Chapter 3 Study Questions

Epidemiology for Public Health Practice Chapter 3 Study Questions

Corie Spadaro

Southern New Hampshire University

CHAPTER 3 QUESTIONS 2

Epidemiology for Public Health Practice Chapter 3 Study Questions

Question number 1

A. The crude death rate is the death rate from all causes of death for a population

(CDC.gov). It is a rate with a numerator divided by a denominator. The numerator

consists of the number of deaths in a certain year and the denominator is the total

population during the midpoint of the year. The number is usually multiplied by 100,000

so that it can be expressed as a frequency per 100,000 individuals.

B. An age specific rate is defined as a rate for a specified age group where the numerator

and denominator refer to the same age group (Friis, 2014). To calculate the rate, the

population is subdivided into certain age groups between 5 and 10 year intervals. Then

one divides the frequency of a disease in a particular age bracket by the total number of

persons within that age range (Friis, 2014).

C. A cause specific rate is a rate that specifies events, such as deaths according to their

causes (Friis, 2014, pg 138). It is the frequency of a disease within a certain age group

divided by the total number of the population within that age group at the midpoint of the

time period multiplied by 100,000. Both cause specific rates and age specific rates are

great indicators of risk.

D. The proportional mortality rate (PMR) is the number of deaths within a population due to

a specific disease or cause divided by the total number of deaths in a population (Friis,

2014 pg. 140). The numerator is the number of deaths of a specific cause such as cancer

during a specific time period and the denominator is the number of deaths due to all

causes during the same time period (Friis, 2014. Pg 142). The proportional mortality rate

is useful in determining the number of deaths within a population due to a certain cause.
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E. The maternal mortality rate is the number of maternal deaths due to complications with

childbirth per 10,000 or 100,000 live births (Friis, 2014. Pg 136). There are many factors

that contribute to women dying while giving birth. Some of the factors are the access to

healthcare, the food that the mother eats, and the amount of money one has. The reason

why access to healthcare affects the number of woman who die while given childbirth are

health care practitioners are trained to deliver babies and save mothers lives. Some

people in less developed countries don’t have access to all the healthcare we have in the

United States which may lead to significantly more problems in less developed countries.

The amount of money that one has can also affect the number since people with less

money may not have health insurance making it very expensive for them to stay in the

hospital. People with more money tend to have the very best doctors that specialize in

delivery and spend more time with their patients.

F. The infant mortality rate measures the risk of dying during the first year of life among

infants born alive (Friis, 2014. Pg 132). The numerator is the number of infant deaths

among infants ages 0-365 days during the year and the denominator is the number of live

births during the same year. The numerator is divided by the denominator and multiplied

by 1,000 to show the number of deaths per 1,000 live births. Infant mortality rates are the

highest in less developed countries in the world. This can be due to many factors

including the education of the doctors, access to clean water, less pollution, and the

hygiene in the hospitals. Infant mortality rates are significantly different depending on

race and ethnicity. Non-Hispanic black women have more than twice the risk of their

infant dying compared to all other races in the United States.

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G. The neonatal mortality rate measures the risk of dying among newborn infants who are

under the age of 28 days in a given year Friis, 2014. Pg. 134). To get the neonatal

mortality rate one would divide the numerator by the denominator and multiple the

number by 1,000 live births. The numerator is the number of infants who die within 28

days of births and the denominator is the number of live births.

H. The fetal death rate is defined as the number of fetal deaths after 20 weeks or more of

gestation divided by the number of live births plus fetal deaths and is expressed as a rate

per 1,000 live births and fetal deaths (Friis, 2014. Pg. 130). The late fetal death rate

refers the number of fetal deaths after gestation of 20 weeks or more divided by the

number of live births during a year and is expressed as rate per 1,000 live births (Friis,

2014. Pg. 130).

I. The fetal death ratio refers to the number of fetal deaths after 20 weeks or more gestation

divided by the number of live births during a year. It is expressed as a rate per 1,000 live

births (Friis, 2014. Pg 130).

J. The perinatal mortality rate is the number of late fetal deaths after 28 weeks or more of

gestation plus the number of infant deaths within 7 days of birth divided by the number of

live births plus the number of late fetal deaths. This calculation is used to measure the

number of late fetal deaths plus infant deaths within 7 days of birth (Friis, 2014. Pg. 136).

The perinatal mortality rate can differ due to a variety of different factors including

access to health care, what the mother eats, where someone lives, as well as how a

mother cares for her child. I believe access to health care is probably one of the most

important aspects of the perinatal mortality rate. If one doesn’t have access to quality

healthcare, there can be many different factors that contribute to more infants dying.
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K. The postneonatal mortality rate measures the risk of dying among older infants in a given

year (Friis, 2014 pg. 134). The postneonatal mortality rate is the number of infant deaths

from 28 days to 365 days after birth divided by the number of live births minus the

number of infant deaths under 28 days (neonatal mortality rate) and multiplied by 1,000

live births (Friis, 2014. Pg 135).

