epi

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  1. Epidemiology:
    • study of distribution and determinants of health related states or events in specific populations and the application of this study to control health problems
    • • Goal, essentially, is to limit undesirable health events in a community
  2. Epidemic:
    an unexpectedly large number of cases of an illness, specific health-related behavior, or other health related event in a particular population at a particular time and place
  3. Endemic disease:
    disease that occurs regularly in a population
  4. Epidemiologist
    : studies disease occurrence in defined populations
  5. Pandemic: outbreak of a disease over a wide geographical area, such as a continent
    • Example: avian influenza, which the books list as being the next possible agent to reach pandemic proportions.
  6. History of Epidemiology: 300 B.C., late 1600’s, 1849:
    • : Hippocrates suggests link between disease and environment
    • •Regression until late 1600’s; return to spiritual-causation belief
    • •1849: John Snow studies epidemiology of cholera and extinguishes London outbreak, thereby limiting death and preserving health
  7. •Natality:
    births / total population
  8. •Morbidity:
    number of sick / total population at risk
  9. •Mortality:
    • number deaths / total population at risk
    • Based on population risk: those who are susceptible to a disease in a given population
  10. Incidence rate:
    number of new health related cases of a disease / total number in population at risk
  11. The Importance of Rates Prime importance:
    • •Number of events
    • •Number of cases: the number of people who are sick
    • •Number of deaths
  12. •Acute disease:
    lasts less than 3 months
  13. •Chronic disease:
    lasts longer than 3 months
  14. •Attack rate:
    • incidence rate calculated for a specific population for a single disease outbreak expressed as a percentage
    • oEx: number of people on a flight become sick, and it is suspected that the flight caused the illness. Attack rate could be calculated for the passengers to express who became ill.
  15. •Prevalence rates:
    • all current cases / total population
    • oUseful for chronic diseases: know how many are suffering
  16. •Crude rate:
    denominator includes total population
  17. oCrude birthrate:
    • # births in a year / mid year population
    • +: easy to obtain, good for comparing populations
    • -: misleading if populations differ in age/attributes
  18. •Age-adjusted rate:
    rate used to make comparisons between groups over time when groups differ in age structures
  19. •Specific rates:
    measures morbidity or mortality for particular populations or diseases
  20. Cause specific mortality rate (CSMR):
    • death rate due to a particular disease
    • Number of deaths by disease / total population
  21. Case fatality rate (CFR):
    • percentage of cases of a disease that result in death
    • # deaths in specified time / number of cases in same period
  22. Proportionate mortality ratio (PMR):
    • percentage of overall mortality in a population that is attributable to particular cause
    • # deaths due to specific disease / total number of deaths from all causes in same population in the same period of time
  23. notifiable diseases problems
    • • sometimes only 35% of cases with diseases are reported
    • • clinics may be too busy to report every case
    • • patients can recover before treatment and may not seek care
    • • reporting depends on disease severity
  24. most reliable indicator of a population health’s status
    mortality statistics
  25. • Age adjusted rates show ...
