SOURCES OF DATA What are the most useful data claims to an epidemiologist? 1. Data on vital events 2.

ents 2. Disease statistics 3. Data on physiologic or pathologic conditions 4. Statistics on health resources and services 5. Statistics pertaining to the environment 6. Demographic data 7. Socio-cultural data

Vital \Records These are the certificates of birth, death and marriage required for legal and demographic purposes. Birth Certificates Purposes: 1. To provide denominators (number of live births) predominant 2. To provide information on complications of the pregnancy 3. To provide information on abnormalities of the infant 4. To provide information on birthweight of the child, duration of pregnancy and duration of education and blood group of the mother Death Certificates The introduction of death registration was the foundation of modern epidemiology; it changed the subject from a narrative discipline into a quantitative science. Even today changes in the death rate may give the first indication of epidemiologic conditions and cause-specific death rates are the single most useful source of information in the distribution of many diseases The fact that death rates are most reliable indices of disease occurrence when the interval between incidence and death is short and the Case Fatality Rate of the disease is high applies whether one is estimating the total disease frequency or attempting to interpret a change over time in the distribution of a disease in the population.

Possible Situations in which Births may not be registered 1. Poor peace and order 2. No health worker in attendance 3. Remoteness of areas 4. Lack/absence of reporting forms

Example on how to fill-up the cause of death in a death certificate If a malnourished child has measles and develops bronchopneumonia and you decide that it was the pneumonia that led to the childs death, how will you fill out the birth certificate? Immediate Cause InterveningUnderlyingIf a malnourished child has measles and develops bronchopneumonia and you decide that it was the pneumonia that led to the childs death, how will you fill out the birth certificate? Immediate Cause InterveningUnderlying Try this out: pulmonary edema, myocardial infarction, congestive heart failure. Which blanks do each of these belong if they were all found in just one dead person? Immediate Cause Intervening Underlying -

Evaluating the Quality of Data that we get from each source Good Quality Data must be accurate, timely and complete. 1. Accuracy refers to the ability of the data to represent the true value of what is being measured 2. Timeliness means the data must be made available to be of some use for prevention and control measures or for planning purposes 3. Completeness means that all the needed information must be included

Specific Situations/Examples For Each of the Sources of Variation . Lack of Constancy Blood pressure continually changes throughout the whole day. Thus BP Readings for one person will vary depending on what time the reading is taken and on the condition of the subject himself 2. Lack of Precision Using one BP apparatus, one may get different readings from the same patient. A better example would be weighing scales which have not been calibrated such that it gives different measurements of the weights of the same children. 3. Lack of Congruency measuring instruments have to be standardized against each other to make sure that they are exhibiting

almost similar readings or measurements. Ex. Different weighing scales, different observers or even different data collectors may exhibit a lack of congruency or standardization in how they measure data. 4. Lack of objectivity - this deals more with how the experiences or the personality of a data collector influences his observations

Concepts of Validity & Reliability Validity is the ability of data collection or the measuring device to measure what it is supposed to measure Validity usually used in conjunction with screening test. A screening test should give you a good preliminary idea who is most likely to be sick.

Examples of screening test

1. PAP Smear for cervical cancer 2. cholesterol level for risks of heart disease 3. intraocular pressure for glaucoma 4. FBS for diabetes Components of Sensitivity & Specificity . Sensitivity capacity of the test to pick up or label positive those who have the disease 2. Specificity - capacity of the test to exclude or label negative those who do not have the disease 3. Positive Predictive Value of a Test the chance that a positive result is truly indicative of the presence of the disease/condition 4. Negative Predictive Value of a Test - the chance that a negative result is truly indicative of the absence of the disease/condition Interpret a sensitivity of 90% : 90% of the persons with the disease will be detected by the test being used. Interpret a specificity of 90%:90% of persons without the disease will be correctly labeled by the test as not diseased. Interpret a % false negative of 10%: There will be 10% of persons who have the disease which will not be detected by the test. Interpret a a % false positive of 10%: 10% of healthy people or people without the disease will be incorrectly labeled as positive by the test. Interpret PPV of 85.7%: 85.7% of those who test positive will really have the disease

Interpret NPV of 93.1% : 93.1% of those who tested negative will really not have the disease.

Sample Problem Throat Culture Pos clinical Pos Neg Total 27 10 37 Neg 35 77 112 Total 62 87 149

Solution to the Sample Problem + + a c a+c b d b+d a+b c+d

Solution to the Sample Problem with Interpretations Sensitivity = 27/37 x 100 = 72.97%. Interpretation: 72.97% of those with the disease will be labeled positive by the test. Specificity =77/112 x 100 =68.75%. 68.75% of those without the disease will be labeled as negative by the test. PPV = 27/62 x 100 = 43.55%. 43.55% of those who test positive really have the disease NPV = 77/87 x 100 = 88.51%. 88.51% of those who test negative will really not have the disease

Things to remember about Sensitivity, Specificity, PPV and NPV

Sensitivity & Specificity are inversely related,i.e. When a test is highly sensitive, its specificity is usually low. A sensitive test can pick up most cases of the disease but it will also erroneously label as positive many persons who do not have the disease. A highly specific test will correctly label as negative those who do not have the disease but it will miss many cases. A very sensitive test gives a low positive predictive value since it produces many false positives. A very specific test gives a high positive predictive value. The positive predictive value of a test increases with the prevalence of the disease. As the prevalence increases, the predictive value of a negative test will decrease. Even if the specificity of the test is high, if the prevalence of the condition is low the predictive value will be low.