{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T21:57:24Z","timestamp":1747173444666,"version":"3.40.5"},"reference-count":23,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"unspecified","delay-in-days":73,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2023]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Syndromic surveillance was originally developed to provide early warning compared to laboratory surveillance, but it is increasing used for real-time situational awareness. When a potential threat to public health is identified, a rapid assessment of its impact is required for public health management. When threats are localised, analysis is more complex as local trends need to be separated from national trends and differences compared to unaffected areas may be due to confounding factors such as deprivation or age distributions. Accounting for confounding factors usually requires an in-depth study, which takes time. Therefore, a tool is required which can provide a rapid estimate of local incidents using syndromic surveillance data.<\/jats:p><jats:p>Here, we present \u2018DiD IT?\u2019, a new investigation tool designed to measure the impact of local threats to public health. \u2018DiD IT?\u2019 uses a difference-in-differences statistical approach to account for temporal and spatial confounding and provide a direct estimate of impact due to incidents. Temporal confounding differences are estimated by comparing unaffected locations during and outside of exposure periods. Whilst spatial confounding differences are estimated by comparing unaffected and exposed locations outside of the exposure period. Any remaining differences can be considered to be the direct effect of the local incident.<\/jats:p><jats:p>We illustrate the potential utility of the tool through four examples of localised health protection incidents in England. The examples cover a range of data sources including general practitioner (GP) consultations, emergency department (ED) attendances and a telehealth call and online health symptom checker; and different types of incidents including, infectious disease outbreak, mass-gathering, extreme weather and an industrial fire. The examples use the UK Health Security Agency's ongoing real-time syndromic surveillance systems to show how results can be obtained in near real-time.<\/jats:p><jats:p>The tool identified 700 additional online difficulty breathing assessments associated with a severe thunderstorm, 53 additional GP consultations during a mumps outbreak, 2\u20133 telehealth line calls following an industrial fire and that there was no significant increase in ED attendances during the G7 summit in 2021.<\/jats:p><jats:p>DiD IT? can provide estimates for the direct impact of localised events in real-time as part of a syndromic surveillance system. Thus, it has the potential for enhancing surveillance and can be used to evaluate the effectiveness of extending national surveillance to a more granular local surveillance.<\/jats:p>","DOI":"10.1017\/s0950268823000444","type":"journal-article","created":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T06:01:50Z","timestamp":1678860110000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":4,"title":["DiD IT?: a differences-in-differences investigation tool to quantify the impact of local incidents on public health using real-time syndromic surveillance health data"],"prefix":"10.1017","volume":"151","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8543-477X","authenticated-orcid":false,"given":"Roger","family":"Morbey","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Todkill","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniella","family":"DeAngelis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andre","family":"Charlett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6414-3065","authenticated-orcid":false,"given":"Alex","family":"Elliot","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2023,3,15]]},"reference":[{"doi-asserted-by":"publisher","key":"S0950268823000444_ref19","DOI":"10.1017\/CBO9780511802843"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref3","DOI":"10.1017\/S0950268816000480"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref8","DOI":"10.1111\/irv.12594"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref21","DOI":"10.1371\/journal.pone.0010406"},{"key":"S0950268823000444_ref5","first-page":"235","article-title":"Evaluation of syndromic surveillance in the Netherlands: its added value and recommendations for implementation","volume":"16","author":"van den Wijngaard","year":"2011","journal-title":"Euro Surveillance"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref20","DOI":"10.3201\/eid2410.171940"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref10","DOI":"10.1017\/S0950268812001781"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref2","DOI":"10.1177\/0033354917708995"},{"key":"S0950268823000444_ref9","first-page":"184","article-title":"Developing and validating a new national remote health advice syndromic surveillance system in England","volume":"39","author":"Harcourt","year":"2016","journal-title":"Journal of Public Health"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref23","DOI":"10.1136\/bmj.326.7388.532"},{"key":"S0950268823000444_ref14","first-page":"3660","article-title":"The application of a novel \u2018rising activity, multi-level mixed effects, indicator emphasis\u2019 (RAMMIE) method for syndromic surveillance in England","volume":"31","author":"Morbey","year":"2015","journal-title":"Bioinformatics (Oxford, England)"},{"unstructured":"16. England, PH (2022) Mumps outbreak across England. Available at https:\/\/www.gov.uk\/government\/news\/mumps-outbreaks-across-england?msclkid=d4b6ca16bb2c11ec944e3021a8cb60b4 (Accessed 13\/04\/2022).","key":"S0950268823000444_ref16"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref4","DOI":"10.1017\/S0950268813001088"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref22","DOI":"10.1017\/S0950268805004802"},{"key":"S0950268823000444_ref15","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1080\/07350015.1995.10524589","article-title":"Natural and quasi-experiments in economics","volume":"13","author":"Meyer","year":"1995","journal-title":"Journal of Business and Economic Statistics"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref7","DOI":"10.1136\/emermed-2018-208323"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref12","DOI":"10.1136\/emermed-2011-200684"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref6","DOI":"10.1097\/PHH.0000000000000679"},{"key":"S0950268823000444_ref13","first-page":"e111","article-title":"Novel public health risk assessment process developed to support syndromic surveillance for the 2012 Olympic and Paralympic Games","volume":"39","author":"Smith","year":"2016","journal-title":"Journal of Public Health"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref11","DOI":"10.3390\/ijerph19073876"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref17","DOI":"10.3390\/ijerph182312353"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref18","DOI":"10.1111\/resp.13410"},{"doi-asserted-by":"publisher","key":"S0950268823000444_ref1","DOI":"10.1017\/S0950268819000074"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268823000444","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T11:35:14Z","timestamp":1729078514000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268823000444\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023]]},"references-count":23,"alternative-id":["S0950268823000444"],"URL":"https:\/\/doi.org\/10.1017\/s0950268823000444","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"type":"print","value":"0950-2688"},{"type":"electronic","value":"1469-4409"}],"subject":[],"published":{"date-parts":[[2023]]},"assertion":[{"value":"Copyright \u00a9 The Author(s), 2023. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e56"}}