Development of a prognostic model based on demographic, environmental and lifestyle information for predicting incidences of symptomatic respiratory or gastrointestinal infection in adult office workers

Tapani Hovi, Jukka Ollgren, Jaason Haapakoski, Carita Savolainen-Kopra, Tapani Hovi, Jukka Ollgren, Jaason Haapakoski, Carita Savolainen-Kopra

Abstract

Background: Occurrence of respiratory tract infection (RTI) or gastrointestinal tract infection (GTI) is known to vary between individuals and may be a confounding factor in the analysis of the results of intervention trials. We aimed at developing a prognostic model for predicting individual incidences of RTI and GTI on the basis of data collected in a hand-hygiene intervention trial among adult office workers, and comprising a prior-to-onset questionnaire on potential infection-risk factors and weekly electronic follow-up reports on occurrence of symptoms of, and on exposures to RTI or GTI.

Methods: A mixed-effect negative binomial regression model was used to calculate a predictor-specific incidence rate ratio for each questionnaire variable and for each of the four endpoints, and predicted individual incidences for symptoms of and exposures to RTI and GTI. In the fitting test these were then compared with the observed incidences.

Results: Out of 1270 eligible employees of six enterprises, 683 volunteered to participate in the trial. Ninety-two additional participants were recruited during the follow-up. Out of the 775 registered participants, 717 returned the questionnaire with data on potential predictor variables and follow-up reports for determination of outcomes. Age and gender were the strongest predictors of both exposure to, and symptoms of RTI or GTI, although no gender difference was seen in the RTI incidence. In addition, regular use of public transport, and history of seasonal influenza vaccination increased the risk of RTI. The individual incidence values predicted by the model showed moderate correlation with those observed in each of the four categories. According to the Cox-Snell multivariate formula the model explained 11.2% of RTI and 3.3% of GTI incidences. Resampling revealed mean and 90% confidence interval values of 10.9 (CI 6.9-14.5)% for RTI and 2.4 (0.6-4.4)% for GTI.

Conclusion: The model created explained a relatively small proportion of the occurrence of RTI or GTI. Unpredictable exposure to disease agents, and individual susceptibility factors are likely to be key determinants of disease emergence. Yet, the model might be useful in prerandomization stratification of study population in RTI intervention trials where the expected difference between trial arms is relatively small.

Trial registration: Registered at ClinicalTrials.gov with Identifier NCT00821509 on 12 March 2009.

Keywords: Acute gastrointestinal infection; Acute respiratory infection; Age; Chronic disease; Fixed variable; Gender; Prediction model; Public transport; Risk factor.

Figures

Fig. 1
Fig. 1
Flow chart of the current study
Fig. 2
Fig. 2
Age-dependence of the analyzed endpoints. Incidences of reported exposures to persons with obvious respiratory (RTI, a) and gastrointestinal tract infections (GTI, b), and those of weeks with reported own RTI (c) or GTI symptoms (d). Squares and circles stand for individual values of women, and men, respectively. The locally weighed regression (LOESS) functions with 95% confidence intervals were calculated with the R-statistics separately for the two genders
Fig. 3
Fig. 3
Apparent effects of gender, age, and children in the household on reported exposures and infections. The population was divided arbitrarily into three age groups shown by colors: blue, below 30 years; green 31–40 years; ochre, over 40 years. The boxes (limits 25 and 75%) include a horizontal median line if differing from the bottom line. In addition, individual outlier values and numbers of participant in each subgroup are shown. Panels a and b, reported exposures to people with RTI symptoms; c and d, exposures to GTI; e and f, weeks with reported own RTI symptoms; g and h, reported GTI symptoms
Fig. 4
Fig. 4
Correlation of model-predicted relative risk scores with observed incidences of different endpoints. Exposures to respiratory tract infection (RTI) (left upper panel), of reported weeks with RTI symptoms (left lower), of exposures to gastrointestinal tract infection (GTI) (upper right), and of reported weeks with GTI symptoms (lower right). Locally weighted regression is shown by LOESS curves

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