Biostatistics Commons^™

Evaluation Of Student Outcomes In Online Vs. Campus Biostatistics Education In A Graduate School Of Public Health, John Mcgready, Ron Brookmeyer

Ron Brookmeyer

Objective: To compare student outcomes between concurrent online and on-campus sections of an introductory biostatistics course offered at a U.S. school of public health in 2005. Methods: Enrolled students (95 online, 92 on-campus) were invited to participate in a confidential online survey. The course outcomes were compared between the two sections adjusting for differences in student characteristics. Results: Seventy-two online (76%) and 66 (72%) on-campus enrollees participated. Unadjusted final exam scores for the online and on-campus sections were respectively 85.1 and 86.3 (p = 0.50) in term 1, and 87.7 and 86.9 (p=0.58) in term 2. After adjustment for student …

Estimation Of Hiv Incidence Using Multiple Biomakers, Ron Brookmeyer, Jacob Konikoff, Oliver Laeyendecker, Susan Eshleman

Ron Brookmeyer

The incidence of human immunodeficiency virus (HIV) is the rate at which new HIV infections occur in populations. The development of accurate, practical, and cost-effective approaches to estimation of HIV incidence is a priority among researchers in HIV surveillance because of limitations with existing methods. In this paper, we develop methods for estimating HIV incidence rates using multiple biomarkers in biological samples collected from a cross-sectional survey. An advantage of the method is that it does not require longitudinal follow-up of individuals. We use assays for BED, avidity, viral load, and CD4 cell count data from clade B samples collected …

National Estimates Of The Prevalence Of Alzheimer's Disease In The United States, Ron Brookmeyer, Denis Evans, Liesi Hebert, Langa Kenneth, Heeringa Steven, Plassman Brenda, Kukull Kenneth

Ron Brookmeyer

Several methods of estimating prevalence of dementia are presented in this article. For both Brookmeyer and the Chicago Health and Aging project (CHAP), the estimates of prevalence are derived statistically, forward calculating from incidence and survival figures. The choice of incidence rates on which to build the estimates may be critical. Brookmeyer used incidence rates from several published studies, whereas the CHAP investigators applied the incidence rates observed in their own cohort. The Aging, Demographics, and Memory Study (ADAMS) and the East Boston Senior Health Project (EBSHP) were sample surveys designed to ascertain the prevalence of Alzheimer’s disease and dementia. …

Statistical Considerations In Determining Hiv Incidence From Changes In Hiv Prevalence, Ron Brookmeyer, Jacob Konikoff

Ron Brookmeyer

The development of methods for estimating HIV incidence is critical for tracking the epidemic and for designing, targeting and evaluating HIV prevention efforts. One method for estimating incidence is based on changes in HIV prevalence. That method is attracting increased attention because national population-based HIV prevalence surveys, such as Demographic and Health Surveys, are being conducted throughout the world. Here, we consider some statistical issues associated with estimating HIV incidence from two population-based HIV prevalence surveys conducted at two different points in time. We show that the incidence estimator depends on the relative survival rate. We evaluate the sensitivity of …

Measuring The Hiv/Aids Epidemic: Approaches And Challenges, Ron Brookmeyer

Ron Brookmeyer

In this article, the author reviews current approaches and methods for measuring the scope of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic and their strengths and weaknesses. In recent years, various public health agencies have revised statistical estimates of the scope of the HIV/AIDS pandemic. The author considers the reasons underlying these revisions. New sources of data for estimating HIV prevalence have become available, such as nationally representative probability-based surveys. New technologies such as biomarkers that indicate when persons became infected are now used to determine HIV incidence rates. The author summarizes the main sources of errors and …

On The Statistical Accuracy Of Biomarker Assays Of Hiv Incidence, Ron Brookmeyer

Ron Brookmeyer

Objective: To evaluate the statistical accuracy of estimates of current HIV incidence rates from cross-sectional surveys, and to identify characteristics of assays that improve accuracy.

Methods: Performed mathematical and statistical analysis of the cross-sectional estimator of HIV incidence to evaluate bias and variance. Developed probability models to evaluate impact of long tails of the window period distribution on accuracy.

Results: The standard cross-sectional estimate of HIV incidence rate is estimating a time-lagged incidence where the lag time, called the shadow, depends on the mean and the coefficient of variation of window periods. Equations show how the shadow increases with the …

Should Biomarker Estimates Of Hiv Incidence Be Adjusted?, Ron Brookmeyer

Ron Brookmeyer

Objective: To evaluate adjustment procedures that have been proposed to correct HIV incidence rates derived from cross-sectional surveys of biomarkers (BED). These procedures were motivated by some reports that the biomarker BED approach overestimates incidence when compared to cohort studies.

Design: Considered the Hargrove and McDougal adjustment procedures that adjust biomarker estimates of HIV incidence rates for misclassification with respect to the timing of infections.

