Models for surveillance data under reporting delay: applications to US veteran first-time suicide attempters

Surveillance data provide a vital source of information for assessing the spread of a health problem or disease of interest and for planning for future health-care needs. However, the use of surveillance data requires proper adjustments of the reported caseload due to underreporting caused by reporting delays within a limited observation period. Although methods are available to address this classic statistical problem, they are largely focused on inference for the reporting delay distribution, with inference about caseload of disease incidence based on estimates for the delay distribution. This approach limits the complexity of models for disease incidence to provide reliable estimates and projections of incidence. Also, many of the available methods lack robustness since they require parametric distribution assumptions. We propose a new approach to overcome such limitations by allowing for separate models for the incidence and the reporting delay in a distribution-free fashion, but with joint inference for both modeling components, based on functional response models. In addition, we discuss inference about projections of future disease incidence to help identify significant shifts in temporal trends modeled based on the observed data. This latter issue on detecting 'change points' is not sufficiently addressed in the literature, despite the fact that such warning signs of potential outbreak are critically important for prevention purposes. We illustrate the approach with both simulated and real data, with the latter involving data for suicide attempts from the Veteran Healthcare Administration.