hap ve Occur Diseate1Oke de Sue TNans aH MaaureSST MOL EE REFERENCES 1, Thacker, Berkelman RL: Publi health sarellance in the ‘ite States Epidemiol Rey 1016-190, 1988 2, Murray Clly Rosenfield LC, Lim 8, eta: Global malts rorality between 1980 and 2010: A systematic anshse ance S79413-43, 2012 4, United States Noclear Regultory — Commisson— Iickgrounder on the Three Mile Ind Accident. ps suc goeneing rnc cllectionst sheet Sai REVIEW QUESTIONS FOR CHAPTER 3 4. Bard. Verge Hubert P Chernobyl 10 yearsfte H ‘onsequencss, Epidemiol Rev 19:187-204, 1997, 5. ErkinuntiT, Ont T Stenbuis Rta The let of dt ferent agnostic crera on the prevalence of deme, IN Engl J Med 35751667=1674, 1997 Lagabos SW, Wessen Bl, Zlen Me Ap analysis of contami ate ell water and health fest in Woburn, Massach seus J Am Sat Asoc B1583-585, 1986 2. Hare & Gis Action New York, Random House, 1995, At an initial examination in Oxford, Mass., migraine headache was found in 5 of 1,000 men aged 30 t0 35 years and in 10 of 1,000 women aged 30 to 35 years. The inference that women have a two times greater risk of developing migraine headache than do men in this age group is: a. Correct D, Incorrect, because a ratio has been used to ‘compare male and female rates Incorrect, because of failure to recognize the effect of age in the two groups 4. Incorrect, because no data for a comparison for control group are given fe. Incorrect, because of failure 10 distinguish between incidence and prevalence 2. A prevalence survey conducted from January 1 through December 31, 2012, identified 1,000 cases of schizophrenia in a city of 2 million persons. The incidence rate of schizophrenia in this population is 5/100,000 persons each year, What percent ofthe 1,000 cases were newly diag- nosed in 2012% 3. Which of the following is an advantage of active surveillance? a, Requires less project staff b. Is relatively inexpensive 10 employ © More accurate due to reduced repor burden for health care providers 4. Relies on different disease definitions 10 account for all cases . Reporting systems can quickly be developed. 4. What would be the effect on age-specific inci dence rates of uterine cancer if women with hysterectoniies were excluded from the denomi- nator of the calculations, assuming that there ave some women in each age group who have had hysterectomi a. The rates would remain the same . The rates would tend to decrease c. The rates would tend to inerease 4. The rates would inerease in older groups and decrease in younger groups e. It cannot be determined whether the rates would increase or decrease 5. A survey was conducted among the non: hospitalized adult population of the United States during 2008 through 2011. ‘The results from this survey are shown below. ‘AgeGroup _Persons with Hypertension (%) 18-29 years 1 30-39 years 0 40-89 yeuts 2 -39 years 4“ 160-69 years st 7 and older ot The researchers stated that there was an age- related increase in the risk of hypertension in this population. You conclude that the research: crs’ interpretation: a. Is correct b, Is incorrect because it was not based on rates «. Is incorrect because incidence rates do not describe risk 4d. Is incorrect because prevalence is used «. Is incorrect because the calculations are not age-adjusted Additional review questions on the next pageQuestions 6 and 7 use the information below: Population of the city of Atlantis on March 30,2012 = 183,000 No. of new active cases of TB occurring between January 1 and June 30, 2012 = 26 No. of active TB cases according tothe ‘on June 30, 2012 = 264 city register 6. The incidence rate of active cases of TB for the 6-month period wast 7 per 100,000 population b. 14 per 100,000 population 6. 26 per 100,000 population 4. 28 per 100,000 population ©. 130 per 100,000 population (19) Section THE EPIDEMIOLOGIC APPROACH TO DISEASE AND INTERVENTION 7. The prevalence rate of active TB as of June 30, 2012, was: a. 14 per 100,000 population b. 130 per 100,000 population ‘& 144 per 100,000 population 4. 264 per 100,000 population None of the aboveChapiera The O&eurenea of Diveadé! ll Merialty and Other Mensuresof DMeaie impact Peo: Cho gery € pidrmwsloyy by i Fe cues Wikon) “TU pause for a moment so you can et this information sink in.” Figure 4-27. “rilpsuse fra momen so you an this information sink in? (November 2%, 2010, fs, The New Yorker Astor Graham REFERENCES 1. De leanoir Se A Very Basy Death (O'Brian, Neve York, Pantheon Books, 1955 Premature moray in the United Sate: Public health ses inthe ws of Yrs of potential He et, 988, MAW 3s(Suppl 28):1-118, 1986, National Cente for Health Sait fstructons for Cs sing the Underlying Casse of Death, 1983. Hyasil MD, 1 1. Chamblce Rk sans MC: TRANSAX: The NCHS Stem for Pradasing Multiple Cause-of Death Statistics, 1968-1078, slated by Patrick No.29, Bethea, MD, Department of Heath and Human Series, December 199 n American Heskh Organization Specs Program for Heath Anais (SHA) Standardization: & classic epidemiological mete forthe compara of aes. Epidemiol Bull 238-12, 202 Anderson RN, Rosenberg HIM: Age Stundadizationof Death Rats Inplementatio of the Year 2000 Standard. National Vital Statics Reports, Vol. 47, No 8p. I-16, Hyatvil (MD, Nations Cte for Healh tates, Octobe 7.1998. ‘tal and Health Statist, serss 1, No, 20, DHHS publica: &, Maray CHL Lopee AD: The Global Baden of Disease Cam tion No (PHS) 86-1323, Nishinglon, DC, Bursa of Vital bridge BLA Harvard Unversity Pros, 1986 nd Hoh Statist ae 198, 9, The Global Burden of Dssise 2004 Update Genes, Word Sage G, Robe Fe, Grant 8, Dufour MC: Liver Cinhess ort the Unita Sats, 1970-90 Surveillance Report REVIEW QUESTIONS FOR CHAPTER 4 Questions 1 and 2 are based on the information, given below: In an Asian countey with a