Methods: Performed mathematical and statistical analysis of the adjustment formulas. Evaluated sources of error in cohort studies of incidence that could also explain discrepancies between cohort and biomarker estimates.

Results: The McDougal adjustment has no …

The Effects Of Herd Immunity On The Power Of Vaccine Trials, Blake Charvat, Ron Brookmeyer, Jay Herson

Ron Brookmeyer

We evaluate the effects of herd immunity on the power of vaccine trials. We consider large-scale trials in which persons are individually randomized to either placebo or vaccine. We evaluate the adequacy of naive power calculations that ignore the effects of herd immunity such as those based on the comparison of two independent binomials. We developed a simulation design to evaluate the quantitative effects of herd immunity on power. The simulation design accounted for nonhomogeneous mixing. We found that naive power calculations that ignore the effects of herd immunity can seriously overestimate power. In fact, we found that as sample …

Worldwide Variation In The Doubling Time Of Alzheimer's Disease Incidence Rates, Kathryn Ziegler-Graham, Ron Brookmeyer, Elizabeth Johnson, H. Michael Arrighi

Ron Brookmeyer

Background The doubling time is the number of chronological years for the age-specific incidence rate to double in magnitude. Doubling times describe the rate of increase of the risk of Alzheimer's disease (AD) with advancing age. Estimates of doubling times of AD assist in understanding disease etiology and forecasting future disease prevalence. The objective of this study was to investigate regional and gender differences in the doubling of AD age-specific incidence rates.

Methods We identified all studies in the peer review literature that reported age-specific incidence rates for AD. We modeled the logarithm of the incidence rate as a linear …

Software To Forecast The Global Burden Of Alzheimer's Disease, Ron Brookmeyer, Elizabeth Johnson, Kathryn Ziegler-Graham, H. Michael Arrighi

Ron Brookmeyer

Software was developed to forecast the global burden of Alzheimer’s disease and evaluate the potential impact of interventions that delay disease onset and progression. The output includes 50 year projections of Alzheimer's disease prevalence by stage of disease and region of the world. The methods are based on a stochastic multi-state model The software incorporates U.N. worldwide population forecasts and data from epidemiological studies on risks of Alzheimer’s disease. The user can also supply their own population projections, and modify input parameters for the model including the disease incidence rates, effects of interventions on disease onset and progression, and stages …

Confidence Intervals For Biomarker-Based Human Immunodeficiecny Virus Incidence Estimates And Differences Using Prevalent Data, Ron Brookmeyer, S Cole, H Chu

Ron Brookmeyer

Prevalent biological specimens can be used to estimate human immunodeficiency virus (HIV) incidence using a two-stage immunologic testing algorithm that hinges on the average time, say T, between testing HIV positive on highly and less sensitive enzyme immunoassays. Common approaches to confidence interval (CI) estimation for this incidence measure have included (1) ignoring the random error in T or (2) employing a Bonferroni adjustment to the box method. The authors present alternative Monte Carlo-based CIs for this incidence measure, as well as CIs for the biomarker-based incidence difference; standard approaches to CIs are typically appropriate for the incidence ratio. Using …

Modeling The Effect Of Alzheimer's Disease On Mortality, Elizabeth Johnson, Ron Brookmeyer, Kathryn Ziegler-Graham

Ron Brookmeyer

Mortality rate ratios and the associated proportional hazards models have been used to summarize the effect of Alzheimer's disease on longevity. However, the mortality rate ratios vary by age and therefore do not provide a simple parsimonious summary of the effect of the disease on lifespan. Instead, we propose a new parameter that is defined by an additive multistate model. The proposed multistate model accounts for different stages of disease progression. The underlying assumption of the model is that the effect of disease on mortality is to add a constant amount to death rates once the disease progresses from an …

Modeling The Incubation Period Of Anthrax, Ron Brookmeyer, Elizabeth Johnson, Sarah Barry

Ron Brookmeyer

Models of the incubation period of anthrax are important to public health planners because they can be used to predict the delay before outbreaks are detected, the size of an outbreak and the duration of time that persons should remain on antibiotics to prevent disease. The difficulty is that there is little direct data about the incubation period in humans. The objective of this paper is to develop and apply models for the incubation period of anthrax. Mechanistic models that account for the biology of spore clearance and germination are developed based on a competing risks formulation. The models predict …

Modeling An Outbreak Of Anthrax, Ron Brookmeyer

Ron Brookmeyer

Introduction

On October 2, 2001 a sixty-three-year-old Florida man who worked as a photo editor at a media publishing company was admitted to an emergency department complaining of nausea, vomiting, and fever. His symptoms began four days earlier on a recreational trip to North Carolina. The man died shortly thereafter. An astute clinician quickly made the surprising diagnosis of inhalational anthrax, which is a serious and deadly disease. The diagnosis was surprising because inhalational anthrax is extremely rare; only 18 cases were reported in the United States between 1900 and 1978. Public health officials at first believed that the Florida …

Biosecurity And The Role Of Statisticians, Ron Brookmeyer

Ron Brookmeyer

No abstract provided.

