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Epidemiologic Methods

Edited by faculty of the Harvard School of Public Health

Ed. by Tchetgen Tchetgen, Eric J / VanderWeele, Tyler J. / Daniel, Rhian

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Use of Individual-level Covariates to Improve Latent Class Analysis of Trypanosoma cruzi Diagnostic Tests

Aaron W. Tustin / Dylan S. Small / Stephen Delgado / Ricardo Castillo Neyra / Manuela R. Verastegui / Jenny M. Ancca Juárez / Víctor R. Quispe Machaca / Robert H. Gilman / Caryn Bern / Michael Z. Levy
Published Online: 2012-08-29 | DOI: https://doi.org/10.1515/2161-962X.1005


Statistical methods such as latent class analysis can estimate the sensitivity and specificity of diagnostic tests when no perfect reference test exists. Traditional latent class methods assume a constant disease prevalence in one or more tested populations. When the risk of disease varies in a known way, these models fail to take advantage of additional information that can be obtained by measuring risk factors at the level of the individual. We show that by incorporating complex field-based epidemiologic data, in which the disease prevalence varies as a continuous function of individual-level covariates, our model produces more accurate sensitivity and specificity estimates than previous methods. We apply this technique to several simulated populations and to actual Chagas disease test data from a community near Arequipa, Peru. Results from our model estimate that the first-line enzyme-linked immunosorbent assay has a sensitivity of 78% (95% CI: 62-100%) and a specificity of 100% (95% CI: 99-100%). The confirmatory immunofluorescence assay is estimated to be 73% sensitive (95% CI: 65-81%) and 99% specific (95% CI: 96-100%).

This article offers supplementary material which is provided at the end of the article.

Keywords: Chagas disease; latent class analysis; Trypanosoma cruzi

About the article

Published Online: 2012-08-29

Citation Information: Epidemiologic Methods, Volume 1, Issue 1, Pages 33–54, ISSN (Online) 2161-962X, DOI: https://doi.org/10.1515/2161-962X.1005.

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©2012 Walter de Gruyter GmbH & Co. KG, Berlin/Boston.Get Permission

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