in Indonesia. Design effects were strongly dependent on cluster size. The design effects for clusters of size 50 would have ranged from 1.38 to 4.73. Pairwise odds ratios for diarrhea clustering within households ranged from 1.88 (95% CI 1.61-2.19) in Nepal to 10.05 (95% CI 8.46-11.94) in Indonesia. Household odds ratios were always larger than village odds ratios. The village and household pairwise odds ratios adjusted for age, the type of latrine used by the household, and presence of a market in the village were slightly higher than the unadjusted odds ratios. Alternating logistic regression provided useful estimates of disease clustering within villages and household while allowing for covariate adjustment.
利用过去十年在马拉维、赞比亚、印度尼西亚和尼泊尔进行的四项基于人群的患病率调查数据，研究了学龄前儿童腹泻病在家庭和村庄内的聚集程度。使用腹泻患病率、聚类规模以及抽样单元（村庄）内腹泻聚集的程度来计算每项聚类调查的设计效应。采用一种最新开发的统计方法——交替逻辑回归，来估计居住在村庄内多达589名此类儿童的家庭中，多达9名学龄前儿童的疾病关联。估计村庄内腹泻聚集的成对优势比范围从赞比亚的1.03（95%置信区间（CI）1.01 - 1.07）到印度尼西亚的2.19（95% CI 1.73 - 2.78）。设计效应范围从赞比亚的2.07（95% CI 1.26 - 3.19）到印度尼西亚的7.93（95% CI 5.16 - 11.52）。设计效应强烈依赖于聚类规模。规模为50的聚类的设计效应范围为1.38至4.73。家庭内腹泻聚集的成对优势比范围从尼泊尔的1.88（95% CI 1.61 - 2.19）到印度尼西亚的10.05（95% CI 8.46 - 11.94）。家庭优势比总是大于村庄优势比。针对年龄、家庭使用的厕所类型以及村庄内是否有市场进行调整后的村庄和家庭成对优势比略高于未调整的优势比。交替逻辑回归在允许进行协变量调整的同时，为村庄和家庭内的疾病聚集提供了有用的估计。
