MEASURES OF DISEASE FREQUENCY - EXERCISES

1. In a mass screening of 1,000 65-year old men, 100 were found to

have a certain disease. During the following 10-year period another
200 contracted this disease. Which measure (s) of disease frequency
can be calculated? Calculate this/these.

Answer: P = 100 / 1,000 = 0.10

CI（ Cumulative Incidence）
= 200/（ 1000-100） = 0.22 over a 10-year period

2. Among those admitted to a psychiatric treatment center there

were carriers of hepatitis B in some wards but not in others. To
investigate the extent to which this affected the occurrence of hepatitis
B among personnel, employees of the treatment center were examined
with regard to the presence of serological markers. Of 67 people
working on the wards with carriers, 14 had markers for hepatitis B. Of
72 people working on the other wards, 4 had these markers. Which
measure of occurrence of markers can be calculated? Calculate this for
each of the two personnel groups.
Answer: P1 = 14 / 67 = 0.21
P0 = 4 / 72 = 0.06

3. To enable early discovery and treatment of cervical cancer,

1
regular gynaecological check-ups were carried out on women aged
30-59 years. Follow-up of women who were found not to have the
disease at the initial examination covered 338,294 person-years at risk
and resulted in the identification of 123 new cases of carcinoma in
situ. Which measure of occurrence can be calculated? Calculate this.
Answer: I = 123 / 338,294 = 0.000363 per person-years
= 36.3 / 105 person-years

4. In a mass screening of 5,000 women, 25 of these were found to

have breast cancer. During the next five years 10 more of the
examined women developed breast cancer. Which measures of disease
occurrence can be calculated? Calculate these.
Answer: P = 25 / 5,000 = 0.005
CI（ Cumulative Incidence）
= 10/（ 5000-25） = 0.002 over a 5-year period

5. During a 5-year period, 270 cases of duodenal ulcer occurred in

the male population of a city. The number of men in the city was
18,500 at the beginning of the period and 21,500 at the end. Which
measure of disease occurrence can be calculated? Calculate this.
Answer: Number of cases = 270
Average population size = （ 18,500 + 21,500） / 2 = 20,000
Observation period = 5 years
2
 Total risk period = 20,000 x 5 = 100,000 person-years
I = 270 / 100,000 = 0.0027 per person-years
6. The figure below displays the follow-up experience of members
of a small study cohort between 1 January 1994 to 30 June 1999 from
entry (>) to follow-up until death (DC if due to disease C, DO for
other causes) or censoring (o). For those subjects contracting disease
C the time of diagnosis is also marked (• = onset of C).

• = disease onset o= censoring or withdrawal

DC = death from disease C DO = death from other cause

Calculate the values of the following measures:

(a) incidence rate of disease C during the period from 1 Jan 1994 to
31 Dec 1998,
3
Answer: sum of individual person-times (years) since entry until exit
(onset of disease orcensoring):
2.5 + 3.5 + 1.5 + 3.0 + 4.5 + 0.5 + 1.0 + 2.5 + 2.5 + 2.5 + 1.5 + 1.5 =
27 years
Number of cases = 5
incidence rate of C: 5/27 y = 18.5 per 100 y.
(b) mortality rate from disease C during the same period,
Answer: Follow-up continued after onset of C for the 5 affected
subjects; thus the total person-years will be:
27 + 2 + 1.5 + 1 + 0.5 + 0.5 = 32.5 years
Number of cases = 1
mortality rate of C: 1/32.5 y = 3.1 per 100 y.
(c) mortality rate from all causes during the same period,
Answer: Person-years same as in (b), and no. of cases = 4.
Hence, mortality rate from all causes = 4/32.5 y =12.3 per 100 y.
(d) mortality rate during the same period from all causes after the
onset of C among those have contracted C,
Answer: Person-years = 2 + 1.5 + 1 + 0.5 + 0.5 = 5.5 years,
contributed by only those affected.
Cases were 2,
mortality rate = 2/5.5 y = 36.4 per 100 y,
(e) prevalence of C on 30 September 1996, and on 31 December
1998
4
Answer: Prevalence of C on 30 September 1996 was 1/7 = 14 %
and Prevalence of C on 31 December 1998 was 3/5 = 60 %.

7. In the table below are given the size (in 1000s) of the male
population in Finland aged 0-14 years (the age range of ”childhood”
in pediatrics!) on the 31 December in each year from 1991 to 2000.

The following numbers of cases describe the incidence and

mortality of acute leukaemia in this population for two calendar
periods: 5 years 1993 to 1997 (source: NORDCAN), and year 1999
only (source: Finnish Cancer Registry http://www.cancerregistry.fi/).

(a) Calculate the incidence rates of acute leukaemia in this

population for the two periods.
(b) Calculate similarly the mortality rates of leukaemia.

1993-97 1999
person-years (in 1/2 × (4.95+4.91)×5=24.65 1/2 × (4.85 + 4.81) × 1 = 4.83
100000s)
(a): incidence rate 113/24.65 = 4.6 26/4.83 = 5.4
(per 105 y)
(b): mortality rate 22/24.65 = 0.9 3/4.83 = 0.6
(per 105 y)
5
( c) Is there evidence about any change in the incidence and/or
mortality between these two periods?
Answer: There are too few cases for any conclusions.
(d) What would you conclude about the fatality of leukemia in
children?
Answer: It appears that most children survive, but this is not the
correct way of calculating survival or fatality measures!

8. The Alpha Tocopherol Beta Caroten (ATBC) Prevention Trial (N

Engl J Med 1994; 330:1029-35) addressed among other things the
possible benefits of daily intake of vitamin E supplements in reducing
the incidence of cancer among male smokers. The study population of
29133 regularly smoking 50-69 years old Finnish men were
randomized into two groups: active treatment (vitamin E
supplementation), and placebo (no supplementation). The following
results were obtained for cancer of the prostate after an average
follow-up time of 6 years:

(a) Calculate the person-years at risk in the two study groups

6
separately.
Answer: Person-years in the two groups:
99÷(11.6/10000 )y= 85345 y,
151÷(17.8/10000) y= 84831 y
(b) Estimate the“relative risk” and “excess risk” measuring the
effect of daily supplementation with vitamin E on the risk prostate
cancer.
Answer: “Relative risk”:
– incidence rate ratio = 11.6/17.8 = 0.652,
”Excess risk”:
– rate difference = 11.6 − 17.8 = −6.2 per 10000 y,
(c) Estimate preventive fraction, whichever more appropriate, to
describe the proportional impact of vitamin E supplementation.
Answer: Preventive fraction:
– from rates: (17.8 − 11.6)/17.8 = 0.348 = 35%,