Quantifying the under-reporting of uncorrelated longitudal data: the genital warts example

Abstract

Background Genital warts are a common and highly contagious sexually transmitted disease. They have a large economic burden and affect several aspects of quality of life. Incidence data underestimate the real occurrence of genital warts because this infection is often under-reported, mostly due to their specific characteristics such as the asymptomatic course. Methods Genital warts cases for the analysis were obtained from the Catalan public health system database (SIDIAP) for the period 2009-2016. People under 15 and over 94 years old were excluded from the analysis as the incidence of genital warts in this population is negligible. This work introduces a time series model based on a mixture of two distributions, capable of detecting the presence of under-reporting in the data. In order to identify potential differences in the magnitude of the under-reporting issue depending on sex and age, these covariates were included in the model. Results This work shows that only about 80% in average of genital warts incidence in Catalunya in the period 2009-2016 was registered, although the frequency of under-reporting has been decreasing over the study period. It can also be seen that this issue has a deeper impact on women over 30 years old. Conclusions Although this study shows that the quality of the registered data has improved over the considered period of time, the Catalan public health system is underestimating genital warts real burden in almost 10,000 cases, around 23% of the registered cases. The total annual cost is underestimated in about 10 million Euros respect the 54 million Euros annually devoted to genital warts in Catalunya, representing 0.4% of the total budget.

Epidemiological Trends and Economic Burden of Genital Warts in Dutch Primary Care

“…Second, many cases may be undetected because of shame or an asymptomatic representation of the disease. A recent study in Catalunya (Spain), estimated that approximately one-fifth of GW cases was not registered, especially for women over the age of 30 [45]. Third, costs of secondary care as calculated here are expected to be much higher in actual clinical practice.…”

New statistical model for misreported data with application to current public health challenges

“…As shown in Table 4 , the estimates related to underreporting reveal a lower intensity (although a higher frequency probably related to its periodicity) of the issue compared to the previous example, as could be expected. In fact, is not significantly different to zero, so a simpler model for uncorrelated misreported data like the one proposed in 30 might be enough.…”

Knowing the unknown: The underestimation of monkeypox cases. Insights and implications from an integrative review of the literature

“…More specifically, our comprehensive literature search enabled us to identify the following determinants of the underestimation of STDs: asymptomatic course (Wahdan, 1995;Shahesmaeili et al, 2018;Moriña et al, 2021); atypical clinical and epidemiological features (Ni et al, 2016), including atypical/unusual transmission routes (Allard et al, 2017;Lee and Nishiura, 2017;Timsit et al, 2018); differences in case definition (Schulte et al, 1992;Rompalo et al, 1997), and in regional/national testing rates (Koper et al, 2013;Kustec et al, 2016); underestimation among specific age groups, like the youth and the elderly, and populations, such as minority communities and visible racialized groups (Webster et al, 1993), migrant workers (Fakoya et al, 2015;Steen et al, 2019), sex workers (Agacfidan Brown et al, 2015;Hong et al, 2011;Mirzazadeh et al, 2014;Shahesmaeili et al, 2018), or swingers (Niekamp et al, 2021); use of low-sensitivity and/or low-specificity diagnostic assays (Koutsky et al, 1992;Schulte et al, 1992;Ashley et al, 1993;Petersen et al, 1995;Schachter and Chow, 1995;Schwebke et al, 1996;Paget et al, 2002;Dhawan et al, 2006;Munson et al, 2008;Lusk et al, 2010;Andrea and Chapin, 2011;Gratzer et al, 2014), or inadequate clinical and microbeisolation procedures (Koutsky et al, 1992;Lin et al, 1992); inadequate STD screening policies/protocols (Wahdan, 1995;Lusk et al, 2010;…”