PONE-D-23-15168Concurrent Disease Burden from Multiple Infectious Diseases and the Influence of Social Determinants in the Contiguous United StatesPLOS ONE

Dear Dr. Sloan-Aagard,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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ACADEMIC EDITOR: 

The manuscript addresses an important issue and has merit. However, authors must carefully attend to the concerns raised by the reviewers. This involves addressing various aspects:

• Ensuring language and terminology are clear in the entire text, tables, and figures.
• Expanding on the study's justification and objectives for better understanding.
• Providing necessary clarifications on study design, datasets, definitions, and analyses.
• Enhancing graph color contrast for better visual clarity.
• Elaborating further on study conclusions and their implications.

By addressing these points, the authors can substantially enhance the manuscript's clarity, validity, and impact.

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Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Abstract:

Please write numbers less than 10 in letters (in the whole of the text)

Introduction:

Please replace "vaccination rates" with vaccination coverage.

Please justify the necessity of this study and write the aim of the study, in the last paragraph of the introduction.

Methods:

What is your study design?

What are the existing data sets? Do you mean the surveillance system?

Please refer to the source of data. In addition, please provide the definition of TB, HIV, COVID-19, and influenza in the US surveillance system.

Please provide the definition of a cluster for TB, HIV, COVID-19, and Influenza.

How to determine the expected cases?

What is the definition of high-risk and low-risk areas and clusters?

Please define the dependent variable. How to measure the dependent variable?

What are the covariates, and how to measure them?

How to assess the socioeconomic status of counties?

Results

In the first paragraph of the results, describe your data. For example, number of counties and incidence of the mentioned diseases in each county, and percent of the population below the poverty line in each county.

The authors declared "The percent of the county population at or below 125% of the US poverty level in counties identified as part of clusters ranged from 7.65% to 44.8%" 125% is correct?

Reviewer #2: Comments of Reviewer

This study aims to assess concurrent disease burden from multiple infectious diseases and the influence of social determinants in the contiguous United States. They applied the Kulldorff scan statistic to examine the relative risk of each disease by year depending on available data on COVID-19, HIV, influenza, and tuberculosis by county in the United States from 2019-2022. The unadjusted analysis showed higher numbers of clusters of TB, HIV, and influenza in urban areas, the south, and along the coastline, while COVID-19 clusters appeared separate. Upon adjusting for poverty, much more localized and rural clusters more in the interior of the country for HIV, TB and COVID-19. In my opinion, the obtained results can be used to inform policy makers and the public health. However, there are some issues that need to be addressed.

Major

1- I have concerns about the structure of this manuscript. The introduction and method of this manuscript is written very briefly. This manuscript does not have a conclusion section; it seems that it is better to add conclusion to the manuscript.

Abstract

Introduction

1- The introduction section is written very briefly, it is better to explain more about a brief statement of the overall aim of the work and a comment about whether that aim was achieved in the last paragraph. Moreover, please define the problem addressed and why it is important.

Method

1- Please clarify that you used the radius of the population coverage or the geographical radius? Why?

2- Please clarify that the discrete Poisson probability model or Poisson model was used because the incidence for some disease like TB and HIV were not very high

3- Please explain more about the most likely cluster area, and other clusters.

4- Please explain more about the selection of the maximum radius of the spatial

scanning window and the maximum length of the temporal scanning window. Why did you consider the maximal spatial cluster 10% of the population at risk?

5- Please clarify that you used monthly or annual incidences.

6- Please explain more about circular window.

7- Please clarify that did your study have an ethical approval and ethical code?

Results

1- Please move the first paragraph of the results in to the method section.

2- Please change the colors in the Graphs, the colors are not recognizable.

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Comments.docx

Concurrent Disease Burden from Multiple Infectious Diseases and the Influence of Social Determinants in the Contiguous United States

PONE-D-23-15168R1

Dear Dr. Chantel Sloan-Aagard,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Sana Eybpoosh

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

Reviewer #3: I Don't Know

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: (No Response)

Reviewer #3: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

Reviewer #3: Yes: Amin Doosti-Irani

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