Registry cohort, 2021 to 2025, seven regions

Epidemiology poster

An epidemiology poster has three obligations: print the case definition, reconcile the records flow, and put the denominators where a reader can redo the division. This A0 landscape example does all three for a fictional five year Ross River virus registry study, with incidence by region in one chart and a rate ratio of 2.4 as the key number.

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BU
Coastal regions carry 2.4 times the Ross River virus incidence of inland regions, 2021 to 2025
C. Whitlam ¹, N. Ibrahim ¹, L. Ferraro ²
1 School of Population Health, Barrow University · 2 State Notifiable Diseases Unit
Abstract
A five year retrospective study of the state notifications register, covering 9,412 Ross River virus notifications across seven health regions with a combined population of 4.1 million. After removing duplicates, records without a residential postcode and probable only cases, 8,236 laboratory confirmed cases remained: 42.4 per 100,000 person years overall, 62.8 in the three coastal regions against 26.1 in the four inland ones, an adjusted rate ratio of 2.4 (95% CI 2.3 to 2.5).
REFERENCES
1.Whitlam C, Ibrahim N. Arbovirus notification completeness in state surveillance data. Surveillance Methods Quarterly 2024;17(3):190-205.
2.Ferraro L, Whitlam C. Postcode linkage of notifiable disease records: a validation study. Data Linkage Notes 2023;8(1):55-68.
3.Ibrahim N, Adler Y. Poisson models for regional incidence comparisons. Applied Epidemiology Briefs 2025;12(2):101-114.
Why regional incidence
Ross River virus is the most commonly notified mosquito borne infection in the state, and vector control money is allocated by region, so the operational question is not whether the disease is present but where a dollar of larval control buys the most prevented cases. Statewide incidence figures cannot answer that; they average the salt marsh coast with the dry inland and satisfy nobody. This study breaks five years of notifications into seven regions on one denominator of person years, prints the case definition it counted with, and reconciles every record from notification to analysis so the regional comparison can be trusted before it is acted on.
METHODS
Case definition. Laboratory confirmed notification (IgM and IgG, or PCR) with onset in the study period and residence in one of the seven regions.
Data. State notifications register, 2021 to 2025, linked to residential postcode and assigned to health region.
Population. Mid year regional estimates summed over the five years: 20.5 million person years total, 19.42 million after exclusions.
Exclusions. 1,176 records: 402 duplicate notifications, 318 with no residential postcode and 456 probable only cases; all in the flow.
Analysis. Incidence per 100,000 person years by region; Poisson regression for the coastal against inland rate ratio, adjusted for age band and year.
RECORDS FLOW
Notifications received
n = 9,412
Excluded
n = 1,176
Confirmed cases
n = 8,236
Coastal regions (3)
n = 5,420
Inland regions (4)
n = 2,816
Analysed
n = 8,236
Incidence per 100,000
N Coast
S Coast
W Plains
Far West
020406080
Figure 1. Incidence per 100,000 person years by region, 2021 to 2025. The three coastal regions hold the three highest rates.
Source: Trial dataset, 2026.
Results
Coastal incidence was 62.8 per 100,000 person years (5,420 cases over 8.63 million person years) against 26.1 inland (2,816 over 10.79 million), a crude ratio of 2.41 and an adjusted rate ratio of 2.4 (95% CI 2.3 to 2.5) after age band and year. Overall incidence was 42.4 per 100,000 person years, 8,236 cases over 19.42 million person years, and every one of those denominators is printed in Methods so the division can be redone at the stand. The regional gradient is steep and consistent. Northern Coast led every year at 71.3 per 100,000 followed by Central Coast at 58.9 and Southern Coast at 56.2, while no inland region exceeded the Ranges at 31.4. The gap between the lowest coastal and highest inland region, 24.8 per 100,000, is itself larger than the total incidence of the Far West at 19.2. Time and age sharpened rather than changed the picture. 2024 was the peak year with 2,310 cases statewide, following two wet summers, and the peak was proportionally larger on the coast, consistent with salt marsh breeding driving the coastal excess. Incidence was highest at ages 40 to 59 in every region, so the coastal excess is not an artefact of older coastal populations; the adjusted and crude ratios agreeing to one decimal makes the same point statistically. Notification counts by year and region, with their person year denominators and the age band model estimates, are available in full through the QR link on this board.
2.4
rate ratio, coastal against inland regions
95% CI 2.3 to 2.5; 8,236 cases over 19.42 million person years
Discussion
Three limits shape what this board can claim. Notification depends on a doctor ordering serology, and testing is easier to reach in coastal towns, so some of the coastal excess is likely ascertainment; the size of the true difference is less certain than its direction. Residence is not exposure: postcode places a case at home, and a Far West resident infected on a coastal holiday counts inland, which biases the ratio toward one and means the true coastal excess is unlikely to be smaller than reported. Five years including two wet summers is long enough to smooth single season noise but not climate cycles, and the 2024 peak shows how strongly rainfall drives this virus. None of these limits touches the ranking of regions, which is what the vector control budget needs; all three touch the precision of the 2.4, which is why the interval is printed beside it wherever it appears on this board. What the board deliberately does not carry is a map. The seven regions are named in the chart and ordered by rate instead, which makes the ranking legible from further away than a choropleth would, and the full regional boundaries sit behind the QR code with the data. The case definition also earns its block: admitting probable only cases would have raised every rate while blurring the comparison, since probable diagnoses cluster where testing is scarce, which is inland.
CONCLUSION
Confirmed Ross River virus incidence is 2.4 times higher in coastal regions. Vector control effort should follow the three coastal regions first, where the same budget prevents more than twice the cases it would inland.
8,236 confirmed cases, 42.4 per 100,000 person years
Coastal 62.8, inland 26.1 per 100,000
Rate ratio 2.4 (95% CI 2.3 to 2.5)
Target vector control at the three coastal regions

Block by block

What each block on the board is for, in the order a reader walks it.

