title: Hospitalization records as a tool for evaluating performance of food- and water-borne disease surveillance systems: a Massachusetts case study.
abstract: We outline a framework for evaluating food- and water-borne surveillance systems using hospitalization records, and demonstrate the approach using data on salmonellosis, campylobacteriosis and giardiasis in persons aged ≥65 years in Massachusetts. For each infection, and for each reporting jurisdiction, we generated smoothed standardized morbidity ratios (SMR) and surveillance to hospitalization ratios (SHR) by comparing observed surveillance counts with expected values or the number of hospitalized cases, respectively. We examined the spatial distribution of SHR and related this to the mean for the entire state. Through this approach municipalities that deviated from the typical experience were identified and suspected of under-reporting. Regression analysis revealed that SHR was a significant predictor of SMR, after adjusting for population age-structure. This confirms that the spatial "signal" depicted by surveillance is in part influenced by inconsistent testing and reporting practices since municipalities that reported fewer cases relative to the number of hospitalizations had a lower relative risk (as estimated by SMR). Periodic assessment of SHR has potential in assessing the performance of surveillance systems.
authors.affiliation: Farm Animal and Veterinary Public Health, Faculty of Veterinary Science, The University of Sydney, Sydney, New South Wales, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity/School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Bureau of Infectious Diseases, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, United States of America.
authors.forename: Siobhan M
authors.initials: SM
authors.lastname: Mor
authors.affiliation: Massachusetts Department of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Alfred
authors.initials: A
authors.lastname: DeMaria
authors.affiliation: Bureau of Infectious Diseases, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, United States of America; Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, Massachusetts, United States of America.
authors.forename: Elena N
authors.initials: EN
authors.lastname: Naumova
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018563:Disease Notification; D062665:Epidemiological Monitoring; D005517:Foodborne Diseases / Q000453:epidemiology*; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D008404:Massachusetts; D015397:Program Evaluation / Q000379:methods*; D011996:Records; D018570:Risk Assessment; D012480:Salmonella Infections / Q000453:epidemiology
references.citation: Stat Med. 2001 Jul 30;20(14):2183-204
references.pmid: 11439429
references.citation: Clin Infect Dis. 2005 Sep 1;41(5):698-704
references.pmid: 16080093
references.citation: JAMA. 1999 Nov 17;282(19):1845-50
references.pmid: 10573276
references.citation: BMC Public Health. 2011 Jun 07;11:444
references.pmid: 21649919
references.citation: Rev Environ Contam Toxicol. 2008;192:117-58
references.pmid: 18020305
references.citation: Am J Public Health. 1990 Dec;80(12):1487-90
references.pmid: 2240336
references.citation: Public Health Rep. 2000 Sep-Oct;115(5):436-47
references.pmid: 11236016
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Jun 10;60(22):749-55
references.pmid: 21659984
references.citation: Ann Neurol. 1991 Oct;30(4):618-21
references.pmid: 1789689
references.citation: Am J Infect Control. 2003 Aug;31(5):274-9
references.pmid: 12888762
references.citation: Clin Epidemiol. 2009 Aug 09;1:67-74
references.pmid: 20865088
references.citation: Emerg Infect Dis. 2011 Jan;17(1):16-22
references.pmid: 21192849
references.citation: Stat Med. 2000 Sep 15-30;19(17-18):2217-41
references.pmid: 10960849
references.citation: BMC Public Health. 2009 Dec 03;9:447
references.pmid: 19958556
references.citation: JAMA. 2001 Jan 17;285(3):313-9
references.pmid: 11176841
references.citation: Clin Infect Dis. 2010 Feb 1;50(3):397-404
references.pmid: 20047497
references.citation: Public Health Rep. 1991 Jan-Feb;106(1):95-7
references.pmid: 1899946
references.citation: Clin Infect Dis. 2009 Mar 15;48(6):698-705
references.pmid: 19199827
references.citation: MMWR Recomm Rep. 2001 Jul 27;50(RR-13):1-35; quiz CE1-7
references.pmid: 18634202
references.citation: MMWR Morb Mortal Wkly Rep. 2009 Feb 27;58(7):169-72
references.pmid: 19247263
references.citation: Emerg Infect Dis. 1999 Nov-Dec;5(6):779-87
references.pmid: 10603211
references.citation: J Water Health. 2006;4 Suppl 2:241-53
references.pmid: 16895093
references.citation: J Public Health Manag Pract. 2008 Nov-Dec;14(6):533-42
references.pmid: 18849773
references.citation: MMWR Morb Mortal Wkly Rep. 2005 May 13;54(18):453-6
references.pmid: 15889006
references.citation: Public Health Rep. 2010 Nov-Dec;125(6):843-50
references.pmid: 21121229
references.citation: Clin Infect Dis. 2006 Feb 15;42(4):498-506
references.pmid: 16421794
references.citation: Infect Control Hosp Epidemiol. 1998 Mar;19(3):175-80
references.pmid: 9552185
references.citation: J Am Med Inform Assoc. 2009 Jan-Feb;16(1):18-24
references.pmid: 18952940
references.citation: Emerg Infect Dis. 2011 Jan;17(1):7-15
references.pmid: 21192848
references.citation: Emerg Infect Dis. 2011 Jan;17(1):23-9
references.pmid: 21192850
references.citation: Am J Epidemiol. 2003 Jan 1;157(1):48-57
references.pmid: 12505890
references.citation: Infect Control Hosp Epidemiol. 2006 Apr;27(4):427-30
references.pmid: 16622826
references.citation: J Food Prot. 2012 Jan;75(1):123-31
references.pmid: 22221364
references.citation: Clin Infect Dis. 2009 Sep 15;49(6):949-55
references.pmid: 19663692
references.citation: Int J Food Microbiol. 1996 Jun;30(1-2):113-23
references.pmid: 8856378
references.citation: Environ Res. 2008 Oct;108(2):185-91
references.pmid: 18706542
references.citation: Am J Infect Control. 2007 Apr;35(3):145-9
references.pmid: 17433936