Lauren Eyler1, Alan Hubbard2, Catherine Juillard3. 1. University of California, San Francisco, Center for Global Surgical Studies, San Francisco General Hospital, Box 0807, San Francisco, CA 94143-0807, USA. Electronic address: lauren.eyler@ucsf.edu. 2. University of California, Berkeley, School of Public Health, Division of Biostatistics, 50 University Hall #7360, Berkeley, CA 94720-7360, USA. Electronic address: hubbard@berkeley.edu. 3. University of California, San Francisco, Center for Global Surgical Studies, San Francisco General Hospital, Box 0807, San Francisco, CA 94143-0807, USA. Electronic address: catherine.juillard@ucsf.edu.
Abstract
OBJECTIVES: Low and middle-income countries (LMICs) and the world's poor bear a disproportionate share of the global burden of injury. Data regarding disparities in injury are vital to inform injury prevention and trauma systems strengthening interventions targeted towards vulnerable populations, but are limited in LMICs. We aim to facilitate injury disparities research by generating a standardized methodology for assessing economic status in resource-limited country trauma registries where complex metrics such as income, expenditures, and wealth index are infeasible to assess. METHODS: To address this need, we developed a cluster analysis-based algorithm for generating simple population-specific metrics of economic status using nationally representative Demographic and Health Surveys (DHS) household assets data. For a limited number of variables, g, our algorithm performs weighted k-medoids clustering of the population using all combinations of g asset variables and selects the combination of variables and number of clusters that maximize average silhouette width (ASW). RESULTS: In simulated datasets containing both randomly distributed variables and "true" population clusters defined by correlated categorical variables, the algorithm selected the correct variable combination and appropriate cluster numbers unless variable correlation was very weak. When used with 2011 Cameroonian DHS data, our algorithm identified twenty economic clusters with ASW 0.80, indicating well-defined population clusters. CONCLUSIONS: This economic model for assessing health disparities will be used in the new Cameroonian six-hospital centralized trauma registry. By describing our standardized methodology and algorithm for generating economic clustering models, we aim to facilitate measurement of health disparities in other trauma registries in resource-limited countries.
OBJECTIVES: Low and middle-income countries (LMICs) and the world's poor bear a disproportionate share of the global burden of injury. Data regarding disparities in injury are vital to inform injury prevention and trauma systems strengthening interventions targeted towards vulnerable populations, but are limited in LMICs. We aim to facilitate injury disparities research by generating a standardized methodology for assessing economic status in resource-limited country trauma registries where complex metrics such as income, expenditures, and wealth index are infeasible to assess. METHODS: To address this need, we developed a cluster analysis-based algorithm for generating simple population-specific metrics of economic status using nationally representative Demographic and Health Surveys (DHS) household assets data. For a limited number of variables, g, our algorithm performs weighted k-medoids clustering of the population using all combinations of g asset variables and selects the combination of variables and number of clusters that maximize average silhouette width (ASW). RESULTS: In simulated datasets containing both randomly distributed variables and "true" population clusters defined by correlated categorical variables, the algorithm selected the correct variable combination and appropriate cluster numbers unless variable correlation was very weak. When used with 2011 Cameroonian DHS data, our algorithm identified twenty economic clusters with ASW 0.80, indicating well-defined population clusters. CONCLUSIONS: This economic model for assessing health disparities will be used in the new Cameroonian six-hospital centralized trauma registry. By describing our standardized methodology and algorithm for generating economic clustering models, we aim to facilitate measurement of health disparities in other trauma registries in resource-limited countries.
Authors: S Ariane Christie; Drusia Dickson; Susana N Mbeboh; Frida N Embolo; William Chendjou; Emerson Wepngong; Ahmed N Fonje; Eunice Oben; Kareen Azemfac; Alain Chichom Mefire; Theophile Nana; M Agbor Mbianyor; Patrick Stern; Rochelle Dicker; Catherine Juillard Journal: JAMA Netw Open Date: 2020-05-01
Authors: Kevin J Blair; Michael de Virgilio; Fanny Nadia Dissak-Delon; Lauren Eyler Dang; S Ariane Christie; Melissa Carvalho; Rasheedat Oke; Mbiarikai Agbor Mbianyor; Alan E Hubbard; Alain Mballa Etoundi; Thompson Kinge; Richard L Njock; Daniel N Nkusu; Jean-Gustave Tsiagadigui; Rochelle A Dicker; Alain Chichom-Mefire; Catherine Juillard Journal: BMJ Glob Health Date: 2022-01
Authors: E Wepngong; S A Christie; R Oke; G Motwani; W Chendjou; K Azemafac; F M A Nour; D Dickson; R Dicker; C Juillard; A Chichom-Mefire Journal: Afr J Thorac Crit Care Med Date: 2021-10-04