ArticlePloS one2019
Adjusting for spatial variation when assessing individual-level risk: A case-study in the epidemiology of snake-bite in Sri Lanka.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Burden of Mortality and Morbidity Caused by Snakebites Contributes to Economic Loss in a Rural Population in India.Toxins · 2026Article
- Climate change induced complex shifts in snake distributions expose people to snakebite and threaten biodiversity.PLoS neglected tropical diseases · 2026Article
- Effectiveness of an educational program on nurses' knowledge about management therapy for snakebite in the emergency department.Journal of education and health promotion · 2025Article
- Geographically regulated designs of incidence surveys can match the precision of classical survey designs whilst requiring smaller sample sizes: the case of snakebite envenoming in Sri Lanka.BMJ global health · 2022Article
- Article
- Epidemiological study of snakebite cases in Sikkim: Risk modeling with regard to the habitat suitability of common venomous snakes.PLoS neglected tropical diseases · 2021Article
- Practical Review of the Management of Animal Bites.Plastic and reconstructive surgery. Global open · 2021Review
- Addressing the global snakebite crisis with geo-spatial analyses - Recent advances and future direction.Toxicon: X · 2021Article
- Integrating lay knowledge and practice into snakebite prevention and care in central Africa, a hotspot for envenomation.Toxicon: X · 2021Article
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10 authors.
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Abstract
backgroundHealth outcomes and causality are usually assessed with individual level sociodemographic variables. Studies that consider only individual-level variables can suffer from residual confounding. This can result in individual variables that are unrelated to risk behaving as proxies for uncaptured information. There is a scarcity of literature on risk factors for snakebite. In this study, we evaluate the individual-level risk factors of snakebite in Sri Lanka and highlight the impact of spatial confounding on determining the individual-level risk effects.
methodsData was obtained from the National Snakebite Survey of Sri Lanka. This was an Island-wide community-based survey. The survey sampled 165,665 individuals from all 25 districts of the country. We used generalized linear models to identify individual-level factors that contribute to an individual's risk of experiencing a snakebite event. We fitted separate models to assess risk factors with and without considering spatial variation in snakebite incidence in the country.
resultsBoth spatially adjusted and non-adjusted models revealed that middle-aged people, males, field workers and individuals with low level of education have high risk of snakebites. The model without spatial adjustment showed an interaction between ethnicity and income levels. When the model included a spatial adjustment for the overall snakebite incidence, this interaction disappeared and income level appeared as an independent risk factor. Both models showed similar effect sizes for gender and age. HEmployment and education showed lower effect sizes in the spatially adjusted model.
conclusionsBoth individual-level characteristics and local snakebite incidence are important to determine snakebite risk at a given location. Individual level variables could act as proxies for underling residual spatial variation when environmental information is not considered. This can lead to misinterpretation of risk factors and biased estimates of effect sizes. Both individual-level and environmental variables are important in assessing causality in epidemiological studies.
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