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Adjusting for spatial variation when assessing individual-level risk: A case-study in the epidemiology of snake-bite in Sri Lanka


Autoři: Dileepa Senajith Ediriweera aff001;  Anuradhani Kasthuriratne aff002;  Arunasalam Pathmeswaran aff002;  Nipul Kithsiri Gunawardene aff003;  Shaluka Francis Jayamanne aff004;  Kris Murray aff005;  Takuya Iwamura aff007;  David Griffith Lalloo aff008;  Hithanadura Janaka de Silva aff004;  Peter John Diggle aff009
Působiště autorů: Centre for Health Informatics, Biostatistics and Epidemiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka aff001;  Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka aff002;  Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka aff003;  Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka aff004;  Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St Mary’s Campus, London, United Kingdom aff005;  Grantham Institute—Climate Change and the Environment, Imperial College London, South Kensington, London, United Kingdom aff006;  Faculty of Life Sciences, School of Zoology, Tel Aviv University, Tel Aviv, Israel aff007;  Liverpool School of Tropical Medicine, Liverpool, United Kingdom aff008;  CHICAS, Lancaster University Medical School, Lancaster, United Kingdom aff009
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0223021

Souhrn

Background

Health outcomes and causality are usually assessed with individual level sociodemographic variables. Studies that consider only individual-level variables can suffer from residual confounding. This can result in individual variables that are unrelated to risk behaving as proxies for uncaptured information. There is a scarcity of literature on risk factors for snakebite. In this study, we evaluate the individual-level risk factors of snakebite in Sri Lanka and highlight the impact of spatial confounding on determining the individual-level risk effects.

Methods

Data was obtained from the National Snakebite Survey of Sri Lanka. This was an Island-wide community-based survey. The survey sampled 165,665 individuals from all 25 districts of the country. We used generalized linear models to identify individual-level factors that contribute to an individual’s risk of experiencing a snakebite event. We fitted separate models to assess risk factors with and without considering spatial variation in snakebite incidence in the country.

Results

Both spatially adjusted and non-adjusted models revealed that middle-aged people, males, field workers and individuals with low level of education have high risk of snakebites. The model without spatial adjustment showed an interaction between ethnicity and income levels. When the model included a spatial adjustment for the overall snakebite incidence, this interaction disappeared and income level appeared as an independent risk factor. Both models showed similar effect sizes for gender and age. HEmployment and education showed lower effect sizes in the spatially adjusted model.

Conclusions

Both individual-level characteristics and local snakebite incidence are important to determine snakebite risk at a given location. Individual level variables could act as proxies for underling residual spatial variation when environmental information is not considered. This can lead to misinterpretation of risk factors and biased estimates of effect sizes. Both individual-level and environmental variables are important in assessing causality in epidemiological studies.

Klíčová slova:

Employment – Snakes – Ethnicities – Medical risk factors – Snakebite – Ethnic epidemiology – Sri Lanka – Sinhalese people


Zdroje

1. Smith GD, Hart C, Watt G, Hole D, Hawthorne V. Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley Study. J Epidemiol Community Health. 1998;52: 399–405. doi: 10.1136/jech.52.6.399 9764262

2. Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics. 2006;117: 417–24. doi: 10.1542/peds.2005-0058 16452361

3. Wang J, Li X, Christakos G, Liao Y, Zhang T, Gu X, et al. Geographical Detectors‐Based Health Risk Assessment and its Application in the Neural Tube Defects Study of the Heshun Region, China. Int J Geogr Inf Sci. 2010;24: 107–127. doi: 10.1080/13658810802443457

4. Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: A critical review. J Epidemiol Community Health. 2001;55: 111–122. doi: 10.1136/jech.55.2.111 11154250

5. Ecob R, Jones K. Mortality variations in England and Wales between types of place: An analysis of the ONS longitudinal Study. Soc Sci Med. 1998;47: 2055–2066. doi: 10.1016/s0277-9536(98)00310-4 10075246

6. O’Campo P, Xue X, Wang MC, Caughy M. Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis. Am J Public Health. 1997;87: 1113–1118. doi: 10.2105/ajph.87.7.1113 9240099

7. Ediriweera DS, Kasturiratne A, Pathmeswaran A, Gunawardena NK, Wijayawickrama BA, Jayamanne SF, et al. Mapping the Risk of Snakebite in Sri Lanka—A National Survey with Geospatial Analysis. PLoS Negl Trop Dis. 2016;10. doi: 10.1371/journal.pntd.0004813 27391023

8. Ediriweera DS, Diggle PJ, Kasturiratne A, Pathmeswaran A, Gunawardena NK, Jayamanne SF, et al. Evaluating temporal patterns of snakebite in Sri Lanka: The potential for higher snakebite burdens with climate change. Int J Epidemiol. 2018;47: 2049–2058. doi: 10.1093/ije/dyy188 30215727

9. Jayawardana S, Gnanathasan A, Arambepola C, Chang T. Chronic Musculoskeletal Disabilities following Snake Envenoming in Sri Lanka: A Population-Based Study. PLoS Negl Trop Dis. 2016;10. doi: 10.1371/journal.pntd.0005103 27814368

