title: Incidence and completeness of notification of Legionnaires' disease in The Netherlands: covariate capture-recapture analysis acknowledging regional differences.
abstract: To estimate incidence and completeness of notification of Legionnaires' disease (LD) in The Netherlands in 2000 and 2001, we performed a capture-recapture analysis using three registers: Notifications, Laboratory results and Hospital admissions. After record-linkage, 373 of the 780 LD patients identified were notified. Ascertained under-notification was 52.2%. Because of expected and observed regional differences in the incidence rate of LD, alternatively to conventional log-linear capture-recapture models, a covariate (region) capture-recapture model, not previously used for estimating infectious disease incidence, was specified and estimated 886 LD patients (95% confidence interval 827-1022). Estimated under-notification was 57.9%. Notified, ascertained and estimated average annual incidence rates of LD were 1.15, 2.42 and 2.77/100 000 inhabitants respectively, with the highest incidence in the southern region of The Netherlands. Covariate capture-recapture analysis acknowledging regional differences of LD incidence appears to reduce bias in the estimated national incidence rate.
authors.affiliation: Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands. vanhestr@ggd.rotterdam.nl
authors.forename: N A H
authors.initials: NA
authors.lastname: Van Hest
authors.forename: C J P A
authors.initials: CJ
authors.lastname: Hoebe
authors.forename: J W
authors.initials: JW
authors.lastname: Den Boer
authors.forename: J K
authors.initials: JK
authors.lastname: Vermunt
authors.forename: E P F
authors.initials: EP
authors.lastname: Ijzerman
authors.forename: W G
authors.initials: WG
authors.lastname: Boersma
authors.forename: J H
authors.initials: JH
authors.lastname: Richardus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D018563:Disease Notification; D005260:Female; D005843:Geography; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007877:Legionnaires' Disease / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009426:Netherlands / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D012042:Registries