Comparison of cluster detection using patients and events of medically treated self-inflicted injuries in Alberta, Canada

Rosychuk, Rhonda J.; Colman, Ian; Rowe, Brian H.

doi:10.1007/s10742-009-0048-0

Cited by 4 publications

(2 citation statements)

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“…The population sizes of these areas with similar cases are then compared. More recently, Rosychuk et al [ 9 ] have provided a similar method for events rather than cases by using a compound Poisson distribution and compared the two approaches [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

An exact test to detect geographic aggregations of events

Rosychuk

Stuber

2010

International Journal of Health Geographics

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BackgroundTraditional approaches to statistical disease cluster detection focus on the identification of geographic areas with high numbers of incident or prevalent cases of disease. Events related to disease may be more appropriate for analysis than disease cases in some contexts. Multiple events related to disease may be possible for each disease case and the repeated nature of events needs to be incorporated in cluster detection tests.ResultsWe provide a new approach for the detection of aggregations of events by testing individual administrative areas that may be combined with their nearest neighbours. This approach is based on the exact probabilities for the numbers of events in a tested geographic area. The test is analogous to the cluster detection test given by Besag and Newell and does not require the distributional assumptions of a similar test proposed by Rosychuk et al. Our method incorporates diverse population sizes and population distributions that can differ by important strata. Monte Carlo simulations help assess the overall number of clusters identified. The population and events for each area as well as a nearest neighbour spatial relationship are required. We also provide an alternative test applicable to situations when only the aggregate number of events, and not the number of events per individual, are known. The methodology is illustrated on administrative data of presentations to emergency departments.ConclusionsWe provide a new method for the detection of aggregations of events that does not rely on distributional assumptions and performs well.

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Section: Introductionmentioning

confidence: 99%

An exact test to detect geographic aggregations of events

Rosychuk

Stuber

2010

International Journal of Health Geographics

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“…A few studies have focused on mental health conditions such as depression 23 and self-inflicted injury. [24][25][26][27][28] To our knowledge, we are the first to examine geographic clustering of adolescents aged 10 to 17 years who presented to EDs for mood disorders.…”

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confidence: 99%

Space and time clustering of adolescents’ emergency department use and post-visit physician care for mood disorders in Alberta, Canada: A population-based 9-year retrospective study

Rosychuk¹,

Newton²,

Niu³

et al. 2014

CJPH

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OBJECTIVES:We used a statistical cluster detection technique to identify geographic areas with higher numbers of adolescents who 1) presented to an emergency department (ED) for a mood disorder, and 2) were without a physician follow-up visit for mental health within 30 days of an ED visit. METHODS:We conducted a population-based analysis of ED visits (n = 6,829) made by adolescents aged 10-17 years (n = 5,877) using administrative databases from Alberta, Canada (2002-2011. Statistical analyses included summaries, directly standardized rates (DSRs per 100,000), and the spatial scan cluster test.RESULTS: Sex-and age-adjusted DSRs increased by 21.8% from 2002 to 2011 (160.2/100,000 to 195.1/100,000). Northern Alberta had consistently higher DSRs than other areas of the province and areas in the north, southwest and central parts were identified as geographical and temporal clusters with relative risks of 1.67, 2.78 and 1.42 respectively. Many of these areas also had higher relative risks for adolescents who did not have a mental health-related visit with a physician within 30 days of the ED visit. About 32% (n = 1,870) did not have a post-ED physician visit. CONCLUSION:The potential clusters identified may represent geographic areas with higher disease severity or more acute care sought because of less availability of other services. The clusters are not all likely to have occurred by chance and further investigations and discussions with local health care policy-makers about reducing the number of ED visits for mood disorders and increasing physician follow-up after the ED visit is an important next step.KEY WORDS: Adolescence; cluster analysis; space-time clustering; disease clustering; emergency services; mood disorders La traduction du résumé se trouve à la fin de l'article.

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Does emergency department use and post-visit physician care cluster geographically and temporally for adolescents who self-harm? A population-based 9-year retrospective cohort study from Alberta, Canada

et al. 2016

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BackgroundClustering of adolescent self-harming behaviours in the context of health care utilization has not been studied. We identified geographic areas with higher numbers of adolescents who (1) presented to an emergency department (ED) for self-harm, and (2) were without a physician follow-up visit for mental health within 14 days post-ED visit.MethodsWe extracted a population-based cohort of adolescents aged 15–17 years (n = 3,927) with ED visits during 2002–2011 in Alberta, Canada. We defined the case as an individual with one or more ED presentations for self-harm in the fiscal year of the analysis. Crude case rates were calculated and clusters were identified using a spatial scan.ResultsThe rates decreased over time for ED visits for self-harm (differences: girls −199.6/100,000; p < 0.01; boys −58.8/100,000; p < 0.01), and for adolescents without a follow-up visit within 14 days following an ED visit for self-harm (differences: girls −108.3/100,000; p < 0.01; boys −61.9/100,000; p < 0.01). Two space-time clusters were identified: (1) a North zone cluster during 2002–2006 (p < 0.01) and (2) a South zone cluster during 2003–2007 (p < 0.01). These clusters had higher numbers of adolescents who presented to the ED for self-harm (relative risks [RRs]: 1.58 for cluster 1, 3.54 for cluster 2) and were without a 14-day physician follow-up (RRs: 1.78 for cluster 1, 4.17 for cluster 2). In 2010/2011, clusters in the North, Edmonton, and Central zones were identified for adolescents with and without a follow-up visit within 14 days following an ED visit for self-harm (p < 0.01).ConclusionsThe rates for ED visits for adolescents who self-harm and rates of adolescents without a 14-day physician follow-up visit following emergency care for self-harm decreased during the study period. The space-time clusters identified the areas and years where visits to the ED by adolescents for self-harm were statistically higher than expected. These clusters can be used to identify locations where adolescents are potentially not receiving follow-up and the mental health support needed after emergency-based care. The 2010/2011 geographic cluster suggests that the northern part of the province still has elevated numbers of adolescents visiting the ED for self-harm. Prospective research is needed to determine outcomes associated with adolescents who receive physician follow-up following ED-based care for self-harm compared to those who do not.

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Comparison of cluster detection using patients and events of medically treated self-inflicted injuries in Alberta, Canada

Cited by 4 publications

References 37 publications

An exact test to detect geographic aggregations of events

An exact test to detect geographic aggregations of events

Space and time clustering of adolescents’ emergency department use and post-visit physician care for mood disorders in Alberta, Canada: A population-based 9-year retrospective study

Does emergency department use and post-visit physician care cluster geographically and temporally for adolescents who self-harm? A population-based 9-year retrospective cohort study from Alberta, Canada

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