title: Risk factor redistribution of the national HIV/AIDS surveillance data: an alternative approach.
abstract: OBJECTIVE
  The purpose of this study was to assess an alternative statistical approach-multiple imputation-to risk factor redistribution in the national human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) surveillance system as a way to adjust for missing risk factor information.
  
  
  METHODS
  We used an approximate model incorporating random variation to impute values for missing risk factors for HIV and AIDS cases diagnosed from 2000 to 2004. The process was repeated M times to generate M datasets. We combined results from the datasets to compute an overall multiple imputation estimate and standard error (SE), and then compared results from multiple imputation and from risk factor redistribution. Variables in the imputation models were age at diagnosis, race/ethnicity, type of facility where diagnosis was made, region of residence, national origin, CD-4 T-lymphocyte cell count within six months of diagnosis, and reporting year.
  
  
  RESULTS
  In HIV data, male-to-male sexual contact accounted for 67.3% of cases by risk factor redistribution and 70.4% (SE = 0.45) by multiple imputation. Also among males, injection drug use (IDU) accounted for 11.6% and 10.8% (SE = 0.34), and high-risk heterosexual contact for 15.1% and 13.0% (SE = 0.34) by risk factor redistribution and multiple imputation, respectively. Among females, IDU accounted for 18.2% and 17.9% (SE = 0.61), and high-risk heterosexual contact for 80.8% and 80.9% (SE = 0.63) by risk factor redistribution and multiple imputation, respectively.
  
  
  CONCLUSIONS
  Because multiple imputation produces less biased subgroup estimates and offers objectivity and a semiautomated approach, we suggest consideration of its use in adjusting for missing risk factor information.
authors.affiliation: Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, MS E-47, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA. KMcDavid@cdc.gov
authors.forename: Kathleen McDavid
authors.initials: KM
authors.lastname: Harrison
authors.forename: Tebitha
authors.initials: T
authors.lastname: Kajese
authors.forename: H Irene
authors.initials: HI
authors.lastname: Hall
authors.forename: Ruiguang
authors.initials: R
authors.lastname: Song
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000328:Adult; D003628:Database Management Systems; D016208:Databases, Factual; D018563:Disease Notification; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D040442:Public Health Informatics; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology