International Journal of Epidemiology 2001;30:1351-1359
© International Epidemiological Association 2001
Theory and Methods |
Estimation of the incidence of stroke using a capture-recapture model including covariates
a Department of Public Health Sciences, King's College London, Capital House, 42 Weston Street, London SE1 3QD, UK.
b Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK.
Dr Kate Tilling, Department of Public Health Sciences, 5th Floor, Capital House, 42 Weston Street, London SE1 3QD, UK. E-mail: kate.tilling{at}kcl.ac.uk
Abstract
Background Capture-recapture is often used to assess completeness of a register. However, the usual two-source model relies on assumptions of independence of sources and equality of capture probability which are rarely satisfied in epidemiology. An alternative is to include covariates in capture-recapture models.
Methods We use capture-recapture models including covariates to estimate incidence of stroke in South London. We estimate ascertainment-adjusted age-standardized incidence rates, and calculate confidence intervals for incidence which allow for the uncertainty in estimation of the total number of cases.
Results The crude capture-recapture model (including no covariates) underestimated the number of non-fatal strokes. Demographic and stroke severity variables were associated with the probability of capture. Including covariates led to more plausible results for fatal and non-fatal strokes, and suggested that the stroke register was 88% complete. Adjusting for under-ascertainment increased the estimated incidence from 1.31 (95% CI : 1.21–1.42) to 1.49 (95% CI : 0.38–2.60) per 1000 people.
Conclusions Incidence and age-standardized incidence can be calculated using data from an incomplete register. However, sparse strata can lead to wide confidence intervals for adjusted rates. Cost-effectiveness of routine registers might be increased by using the combination of sources and covariates which most accurately estimates the total number of cases, rather than by aiming for 100% completeness.
Keywords Stroke, incidence, registries, epidemiological methods
Accepted 11 April 2001
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