    • what death would be if no changes occurred in the age makeup of a population
    • o they are a better indicator for examining changes in risk of death over a period of time
  26. -Life expectancy:
    • average number of years a person from a specific cohort is projected to live from a given point of time
    • • has generally increased in America
  27. -Years of potential life lost (YPLL):
    • subtracting a person’s age at death from a predefined, standard age
    • •age 75 often used as the standard
    • operson dies at 59. 75-59 = 16 years
    • vary depending on cause
    • Accidents, cancer kill younger so higher YPLL
  28. -Disability adjusted Life years:
    • measure for the burden of disease that takes into account premature death and loss of healthy life resulting from disability
    • •mortality does not express burden of disease
    • Ex: polio causes loss of healthy life but not reflected in death tables
  29. Health-adjusted life expectancy (HALE):
    sometimes referred to has healthy life expectancy, number of years of healthy life expected, on average, in a given population
  30. -US Census: taken every 10 years; enumeration of the population living in the US
    • •data: income, employment, family size, education, dwelling type, and many other social indicators
    • •used for calculating disease and death rates for program planning
  31. Vital statistics:
    • statistical summaries of vital records; records major life events
    • •births, deaths, marriages, divorces
    • birth: maternal and prenatal care, delivery
    • deaths: rates, expectancy, leading causes, infant mortality
  32. Morbidity and Mortality Weekly Report
    -reported diseases are shown weekly
  33. -National Health Surveys:
    • •health interviews of people
    • •clinical tests
    • •survey of places where care is received
  34. -NHANES: National health and nutrition examination survey
    • •health/nutritional of the general US Population
    • •based on PE, clinical and lab tests, and related procedures
    • o most authoritative source of clinical info on American people
  35. -Behavioral Risk Factor Surveillance System:
    state-based telephone survey to ascertain prevalence of high risk behavior, like smoking or drinking
  36. -Youth Risk Behavior Survey (YRBS): six categories of risks in youth
    • •behaviors that contribute to unintentional violence and injuries
    • •tobacco use
    • •alcohol and drug use
    • •STIS and pregnancy
    • •HIV
    • •Unhealthy dietary habits and physical inactivity
  37. -National Health Care Survey (NHCS):
    nine different national surveys that gather info on nation’s healthcare system
  38. -Descriptive studies:
    • describes disease with respect to person, place, and time (the extent, essentially)
    • First studies carried out on diseases!! Valuable info on detection patterns.
    • Who: head count, as well as age, sex, race, marital status, etc.
    • When: categorized by time of occurrence
    • Summarized by year, for example
  39. Common source epidemic curve:
    graphic display of disease where each case can be traced to a single source of exposure Used to calculate incubation period
  40. incubation period:
    time between exposure and onset of symptoms
  41. Point source:
    exposure occurs at a single point in time
  42. Continuous source:
    • exposure is intermittent
    • Need to discover these to prevent future exposure
  43. Propagated man parts: epidemic curve depicting distribution of cases traceable to multiple sources of exposure
    • Primary cases appear at one end, secondary cases after primary, and tertiary further along the graph
    • Where: residential addresses, travel history are recorded
    • Restaurants, shopping, etc.
    • •Limitations of descriptive studies: not applicable to outbreaks elsewhere and cannot provide info on disease trends.
  44. -Analytic studies:
    test hypotheses about relationships between health problems and possible risk factors
  45. • Risk factors
    • • increase probability of disease
    • o Ex. Does smoking increase risk of lung cancer?
    • • Two different types of analytic studies exist:
  46. Observational studies:
    • investigates natural course of disease
    • Observational studies can be divided into:
  47. Cross sectional:
    info about exposure and disease are collected at the same time
  48. Case/control:
    • seeks to compare diagnosed with a disease and those who are not for prior exposure to specific risks
    • • Familial, behavioral links
    • • Don’t prove causation alone, but indicate future direction of question
  49. o Cohort studies:
    • cohort is classified by exposure to one or more risk factors and observed to determine the rates at which the disease develops in each class
    • Can be prospective (observing a group to see if cigarette smoking leads to disease) or retrospectively (exposure and outcome has already happened)
  50. o Case controls cannot calculate the
    o rate of development of a disease, as the patients already have it
  51. Odds ratio:
    probability about association between risk factors and developing a disease
  52. Cohort studies can
    calculate incidence rate
  53. Relative risk:
    statement of relationship between risk factor and disease (more definitive)
  54. Cohort disadvantages:
    expensive, not practical for rare cases, and take many years to complete
  55. Experimental studies:
    • carried out to identify cause of a disease or determine effectiveness of an intervention
    • Use of control and experimental groups, placebo, etc.
  56. Randomization:
    assigning subjects to treatments in a non-organized manner
  57. Blinding:
    subject remain uninformed and unaware of groups

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