Comparison of surveillance-based metrics for the assessment and monitoring of disease detection: simulation study about type 2 diabetes

Ralph Brinks, Annika Hoyer, Deborah B. Rolka, Oliver Kuss, Edward W. Gregg

Screening and detection of cases are a common public health priority for treatable chronic conditions with long subclinical periods. However, the validity of commonly-used metrics from surveillance systems for rates of detection (or case-finding) have not been evaluated. Using data from a Danish diabetes register and a recently developed illness-death model of chronic diseases with subclinical conditions, we simulate two scenarios of different performance of case-finding. We report different epidemiological indices to assess case-finding in both scenarios and compare the validity of the results. The commonly used ratio of detected cases over total cases may lead to misleading conclusions. Instead, the ratio of undetected cases over persons without a diagnosis is a more valid index to distinguish the quality of case-finding. However, incidence-based measures are preferable to prevalence based indicators. Prevalence-based indices for assessing case-finding should be interpreted with caution. If possible, incidence-based indices should be preferred.