Project description:Unlike most daily decisions, medical decision making often has substantial consequences and trade-offs. Recently, big data analytics techniques such as statistical analysis, data mining, machine learning and deep learning can be applied to construct innovative decision models. With complex decision making, it can be difficult to comprehend and compare the benefits and risks of all available options to make a decision. For these reasons, this Special Issue focuses on the use of big data analytics and forms of public health decision making based on the decision model, spanning from theory to practice. A total of 64 submissions were carefully blind peer reviewed by at least two referees and, finally, 23 papers were selected for this Special Issue.
Project description:New data sources and AI methods for extracting information are increasingly abundant and relevant to decision-making across societal applications. A notable example is street view imagery, available in over 100 countries, and purported to inform built environment interventions (e.g., adding sidewalks) for community health outcomes. However, biases can arise when decision-making does not account for data robustness or relies on spurious correlations. To investigate this risk, we analyzed 2.02 million Google Street View (GSV) images alongside health, demographic, and socioeconomic data from New York City. Findings demonstrate robustness challenges; built environment characteristics inferred from GSV labels at the intracity level often do not align with ground truth. Moreover, as average individual-level behavior of physical inactivity significantly mediates the impact of built environment features by census tract, intervention on features measured by GSV would be misestimated without proper model specification and consideration of this mediation mechanism. Using a causal framework accounting for these mediators, we determined that intervening by improving 10% of samples in the two lowest tertiles of physical inactivity would lead to a 4.17 (95% CI 3.84-4.55) or 17.2 (95% CI 14.4-21.3) times greater decrease in the prevalence of obesity or diabetes, respectively, compared to the same proportional intervention on the number of crosswalks by census tract. This study highlights critical issues of robustness and model specification in using emergent data sources, showing the data may not measure what is intended, and ignoring mediators can result in biased intervention effect estimates.
Project description:Ideally, public health policies are formulated from scientific data; however, policy-specific data are often unavailable. Big data can generate ecologically-valid, high-quality scientific evidence, and therefore has the potential to change how public health policies are formulated. Here, we discuss the use of big data for developing evidence-based hearing health policies, using data collected and analyzed with a research prototype of a data repository known as EVOTION (EVidence-based management of hearing impairments: public health pOlicy-making based on fusing big data analytics and simulaTION), to illustrate our points. Data in the repository consist of audiometric clinical data, prospective real-world data collected from hearing aids and an app, and responses to questionnaires collected for research purposes. To date, we have used the platform and a synthetic dataset to model the estimated risk of noise-induced hearing loss and have shown novel evidence of ways in which external factors influence hearing aid usage patterns. We contend that this research prototype data repository illustrates the value of using big data for policy-making by providing high-quality evidence that could be used to formulate and evaluate the impact of hearing health care policies.
Project description:Often times terms such as Big Data, increasing digital footprints in the Internet accompanied with advancing analytical techniques, represent a major opportunity to improve public health surveillance and delivery of interventions. However, early adaption of Big Data in other fields revealed ethical challenges that could undermine privacy and autonomy of individuals and cause stigmatization. This chapter aims to identify the benefits and risks associated with the public health application of Big Data through ethical lenses. In doing so, it highlights the need for ethical discussion and framework towards an effective utilization of technologies. We then discuss key strategies to mitigate potentially harmful aspects of Big Data to facilitate its safe and effective implementation.
Project description:The United States Department of Health and Human Services (HHS) pledged $90 million to help reduce health disparities with data-driven solutions. The funds are being distributed to 1400 community health centers, serving over 30 million Americans. Given these developments, our piece examines the reasons behind the delayed adoption of big data for healthcare equity, recent efforts embracing big data tools, and methods to maximize potential without overburdening physicians. We additionally propose a public database for anonymized patient data, introducing diverse metrics and equitable data collection strategies, providing valuable insights for policymakers and health systems to better serve communities.
Project description:The digital revolution has contributed to very large data sets (ie, big data) relevant for public health. The two major data sources are electronic health records from traditional health systems and patient-generated data. As the two data sources have complementary strengths-high veracity in the data from traditional sources and high velocity and variety in patient-generated data-they can be combined to build more-robust public health systems. However, they also have unique challenges. Patient-generated data in particular are often completely unstructured and highly context dependent, posing essentially a machine-learning challenge. Some recent examples from infectious disease surveillance and adverse drug event monitoring demonstrate that the technical challenges can be solved. Despite these advances, the problem of verification remains, and unless traditional and digital epidemiologic approaches are combined, these data sources will be constrained by their intrinsic limits.