Modeling The Optimum Duration Of Antibiotic Prophylaxis In An Anthrax Outbreak, Ron Brookmeyer, Elizabeth Johnson, Robert Bollinger

Ron Brookmeyer

A critical consideration in effective and measured public health responses to an outbreak of inhalational anthrax is the optimum duration of antibiotic prophylaxis. We develop a competing-risks model to address the duration of antibiotic prophylaxis and the incubation period that accounts for the risks of spore germination and spore clearance. The model predicts the incubation period distribution, which is confirmed by empirical data. The optimum duration of antibiotic prophylaxis depends critically on the dose of inhaled spores. At high doses, we show that exposed persons would need to remain on antibiotic prophylaxis for at least 4 months, and considerable morbidity …

Statistical Models And Bioterrorism: Application To The U.S. Anthrax Outbreak, Ron Brookmeyer, Natalie Blades

Ron Brookmeyer

In the fall of 2001 an outbreak of inhalational anthrax occurred in the United States that was the result of bioterrorism. Letters contaminated with anthrax spores were sent through the postal system. In response to the outbreak, public health officials treated over 10,000 persons with antibiotic prophylaxis in the hopes of preventing further morbidity and mortality. No persons receiving the antibiotics subsequently developed disease. The question arises as to how many cases of disease may actually have been prevented by the public health intervention of antibiotic prophylaxis. A statistical model is developed to answer this question by relating to the …

Quantitative Evaluation Of Hiv Preventon Programs, Edward Kaplan, Ron Brookmeyer

Ron Brookmeyer

How successful are HIV prevention programs? Which HIV prevention programs are most cost effective? Which programs are worth expanding and which should be abandoned altogether? This book addresses the quantitative evaluation of HIV prevention programs, assessing for the first time several different quantitative methods of evaluation

Prevention Of Inhalational Anthrax In The U.S. Outbreak, Ron Brookmeyer, Natalie Blades

Ron Brookmeyer

No abstract provided.

Aging And The Public Health Impact Of Dementia, Ron Brookmeyer, Claudia Kawas

Ron Brookmeyer

No abstract provided.

Projections Of Alzheimer's Disease In The United States And The Public Health Impact Of Delaying Disease Onset., Ron Brookmeyer, Sarah Gray, Claudia Kawas

Ron Brookmeyer

OBJECTIVES: The goal of this study was to project the future prevalence and incidence of Alzheimer's disease in the United States and the potential impact of interventions to delay disease onset.

METHODS: The numbers of individuals in the United States with Alzheimer's disease and the numbers of newly diagnosed cases that can be expected over the next 50 years were estimated from a model that used age-specific incidence rates summarized from several epidemiological studies, US mortality rates, and US Bureau of the Census projections.

RESULTS: in 1997, the prevalence of Alzheimer's disease in the United States was 2.32 million (range: …

Aids Epidemiology: A Quantitative Approach, Ron Brookmeyer, Mitchell Gail

Ron Brookmeyer

This comprehensive work confronts the problems that are unique to AIDS research and unites them under a single conceptual framework. It focuses on methods for the design and analysis of epidemiologic studies, the natural history of AIDS and the transmission of HIV, methods for tracking and projecting the course of the epidemic, and statistical issues in therapeutic trials. The various methods of monitoring and forecasting this disease receive comprehensive treatment. These methods include back-calculation, which the authors developed; interpretation of survey data on HIV prevalence; mathematical models for HIV transmission; and approaches that combine different types of epidemiological data. Much …

Reconstruction And Future Trends Of The Aids Epidemic In The United States, Ron Brookmeyer

Ron Brookmeyer

There has been considerable uncertainty in estimates of past and current human immunodeficiency virus (HIV) infection rates in the United States. Statistical estimates of historical infection rates can be obtained from acquired immunodeficiency syndrome (AIDS) incidence data and the incubation period. However, this approach is subject to a number of sources of uncertainty and two other approaches, epidemic models of HIV transmission and surveys of HIV prevalence, are used to corroborate and refine the statistical estimates. Analyses suggest the HIV infection rate in the United States grew rapidly in the early 1980s, peaked in the mid-1980s, and subsequently declined markedly. …

The Minimum Size Of The Aids Epidemic In The United States, Ron Brookmeyer, Mitchell Gail

Ron Brookmeyer

A new method based on the reported incubation period of transfusion-associated AIDS was used to estimate the number of AIDS cases likely to arise in the USA among those infected before 1986. Between 1986 and 1991 102 000 new cases are projected, with a total cumulative incidence of 135 000 AIDS cases. These estimates do not account for new infections after 1985 nor very long incubation periods and are thus the smallest numbers to be expected. Even if new infections can be effectively prevented, the epidemic will be five times larger than the number of cases observed so far.