Interrupted time series regression for the evaluation of public health interventions: a tutorial

被引:2214
作者
Bernal, James Lopez [1 ]
Cummins, Steven [1 ]
Gasparrini, Antonio [1 ]
机构
[1] London Sch Hyg & Trop Med, Dept Social & Environm Hlth Res, 15-17 Tavistock Pl, London WC1H 9SH, England
基金
英国医学研究理事会;
关键词
INJURIES; PROGRAM; DESIGN; LONDON; IMPACT;
D O I
10.1093/ije/dyw098
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Interrupted time series (ITS) analysis is a valuable study design for evaluating the effectiveness of population-level health interventions that have been implemented at a clearly defined point in time. It is increasingly being used to evaluate the effectiveness of interventions ranging from clinical therapy to national public health legislation. Whereas the design shares many properties of regression-based approaches in other epidemiological studies, there are a range of unique features of time series data that require additional methodological considerations. In this tutorial we use a worked example to demonstrate a robust approach to ITS analysis using segmented regression. We begin by describing the design and considering when ITS is an appropriate design choice. We then discuss the essential, yet often omitted, step of proposing the impact model a priori. Subsequently, we demonstrate the approach to statistical analysis including the main segmented regression model. Finally we describe the main methodological issues associated with ITS analysis: over-dispersion of time series data, autocorrelation, adjusting for seasonal trends and controlling for time-varying confounders, and we also outline some of the more complex design adaptations that can be used to strengthen the basic ITS design.
引用
收藏
页码:348 / 355
页数:8
相关论文
共 27 条
[1]  
[Anonymous], 1954, Cowles Commission Discussion Paper No. 383
[2]  
[Anonymous], SMOKING DRINKING ADU
[3]   Effects of Italian Smoking Regulation on Rates of Hospital Admission for Acute Coronary Events: A Country-Wide Study [J].
Barone-Adesi, Francesco ;
Gasparrini, Antonio ;
Vizzini, Loredana ;
Merletti, Franco ;
Richiardi, Lorenzo .
PLOS ONE, 2011, 6 (03)
[4]   The effect of the late 2000s financial crisis on suicides in Spain: an interrupted time-series analysis [J].
Bernal, James A. Lopez ;
Gasparrini, Antonio ;
Artundo, Carlos M. ;
McKee, Martin .
EUROPEAN JOURNAL OF PUBLIC HEALTH, 2013, 23 (05) :732-736
[5]   Time series regression studies in environmental epidemiology [J].
Bhaskaran, Krishnan ;
Gasparrini, Antonio ;
Hajat, Shakoor ;
Smeeth, Liam ;
Armstrong, Ben .
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 2013, 42 (04) :1187-1195
[6]   The value of interrupted time-series experiments for community intervention research [J].
Biglan A. ;
Ary D. ;
Wagenaar A.C. .
Prevention Science, 2000, 1 (1) :31-49
[7]   Alternatives to randomisation in the evaluation of public health interventions: design challenges and solutions [J].
Bonell, C. P. ;
Hargreaves, J. ;
Cousens, S. ;
Ross, D. ;
Hayes, R. ;
Petticrew, M. ;
Kirkwood, B. R. .
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 2011, 65 (07) :582-587
[8]   Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption [J].
Callinan, Joanne E. ;
Clarke, Anna ;
Doherty, Kirsten ;
Kelleher, Cecily .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2010, (04)
[9]  
Campbell DT., 1963, EXPT QUASIEXPERIMENT
[10]   Framework for design and evaluation of complex interventions to improve health [J].
Campbell, M ;
Fitzpatrick, R ;
Haines, A ;
Kinmonth, AL ;
Sandercock, P ;
Spiegelhalter, D ;
Tyrer, P .
BRITISH MEDICAL JOURNAL, 2000, 321 (7262) :694-696