10. Ediriweera DS, Kasturiratne A, Pathmeswaran A, Gunawardena NK, Jayamanne SF, Lalloo DG, et al. Health seeking behavior following snakebites in Sri Lanka: Results of an island wide community based survey. PLoS Negl Trop Dis. 2017;11: e0006073. doi: 10.1371/journal.pntd.0006073 29108023

11. Seneviratne U, Dissanayake S. Neurological manifestations of snake bite in Sri Lanka. J Postgrad Med. 2002;48: 275–8; discussion 278–9. 12571382

12. Kularatne SAM. Epidemiology and clinical picture of the russell’s viper (daboia russelii russelii) bite in anuradhapura, sri lanka: A prospective study of 336 patients. Southeast Asian J Trop Med Public Health. 2003;34: 855–862. doi: 10.1016/j.trstmh.2011.07.010 15115100

13. Ariaratnam CA, Sheriff MHR, Theakston RDG, Warrell DA. Distinctive epidemiologic and clinical features of common krait (Bungarus caeruleus) bites in Sri Lanka. Am J Trop Med Hyg. 2008;79: 458–462. doi: 79/3/458 [pii] 18784244

14. Sharma SK, Chappuis F, Jha N, Bovier PA, Loutan L, Koirala S. Impact of snake bites and determinants of fatal outcomes in Southeastern Nepal. Am J Trop Med Hyg. 2004;71: 234–238. doi: 10.4269/ajtmh.2004.71.234 15306717

15. Sinha A, Bhattacharya S, Ram R, Dasgupta U, Ram A, Majumder D. Epidemiological profile of snake bite in South 24 Parganas district of West Bengal with focus on underreporting of snake bite deaths. Indian J Public Health. 2014;58: 17. doi: 10.4103/0019-557X.128158 24748352

16. Hati AK, Mandal M, De MK, Mukherjee H, Hati RN. Epidemiology of snake bite in the district of Burdwan, West Bengal. J Indian Med Assoc. 1992;90: 145–147. 1522302

17. Rahman R, Faiz MA, Selim S, Rahman B, Basher A, Jones A, et al. Annual incidence of snake bite in rural Bangladesh. PLoS Negl Trop Dis. 2010;4. doi: 10.1371/journal.pntd.0000860 21049056

18. Kasturiratne A, Wickremasinghe AR, De Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al. The global burden of snakebite: A literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Medicine. 2008. pp. 1591–1604. doi: 10.1371/journal.pmed.0050218 18986210

19. Caiaffa WT, Antunes CM, de Oliveira HR, Diniz CR. Epidemiological and clinical aspects of snakebite in Belo Horizonte, southeast Brazil. Rev Inst Med Trop Sao Paulo. 1997;39: 113–118. doi: 10.1590/s0036-46651997000200009 9394525

20. Morandi N, Williams J. Snakebite injuries: Contributing factors and intentionality of exposure. Wilderness Environ Med. 1997;8: 152–155. doi: 10.1580/1080-6032(1997)008[0152:SICFAI]2.3.CO;2 11990155

21. R Core Team. R: A language and environment for statistical computing. R Found Stat Comput Vienna, Austria. 2017; doi: 10.1017/CBO9781107415324.004

22. Giorgi E, Diggle P. PrevMap: an R package for prevalence mapping. J Stat Softwar. 2017;10.

23. Diggle PJ, Ribeiro PJ. Model-based Geostatistics. Springer; 2007. doi: 10.1111/1467-9876.00113

24. Clayton DG, Bernardinelli L, Montomoli C. Spatial Correlation in Ecological Analysis. Int J Epidemiol. 1993;22: 1193–1202. doi: 10.1093/ije/22.6.1193 8144305

25. Ross R, Savada A. Sri Lanka: A country study. Washington, DC: GPO for the Library of Congress; 1988.

26. Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, et al. Snakebite mortality in India: A nationally representative mortality survey. PLoS Negl Trop Dis. 2011;5. doi: 10.1371/journal.pntd.0001018 21532748

27. Department of Census and Statistics. Sri Lanka Labour Force Statistics [Internet]. 2016. Available: http://www.statistics.gov.lk/

28. Kularatne AM, Silva A, Maduwage K, Ratnayake I, Walathara C, Ratnayake C, et al. Victims’ response to snakebite and socio-epidemiological factors of 1018 snakebites in a tertiary care hospital in Sri Lanka. Wilderness Environ Med. 2014;25: 35–40. doi: 10.1016/j.wem.2013.10.009 24412659

29. Kularatne SAM, Silva A, Weerakoon K, Maduwage K, Walathara C, Paranagama R, et al. Revisiting Russell’s Viper (Daboia russelii) bite in Sri Lanka: Is abdominal pain an early feature of systemic envenoming? PLoS One. 2014;9. doi: 10.1371/journal.pone.0090198 24587278

30. Harrison RA, Hargreaves A, Wagstaff SC, Faragher B, Lalloo DG. Snake envenoming: A disease of poverty. PLoS Negl Trop Dis. 2009;3. doi: 10.1371/journal.pntd.0000569 20027216

31. Wang F, Luo W. Assessing spatial and nonspatial factors for healthcare access: Towards an integrated approach to defining health professional shortage areas. Health and Place. 2005. pp. 131–146. doi: 10.1016/j.healthplace.2004.02.003 15629681


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