population of 6 million people, 60,000 deaths occurred during the year ending December 31, 2010, These included 30,000 deaths from cholera in 100,000 people who ere sick with cholera 1, What was the cause-specific mortality rate from cholera in 20107 2.What was the case-fatality from cholera in 20107 = Hetth Or on, 20, 3, Age-adjusted death rates are used to: a. Correct death rates for errors in the state- ment of age b. Determin that occurred in specific age groups in a population Correct death information 4. Compare deaths in persons of the same age group . Eliminate the effects of differences in the age distributions of populations in comparing death rates the actual number of deaths rates for missing age4. ‘The mortality rate from disease X in city A is 75/100,000 in persons 65 to 69 years old. The ‘mortality rate from the same disease in city B {is 150/100,000 in persons 65 to 69 years old. The inference that disease X is two times more prevalent in persons 65 to 69 years old in city B than it is in persons 65 to 69 years old in city Ais: a. Correct b. Incorrect, because of failure to distinguish between prevalence and mortality Incorrect, because of failure to adjust for di ferences in age distributions 4. Incorrect, because of failure to dist between period and point prevalence €. Incorrect, because a proportion isused when rate is required to support the inference ish, 5. The incidence rate of a disease is five times greater in women than in men, but the preva- lence rates show no sex difference. The best explanation is that a. The crude all-cause mortality rate is greater b. The case-fatality from this disease is greater The case-fatality from this disease is lower d. The duration of this disease is shorter in ‘e. Risk factors forthe disease are more common in women 6. For a disease such as pancreatic cancer, which is highly fatal and of short duration: 4 Incidence rates and mortality rates will be similar . Morality rates will be much higher than incidence rates & Incidence rates will be much higher than morality rates 4. Incidence rates willbe unrelated to mortality rates ‘& None of the above 7.10 1990, there were 4,500 deaths due to lung diseases in miners aged 20 to 64 years. The ‘expected number of deaths in this occupational group, based on age-specific death rates from lung diseases in all males aged 20 to 64 years, ‘was 1,800 during 1990. What was the standard- ized mortality ratio (SMR) for lung diseases in Section 1 THE EPIDEMIOLOGIC APPROACH TO DISEASE AND INTERVENTION Question 8 is based on the information given below: ‘Annual Cancer Deaths in White Male ‘Workers in Two Industries INDUSTRY A__INDUSTRY 8 % of All of All No.of Cancer No.of Cancer Cancer Site Deaths Deaths Deaths Deaths oS Digestive 1600 28D Oa oO oil Totals 380 100550100 Based on the preceding information, it was con- cluded that workers in industry B are at higher risk of death from respiratory system cancer than workers in industry A. (Assume that the age distri- butions of the workers in the two industries are nearly identical.) 8, Which of the following statements is true? The conclusion reached is correct the conclusion reached may be incorrect because proportionate mortality rates were used when age-specific mortality rates were needed The conclusion reached may be incorrect because there was no comparison group 4. The conclusion reached may be incorrect because proportionate mortality was used when cause-specific mortality rates were needed fe. None of the above 9.8 program manager from an intern health funding agency needs to identify regions that would benefit from an intervention aimed at reducing premature disability. The program ‘manager asks health care consultant to develop a proposal using an index that would help her rake this decision. Which of the following would best serve this purpose? a. Case-fatality . Crude mortality rate & Disability-adjusted life-years 4. Standardized mortality ratio| Chobe The Occurrence of Disease Mortality and Other Measures of Disease Impact CANIN 10. The following are standardized mortality ratios (SMBs) for lung cancer in England: ‘Questions 11 and 12 are based on the information given below: STANDARDIZED MORTALITY RATIOS Occupation «1949-1960 1968-1979, Garpenters 209 15 Bricklayers 2 ne ‘Based on these SMRs alone, clude that ‘a, The number of deaths from lung cancer in carpenters in 1949-1960 was greater tha the number of deaths from lung cancer in bricklayers during the same period b. The proportionate mortality from lung cancer in brieklayers in 1949-1960 was greater than the proportionate mortality from lung cancer in the same occupational oup in 1968-1979 . The age-adjusted rate of death from lung cancer in bricklayers was greater in 1949 1960 than it was in 1968-1979 4. The rate of death from lung cancer in car penters in 1968-1979 was greater than would have been expected for a group of men of similar ages in all occupations @. The proportionate mortality rate from lung cancer in carpenters in 1968-1979 was 1.35 times greater than would have been expected for a group of men of similar ages in all ‘occupations itis possible to con- Numbers of People and Deaths from Disease Z by Age Group in Communities XandY COMMUNITY x COMMUNITY Y No.of No.of Deaths Deaths Age No.of from No.of from Group People DiseaseZ People Disease Z Young 8900-69 ~~—<5000~«aB Old 11000153008 Caleullate the age-adjusted death rate for discase Z in communities X and Y by the direct method, ‘using the total of both communities as the standard population. 11. The age-adjusted death rate from disease Z for community X is 12, The proportionate mortality from disease Z for community ¥ is: a. 946/1,000 . 13.5/1,000 . 20.0/1,000 d. 10.8/1,000 @. None of the above