Beyond case fatality rate: using potential impact fraction to estimate the effect of increasing treatment uptake on mortality
Bibliographic record
Abstract
BACKGROUND: IMPACT is an epidemiological model that has been used to estimate how increased treatment uptakes affect mortality and related outcomes. The model calculations require the use of case fatality rate estimates under no treatment. Due to the lack of data, rates where treatment is partially present are often used instead, introducing bias. A method that does not rely on no-treatment case fatality rate estimates is needed. METHODS: Potential Impact Fraction (PIF) measures the proportional reduction in the disease or mortality risk, when the distribution of a risk factor changes. Here, we first describe a probabilistic framework for interpreting quantities used in the IMPACT model, and then we show how this is connected with PIF, facilitating its use for the estimation of the relative reduction of mortality caused by treatment uptake increase. We compare the proposed and standard methods to estimate the reduction of cardiovascular disease deaths in Ontario, if utilization of coronary heart disease interventions was increased to the level of 90%. RESULTS: Using the proposed method, we estimated that increasing treatment to benchmark levels uptake results in a reduction of 22.5% in cardiovascular mortality. The standard method gives a reduction of 20.8%. CONCLUSIONS: Here we present an alternative method for the estimation of the effect of treatment uptake change on mortality. Our example suggests that the bias associated with the standard method may be substantial. This approach offers a useful tool for epidemiological and health care research and policy.
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Methods About the Canadian research system: no · About a Canadian topic: no | Theoretical or conceptual | high |
| gpt | no category Domain: not available · Genre: Methods About the Canadian research system: no · About a Canadian topic: no | Simulation or modeling | low |
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.043 | 0.160 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
The models disagree on parts of this classification; every voice is preserved in the section at the end of the page.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".