Left panel: title, authors, abstract, references
This layout stacks the title, authors, abstract and reference list in a left panel, so the identity of the study occupies one column and the evidence fills the rest. The abstract already carries the headline arithmetic: 8,236 cases, 42.4 per 100,000 person years, ratio 2.4.
Introduction
The introduction states the operational question, where a dollar of larval control buys the most prevented cases, and why statewide averages cannot answer it. Framing the study around the budget decision is what separates an applied epidemiology board from a surveillance summary.
Methods: the case definition
The first protocol entry is the case definition, laboratory confirmed by IgM and IgG or PCR, onset in period, residence in region, followed by the data source, the denominators, the exclusions and the Poisson model adjusted for age band and year. The definition is printed, not assumed.
Records flow
The six node flow reconciles exactly: 9,412 notifications minus 1,176 excluded gives 8,236 confirmed, splitting into 5,420 coastal and 2,816 inland, with 8,236 analysed. The exclusions are itemised in the methods entry, 402 duplicates, 318 without postcode, 456 probable only, and every arrow survives a calculator.
Incidence by region (Figure 1)
Seven bars, one per region, ordered by rate from Northern Coast at 71.3 down to Far West at 19.2 per 100,000 person years. The three coastal regions hold the top three positions, which makes the geographic claim visible before the model result is read.
Results and the rate ratio
The results block prints the denominators beside the rates, 5,420 cases over 8.63 million person years for 62.8, and gives crude and adjusted ratios together, 2.41 and 2.4. The stat block carries the 2.4 with its interval of 2.3 to 2.5 and the full case count underneath.
Discussion
Three limits, each with its direction: testing access likely inflates the coastal excess, holiday exposure counted at home residence shrinks it, and five years cannot smooth climate cycles. The board also explains why it carries no map: seven named bars rank regions more legibly than a choropleth.
Conclusion points
Four bullet lines a health department can act on: the case count and overall rate, the coastal and inland rates, the ratio with its interval, and the recommendation to target the three coastal regions. The three references are invented for this fictional study, because the reference block is required on this layout; replace them with your sources.
How to adapt this board
Write your case definition first and make it the first protocol entry, then build the flow with the aside node kept to a label and one count, the reasons itemised in methods, and the counts reconciling. Order the region bars by rate rather than alphabetically, and print person years wherever a rate appears so the division can be redone.

What makes this board work

The flow reconciles

9,412 minus 1,176 is 8,236, and the coastal and inland nodes, 5,420 plus 2,816, sum back to it. A records flow that survives a calculator is what makes a registry study believable at a stand.

Person years are printed

The denominators, 8.63 and 10.79 million person years, sit in methods and results, so the 62.8 and 26.1 per 100,000 can be recomputed by any reader rather than taken on trust.

The definition is a block

Laboratory confirmation and residence rules are stated before any number appears, and the discussion shows the choice mattered: admitting probable cases would have blurred the coastal inland comparison.

Questions people ask

What goes on an epidemiology poster?

The case definition, the data source, a records flow that reconciles, the denominators, the incidence estimates, the ratio with its interval and the limits with their directions. This board gives each its own block, and the one thing it leaves off, a map, it replaces with rate ordered bars.

Is a STROBE flow the same as a CONSORT flow?

On this product they use the same six node flow block; only the labels differ. A trial flows people through randomisation, a registry study flows records through exclusions. This board relabels the block as a records flow, with one aside node carrying the 1,176 exclusions, itemised by reason in methods.

Where do person years go?

In the methods protocol as a labelled entry and again beside every rate they support. This board prints 19.42 million person years with the overall rate and the coastal and inland denominators in results, so all three incidence figures can be recomputed from the board alone.

How do I show seven regions in one chart?

One vertical bar per region, ordered by rate, not by geography or alphabet. Ordering by value turns the chart into a ranking, which is the decision relevant view; this board puts the three coastal regions visibly at the top, and the caption says so in one sentence.

Should I adjust for age, and say so?

Adjust for the confounders your data supports and state them in methods; this board names age band and year in its analysis entry. Printing crude and adjusted ratios together, 2.41 and 2.4 here, shows the adjustment did not manufacture the result, which reviewers read as strength.

Can I put a map on the board?

No poster layout has a fillable map slot, and this board argues you rarely need one: seven named bars ordered by rate rank the regions more legibly at a metre than colour shading would. The boundary files and a proper map live behind the QR code with the full data.

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Sources

Written and checked by the OneCraft team. Last checked .