Lecture 2 – Measuring the Occurrence of Disease

 The role of surveillance

o Collection, analysis and interpretation of data
 This is surveillance; we do this for planning
 Diseases are coded in a different way than in clinical practice – we want the disease
definition to be the same across countries
 Surveillance is to be able to capture disease in everyone – not treat a disease
o Planning, implementation and evaluation of public health
 How do we do this?
 Most information that we have for statistics come from the national notifiable diseases surveillance
system, EPA, CDC, etc.
 Surveys are not limited to infections or diseases – we also track congenital diseases, environmental
toxins, etc.
 Passive surveillance – mandatory reporting
o e.g. HIV – but this also depends on how good labs are at reporting, if funds and staff are
available to do this (in this case, we can have under-reporting)
 Active surveillance – specific to a disease or condition
o e.g. More case-finding – people go out looking for that case in a geographic area
o Involves having people dedicated to finding the cases
o Limited to how many resources you have to find cases, and how wide your geographic area is
o E.g. All health centers need to report screening tests for certain cancers; how well a center is
able to screen for cancer is how much that center will receive funds federally
 How much “disease” exists?
o Why do we care? Because certain diseases can be deadly
 Point Prevalence:
o Prevalence per 1,000 = # of existing cases of disease in a population / # of persons in population
*1000
o A snapshot/point in time of how many people have the disease you’re looking at
o Contains new cases and existing cases of the disease
o Can be expressed as a percentage (5 per 100 or 5%, or in more rare diseases per 10,000 or per
100,000)
o NHANES can track this data (as it is a survey of a point in time)
 Period Prevalence:
o Prevalence per 1,000 = # of existing cases of disease / # of people in the population x 1000
o During a SPECIFIED interval of time
o Expressed as a rate: 5/1000 persons in City A had diabetes in 2014
 Incidence:
o Incidence per 1,000 = # of new cases of disease in a population / # of persons at risk for
developing a disease * 1000
o During a specified interval of time
o Issues with incidence: how are you going to find your new cases? People who haven’t been
diagnosed yet are going to be missed, as well as people who are going to be coming to you
 Limitation of incidence (incidence will be underestimated)
o Incidence can also increase over time because people may be identified more easily, not because
transmission increases – finding out WHY incidence increases so fast is important
o A measure of how good the surveillance system is
 Important concepts of incidence:
o Measure of the risk of the disease
o As incidence goes up, so does risk
o The numerator is only the NEW cases of the disease
o Time unit must be clearly specified
o All persons at risk must be followed the entire time period
 Incidence Density:
o Number of new cases / ??
 Cumulative Incidence
 Prevalence = Incidence x Duration
 Stratum-Specific Mortality Rate (e.g. age)
 o Annual rate per 1,000 children in <10 years = total number of deaths from all causes in 1 year in
children younger than 10 years / ???

Lecture 3: Prospective Studies: Cohort, longitudinal, incidence studies