Acknowledgements

Epidemiologic Query & Mapping System

Patrick O’Carroll

Clark Johnson

Richard HoskinsCathy O’Connor

Sherrilynn Fuller Principal Investigator

Public Health System Linkages – Bench to Bedside and Beyond

EpiQMS URL

http://198.187.0.45/EpiQMS/

Also EPIQMS in www.google.com

Components• WWW based - high speed access by local health

• Three user levels (public, practitioner, need-to-know)

• Rates with statistical measures

• Charts & graphs, time trends

• Deals with small numbers (empirical Bayes spatial modeling)

• Static, dynamic and full GIS mapping

• Multiple geographies

• Queries a dynamic database (no or little on-line calculation)

• Allows central Q&A (software & data & statistical measures)

• Comprehensive security model

• Individual id protection (available dimensions)

• Only aggregated data

• Tutorials

Components

Datasets for EpiQMS ABORTIONS 1991-1999BIRTHS CERTIFICATE 1980-1999CANCER RegistryCENSUS DATA  1980 1990 – 1998 2000(state, county, census tract, legislative district, school district, Zip Code, SES cluster zones, climate zones, rural areas)

 COMMUNICABLE DISEASE 1980-1997 DEATHS 1980-2000 ICD9 – ICD10 HOSPITALIZATIONS 1990 -1999 HOSPITALIZATIONS (EPI FILE) 1990-1999 INFANT DEATHS 1981-1999 STD 1993-1999 TUBERCULOSIS 1992-1999 HIV 1992 – 1999 Health of Washington State Youth Violence Crime , housing

Available now

In preparation

Requested

• Original and still primary objective: Communicable disease tracking

• Geographically oriented (maps) • Small numbers• Ease of use and access • Low cost for users

Why do this?

Objectives

• Ease of access to public health data by all citizens while paying strict attention to individual privacy. • Allow medical practitioners routine access to support assessment and surveillance in local health departments, communities, WA DOH, and public health research. • Get people who use public health data to think geographically. Many geographies, some non-standard.

• Uniformity of epidemiologic measures. • Offer on-line instruction in how to use and intrepret public health data. • Software burden is on DOH not users. • Allow down loading of information – tables, charts, maps.

DiagramDOH databases

PreProcessingSAS

EpiQMS database

EpiQMS: Data Server

Population data

Static Maps

Aggregated data

EpiQMS Internet Engine

Dynamic mappingengine

Web server

Data formating

Full GIS

SASpreprosessing

Geocoded data

WWW users citizen users practitioners

need-to-know

How it works …

No identifiers !

DOH:Secure Data Server

SQL server

Indexing - primary key

Disease

Race

Age

Year

Geography

SexNo

Yes

NoNo

OOXOX15Generates Index:

15XOXOO

Aggregating events by:

Breast cancer

Yes

Yes

Cancer Registry security model level I

Available selected selected 5 or 10 yearUser class Dimensions Disease Geography Year Age group Race Sex

Public 3 11 County 1990-99 10 year A M

Zip Code all B F

legislative district I T

W

all

Practitioner 4 all County 1990-99 10 year A M

Zipcode all B F

legislative district I T

census tract W

all

Need-to-Know all all County 1990-99 5 year A M

Zipcode all 10 year B Flegislative district I T

census tract Wblock group allSES clusters

Concurrent dimensions security model level II Available selected selected 5 or 10 year

User class Dimensions Disease Geography Year Age group Race Sex

3 11 3 out of 6 all 10 year all all

Public x x xx x x

x x x4 all 4 out of 6 10 year all all

Practitioner x x x xx x x xx x x x

x x x xx x x

all all all all 5, 10 year all all

Need-to-Know x x x x xx x x xx x x

Who decides which users get various levels of access?

Available selected selected 5 or 10 yearUser class Dimensions Disease Geography Year Age group Race Sex

3 11 3 out of 6 all 10 year all all

Public x x xx x x

x x x4 all 4 out of 6 10 year all all

Practitioner x x x xx x x xx x x x

x x x xx x x

all all all all 5, 10 year all all

Need-to-Know x x x x xx x x xx x x

• Data “owners”• Not EpiQMS team

Tools to help data owners decide:• Probability studies• Count suppression

Thematic Maps

Trivial pursuitword: choropleth

Beginningto think geographically ...

Map

MapIssues in thematic mapping

Different conclusionscan be drawn from

maps of thesame data.

Natural break

Equal ranges

Equal counts

MAUPThe Modifiable ArealUnit Problem (MAUP)

A form of ecological fallacy associated

with the aggregation of data into

areal units for geographical analysis.

There are two effects:

Scale effect: The larger the unit of aggregation, the larger, on

average, is the correlation between two variables.

Aggregation effect: By aggregating data into different blocks, you

can get different correlations.

1960 election:

+0.44 correlation between rural non-farm voting for Nixon in

using Census nine-region division

-0. 22 correlation using the Census four-region division.

Empirical Bayes estimation

• Smoothing to reflect confidence of local estimation of risk

• Prior knowledge of about rates and the observed data are used to develop a prior distribution posterior likelihood prior distribution of data distribution

• previous data• intuition• good guess (or even a bad one)• the data itself - Empirical Bayes

Mean (smoothed rates)std error (Bayesian confidence intervals)

How to estimate disease rates in “small” areas?

Deaths from breast cancer in age 35-44 women

Breast Cancer

0 9030 60

Miles

Bayesian Rate Ratio0.00 to 0.750.75 to 1.251.25 to 2.252.25 to 12.00Other

No Bayes

Bayes

Zipcodes

Blank areas indicate no deaths

Map

What does it take to run EpiQMS?

User

• Internet Explorer• Internet connection 56k or > • Two plug-ins which are easy to deal with. (SVG for maps, ChartFX for charts)

DOH

• SQL server• ChartFX – charting software• SAS for the prep of data • Visual Interdev – standard Internet site development tool. • RoboHelp – help system development package

http://198.187.0.45/EpiQMS/

Fast!