Project description:The last decade has seen significant advances in the accumulation of medical data, the computational techniques to analyze that data, and corresponding improvements in management. Interventions such as thrombolytics and mechanical thrombectomy improve patient outcomes after stroke in selected patients; however, significant gaps remain in our ability to select patients, predict complications, and understand outcomes. Big data and the computational methods needed to analyze it can address these gaps. For example, automated analysis of neuroimaging to estimate the volume of brain tissue that is ischemic and salvageable can help triage patients for acute interventions. Data-intensive computational techniques can perform complex risk calculations that are too cumbersome to be completed by humans, resulting in more accurate and timely prediction of which patients require increased vigilance for adverse events such as treatment complications. To handle the accumulation of complex medical data, a variety of advanced computational techniques referred to as machine learning and artificial intelligence now routinely complement traditional statistical inference. In this narrative review, we explore data-intensive techniques in stroke research, how it has informed the management of stroke patients, and how current work could shape clinical practice in the future.
Project description:IntroductionBig data technologies have been talked up in the fields of science and medicine. The V-criteria (volume, variety, velocity and veracity, etc) for defining big data have been well-known and even quoted in most research articles; however, big data research into public health is often misrepresented due to certain common misconceptions. Such misrepresentations and misconceptions would mislead study designs, research findings and healthcare decision-making. This study aims to identify the V-eligibility of big data studies and their technologies applied to environmental health and health services research that explicitly claim to be big data studies.Methods and analysisOur protocol follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Scoping review and/or systematic review will be conducted. The results will be reported using PRISMA for Scoping Reviews (PRISMA-ScR), or PRISMA 2020 and Synthesis Without Meta-analysis guideline. Web of Science, PubMed, Medline and ProQuest Central will be searched for the articles from the database inception to 2021. Two reviewers will independently select eligible studies and extract specified data. The numeric data will be analysed with R statistical software. The text data will be analysed with NVivo wherever applicable.Ethics and disseminationThis study will review the literature of big data research related to both environmental health and health services. Ethics approval is not required as all data are publicly available and involves confidential personal data. We will disseminate our findings in a peer-reviewed journal.Prospero registration numberCRD42021202306.
Project description:Background: Big data and real-world data (RWD) have been increasingly used to measure the effectiveness and costs in cost-effectiveness analysis (CEA). However, the characteristics and methodologies of CEA based on big data and RWD remain unknown. The objectives of this study were to review the characteristics and methodologies of the CEA studies based on big data and RWD and to compare the characteristics and methodologies between the CEA studies with or without decision-analytic models. Methods: The literature search was conducted in Medline (Pubmed), Embase, Web of Science, and Cochrane Library (as of June 2020). Full CEA studies with an incremental analysis that used big data and RWD for both effectiveness and costs written in English were included. There were no restrictions regarding publication date. Results: 70 studies on CEA using RWD (37 with decision-analytic models and 33 without) were included. The majority of the studies were published between 2011 and 2020, and the number of CEA based on RWD has been increasing over the years. Few CEA studies used big data. Pharmacological interventions were the most frequently studied intervention, and they were more frequently evaluated by the studies without decision-analytic models, while those with the model focused on treatment regimen. Compared to CEA studies using decision-analytic models, both effectiveness and costs of those using the model were more likely to be obtained from literature review. All the studies using decision-analytic models included sensitivity analyses, while four studies no using the model neither used sensitivity analysis nor controlled for confounders. Conclusion: The review shows that RWD has been increasingly applied in conducting the cost-effectiveness analysis. However, few CEA studies are based on big data. In future CEA studies using big data and RWD, it is encouraged to control confounders and to discount in long-term research when decision-analytic models are not used.
Project description:Public health policies can dramatically shape government responses to emerging public health crises. In cases where a response is inadequate, it's natural to seek improvements to these policies to achieve better results in future crises. However, while policies and outcomes are usually visible, the complex dynamics that link them are seldom obvious. Obscure social network structures, power and information asymmetries, and political agendas all influence the translation of policy to action or inaction. Intergovernmental communications are often the only primary sources for researchers investigating these hidden but crucial factors. Public records laws in many countries make such documents available upon request, but their structure, format, and scale are rarely accessible in practice. Fortunately, recent advances in free and open-source data science tools are making this problem tractable. In this visual brief, we demonstrate using such tools to mine a large image dataset and reconstruct decision-making during the Flint Water Crisis in Michigan, USA.