Prevalence in two-phase surveys: accuracy of screening procedure and corrected estimates.
BACKGROUND
Two-phase surveys often are used to estimate prevalence, in particular when the disease is rare or the case ascertainment procedure difficult and/or costly. However, few authors of such surveys take into account the sensitivity error associated with the use of a screening procedure in the first phase and its imprecision in correcting the prevalence estimate and confidence interval.


METHODS
Two examples of two-phase surveys of rheumatic diseases (hip and knee osteoarthritis, rheumatoid arthritis and spondyloarthropathies) are used to present methodological approaches to obtain corrected prevalence estimates. Two methods for assessing the accuracy of the screening procedure are described--two-phase pilot and case-control designs--that are best suited for frequent and rare diseases, respectively, and naive and corrected estimates of prevalence compared.


RESULTS
When the sensitivity error is not taken into account, prevalence is underestimated, as is, especially, the width of its confidence interval. In our examples, the corrected confidence interval width increased up to 50% as compared with naïve one.


CONCLUSIONS
The screening procedure accuracy should be thoroughly assessed in two-phase prevalence surveys and prevalence estimates and their confidence intervals corrected accordingly.
Morvan
Johanne
J
School of Public Health, Nancy University, Nancy, France.
Coste
Joël
J
Roux
Christian H
CH
Euller-Ziegler
Liana
L
Saraux
Alain
A
Guillemin
Francis
F
D016001:Confidence Intervals; D015340:Epidemiologic Research Design; D005602:France / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000592:standards*; D015207:Osteoarthritis, Hip / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D015203:Reproducibility of Results