Comparing Multiple Imputation Methods to Address Missing Patient Demographics in Immunization Information Systems: Retrospective Cohort Study
Notice bibliographique
Résumé
Background: Immunization Information Systems (IIS) and surveillance data are essential for public health interventions and programming; however, missing data are often a challenge, potentially introducing bias and impacting the accuracy of vaccine coverage assessments, particularly in addressing disparities. Objective: This study aimed to evaluate the performance of 3 multiple imputation methods, Stata's (StataCorp LLC) multiple imputation using chained equations (MICE), scikit-learn's Iterative-Imputer, and Python's miceforest package, in managing missing race and ethnicity data in large-scale surveillance datasets. We compared these methodologies in their ability to preserve demographic distribution, computational efficiency, and performed G-tests on contingency tables to obtain likelihood ratio statistics to assess the association between race and ethnicity and flu vaccination status. Methods: In this retrospective cohort study, we analyzed 2021-2022 flu vaccination and demographic data from the West Virginia Immunization Information System (N=2,302,036), where race (15%) and ethnicity (34%) were missing. MICE, Iterative Imputer, and miceforest were used to impute missing variables, generating 15 datasets each. Computational efficiency, demographic distribution preservation, and spatial clustering patterns were assessed using G-statistics. Results: After imputation, an additional 780,339 observations were obtained compared with complete case analysis. All imputation methods exhibited significant spatial clustering for race imputation (G-statistics: MICE=26,452.7, Iterative-Imputer=128,280.3, Miceforest=26,891.5; P<.001), while ethnicity imputation showed variable clustering patterns (G-statistics: MICE=1142.2, Iterative-Imputer=1.7, Miceforest=2185.0; P: MICE<.001, Iterative-Imputer=1.7, Miceforest<.001). MICE and miceforest best preserved the proportional distribution of demographics. Computational efficiency varied, with MICE requiring 14 hours, Iterative Imputer 2 minutes, and miceforest 10 minutes for 15 imputations. Postimputation estimates indicated a 0.87%-18% reduction in stratified flu vaccination coverage rates. Overall estimated flu vaccination rates decreased from 26% to 19% after imputations. Conclusions: Both MICE and Miceforest offer flexible and reliable approaches for imputing missing demographic data while mitigating bias compared with Iterative-Imputer. Our results also highlight that the imputation method can profoundly affect research findings. Though MICE and Miceforest had better effect sizes and reliability, MICE was much more computationally and time-expensive, limiting its use in large, surveillance datasets. Miceforest can use cloud-based computing, which further enhances efficiency by offloading resource-intensive tasks, enabling parallel execution, and minimizing processing delays. The significant decrease in vaccination coverage estimates validates how incomplete or missing data can eclipse real disparities. Our findings support regular application of imputation methods in immunization surveillance to improve health equity evaluations and shape targeted public health interventions and programming.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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