Documente Academic
Documente Profesional
Documente Cultură
SUBJECT
EPIDEMIOLOGY (MPH 501)
TOPIC
WITH THE USE OF EXAMPLES, DISCUSS HOW MEASURES OF DISEASE
FREQUENCY AND MEASURES OF ASSOCIATION ARE APPLIED IN
EPIDEMIOLOGY ET AL.
NAME
JERRY SELASE SIFA
LECTURER
DR FRANK BAIDEN
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1.0 Introduction
Epidemiology is the study of the distribution and determinants of health-related states or events in
specified populations and the application of this study to control of health problems(CDC, 2012).
Epidemiology studies the frequency of diseases in relation to populations, and their relation to the
population size. It also examines the occurrences of the diseases in relation to time and place. In
other words, epidemiologists provide answers to questions such as who gets a disease, how much
of the disease there is, and what makes the person (population) vulnerable to the disease?
(Macfarlane, n.d.). In assay to address such questions, epidemiologists embark on activities to
measure disease occurrence and measure association of exposure and outcomes of health events.
2.0 Fractions used for describing diseases- Ratio, Proportion and Rate
2.1) Ratio
Ratio is a comparison of two values that are not required to be related. In other words, it is a
fraction which the numerator is not a subset of the denominator. Ratio is used by epidemiologists
as a descriptive and analytical tool(CDC, 2012). As a descriptive tool, ratio is used to describe the
relations items or variable. As analytical tool, it is used to estimate and compare health event
outcomes such as diseases, injuries and deaths across time, person and place. In epidemiology,
ratio manifests in the forms such as risk ratio (relative risk), rate ratio, and odds ratio(CDC,
2012). It is mathematically expressed as:
a
n
b 10
To illustrate: A country has a population size of 27, 000,000 and 100, 000 public toilets. To
determine the public toilet population ratio. I do the following:
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100,000
27,000,000 1000 = 3.7
Interpretation: 3.7 public toilets per 1000 people or 1 public toilet for 270 people
2.2 Proportion
Proportion is a fraction that compares a part to the whole. Put differently, it is the fraction that has
its numerator being part of its denominator. This may be expressed as a decimal, a fraction, or a
percentage. It is very useful to epidemiologists because, it offers them the opportunity to make
comparisons that are not possible with raw numbers. It is also used for descriptive purpose such
as describing the relation of an exposure to health outcome. It is mathematically expressed as:
Number of personsevents with a particular characteristic
n
Total number of personsevents , of which the numerator is a subse 10
Assuming Dr Frank Baiden assigns first year MPH students to find out the proportion of men in
Ghana living with HIV/AIDS. The students went to Ghana AIDS Commission (GAC) and found
that 100,000 men are living with HIV/AIDS. The students went to Ghana Statistical Service and
were informed there are 8, 000,000 men in Ghana. To determine the proportion, they did the
following:
100,000
8,000,000 100= 1.25%
2.3 Rate
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CDC (2012) describes rate as A rate is a measure of the frequency with which an event occurs in
a defined population over a specified period of time. Because rates put disease frequency in the
perspective of the size of the population, rates are particularly useful for comparing disease
frequency in different locations, at different times, or among different groups of persons with
potentially different sized populations; that is, a rate is a measure of risk. A rate has a numerator,
a denominator and a stated time period: for example, 10 suicides per 100,000 persons per year.
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In such as case, an epidemiologist would want to go beyond the mere number of occurrences to
determine the rate of new disease occurrences using the mathematical formula below:
Number of people who got chicken pox
10n
Cumulative Incidence =
12
148
102 = 8 per 100 people from 6th October, 2016 to 10th October,
of heart disease, but 100 had been lost to follow - up. After two years, one had a new
diagnosis of heart disease, and another 99 had been lost to follow up. After three years,
another seven had new diagnoses of heart disease, and 793 had been lost to follow - up.
After four years, another 8 had new diagnoses with heart disease, and 392 more had been
lost to follow - up.
Number of new cases of heart disease
Time each person was observed , totaled for all persons
Numerator = number of new cases of heart disease
= 0 + 1 + 7 + 8 = 16
Incidence Density=
(700 + x 8 + x 392)
16
6,400 1000 = 2.5 cases per 1,000 person-years
3.1 Prevalence
The prevalence of disease is the proportion number of individuals in a population with a disease
or other personal attribute. It is used by epidemiologists to ascertain the burden of a disease and it
serves as a point of planning and allocating resources. To illustrate:
A questionnaire was distributed to the workforce of a company producing bottled water
for Ensign College of Public Health on a particular working day. Of the 1534 workers,
178 reported headaches on the survey day.
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Prevalence=178 cases
Prevalence (proportion) =
178
1534
100
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0.11
0.04 =2.75
Interpretation
Values above 1 indicate a greater risk in A, values below 1 indicate a greater risk in B, while a
value of 1 implies equal risk in both groups. In this case the risk of suffering gastrointestinal is
2.75 times higher in source A than source B.
4.2 Odd ratio
Basically, odd ratio is the comparison of two odds. That is, odds of exposure in a group is the
number exposed in a group divided by the number not exposed. Epidemiologists use it in a casecontrol study and cross sectional to determine association of exposure with an outcome. If the
ratio for instance is above 1, epidemiologists interpret that cases are more likely to be exposed to
a particular factor than controls, and if the ratio is less than 1, the opposite is true. If the ratio is
close or equal to 1 it implies that the odds of exposure are very similar in the two groups.
Exposure to smoking
Smokers
Non smokers
10,000
Cancer
100 (a)
80 (c)
No cancer
1,900 (b)
7,920 (d)
Total
2,000
8,000
Odds ratio = ad / bc
100 (7,920)
80 (1,900) =5.2
Interpretation
This implies that those who smoke are 5.2 times likely to have been exposed to smoking.
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100 =83.3
Sick
50
85
35
Total
60
100
40
100 =85
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35
40
100 =87.5
100 =83.3
Interpretation:
Vegetables with ranch of 87.5% Attack Rate is most likely responsible for the gastroenteritis
outbreak.
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Cancer
84
87
No cancer
2,916
4,913
Total
3,000
5000
Relative Risk is used because the study suggests Prospective Study (Cohort Studies).
Relative Risk = Formulae
Risk in the exposed:
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84
100 = 2.8%
3000
Interpretation
It is observed that those who smoked are 1.6 times likely to develop cancer than those who do not
smoke.
4b.) Assuming 35% of the population smoked, what is the attributable risk in the total
population?
Exposure to smoking
Smokers
Non smokers
8000
Cancer
84
87
No cancer
2,716
5,113
Total
2,800
5200
If 35% of the population smoked, then the new number of those who smoked is 2,800.
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35
8000=2,800
100
Calculating Attributable Risk
Risk exposed groupRisk unexposed group
= Attributable Risk
Risk exposed group
Risk in exposed group:
84
=0.03
2,800
Risk in unexposed group
87
=0.017
5200
Attributable Risk
Risk exposed groupRisk unexposed group
= Attributable Risk
Risk exposed group
0.030.017
=0.433 100= 43.3%
0.03
Interpretation:
This implies that 43.3% of cancer found among those who smoke is due to their exposure to
smoking.
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REFERENCES
Beaglehole, R. B. R. K. T. (1993). Basic Epidemiology. Geneva: World Health Organisation.
CDC. (2012). Principles of Epidemiology in Public Health Practice: An intro to Applied
Epidemiology and Biostatistics.
Macfarlane, S. J. A. & M. J. G. (n.d.). Epidemiological Studies: A Practical Guide.
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