L. The crude birth rate refers to the number of live births during a specified period of time

per the resident population during the midpoint of the time period and is express at a rate

per 1000 (Friis, 2014. Pg 127). The crude birth rate is calculated by dividing the number

of live births within a given period by the population size at the middle of that time

period and multiplying the number by 1,000. The crude birth rate is used to project

population change and it is affected by the number and age composition of woman of

childbearing age (Friis, 2014. Pg. 127).

M. The general fertility rate is used for comparisons of fertility among age, racial, and

socioeconomic groups (Friis, 2014. Pg. 127). The general fertility rate is the number or

live births within a year divided by the number of women age 15-44 years during the

midpoint of the year and is expressed by 1,000 women aged 15-44 (Friis, 2014. Pg. 128-

129).

N. The age adjusted standardized rate is the total expected number of deaths divided by the

total estimated 2000 population times 100,000 (Friis, 2014. Pg 144). The standardized

rate or direct method is used if the age specific death rates in a population to be

standardized are known and a suitable standard population is known (Friis, 2014. Pg.

144).
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O. The direct method of adjustment requires the application of the observed rates of disease

in a population to some standard population to derive an expected number (rate) or

mortality (Friis, 2014. Pg 147). By standardizing the observed rates of disease in the

populations being compared to the same reference population one is thereby assured that

any observed differences that remain are not simply a reflection of differences in

population structure with respect to factors such as age, races, and sex (Friis, 2014. Pg

147).

P. The indirect method of adjustment is used when the age-specific death rates of the

population for standardization is unknown or unstable. The stratum-specific rates of a

larger population such as that of the United States are applied to the number of persons

within each stratum of the population of interest to obtain the expected number of deaths

(Friis, 2014. Pg. 149).

Q. The standardized mortality ratio (SMR) is the observed number of deaths divided by the

expected number of deaths (Friis, 2014. Pg 150). Specific rates for comparison of a

population are multiplied by local population counts or estimates, and summed to yield

the expected number of deaths. The actual or observed deaths are divided by the

expected deaths to give a ratio. The ratio is the difference between the mortality of the

population under study and the population as it would be if it experienced of the age

specific rates of the population being compared.

Question number 2

Age-specific Death rates of Malignant Neoplasms of Trachea, Bronchus, and Lung Deaths, USA,

Age Calculation of Age Age-Specific Death

(Years) Specific death rates Rates per 100,000
25-34 154/39,872,598 0.39
35-44 2,478/44,370,594 5.58
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45-54 12,374/40,804,599 30.32

55-64 30,956/27,899,736 110.95
65-74 49,386/18,337,044 269.32

There are many inferences that can be made from the age-specific death rates calculated

above. The age specific rate is the number of cases per age group of a population during a

specified time period divided by the number of persons who are in the same age group during the

same time period (Friis, 2014. Pg. 139). The table above indicates the number of deaths due to

malignant neoplasms within certain age groups. One can infer that the risk of death among 25-

34 year olds is 0.39 per 100,000 deaths. From the ages of 34-45 the risk of dying is 5.58 per

100,000. From the ages of 45-54, the death rate in this age group is 30.32 per 100,000. The 55-

64 year olds, death rate is 110.92 per 100,000. The number of deaths from malignant neoplasms

among the age group 65-74 is 269 deaths per 100,000 people in the population.

The age-specific is a much better indicator of risk than crude rates, especially for rates

specific to defined subsets of the population (Friis, 2014. Pg. 1.39). The age specific rate is not

able to be compared if the populations within the age groups are different. While we can infer

that the risk of death increases as a person gets older we cannot compare and contrast the rates

since the different subsets of the population all have different populations. If one was to

calculate the age adjusted rate using the same standard age of distribution the results would be

easier to compare as well as visualize. The 65-74 age group has the greatest chance of dying

from malignant neoplasms than any other age group. As a person ages, the risk of dying from

malignant neoplasms increases.

Question Number Five

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To calculate the prevalence of the number of individuals that were infected with HIV

during the period of January 2013 to December 2013, one would divide the number of residents

who were infected with HIV by the population of Metroville. The number of people in

Metroville infected with HIV was 4,367 and the total population was 3,187,463 in June 2013.

By dividing the numerator 4,367 by the denominator 3,187,463 (4,367 / 3,187,463) the

prevalence of HIV in Metroville in 2013 was 137 people per 100,000.

To calculate the incidence rate, one would divide the number of new cases of HIV by the

total population at risk in Metroville in the year 2013. The numerator would consist of the

number of new cases of HIV and the denominator would be the total population at risk in

Metroville in 2013 and would be found by subtracting the total population by the number of

infected cases in 2013 (prevalence). The number of new cases, 768 divided by the population

(3,187,463-4,367= 3,183,063) minus the number of people already infected with HIV would

make the total population at risk 3,183,063. By dividing the 768 new cases that occurred in 2013

by the population at risk 3,183,063, the incidence rate would be 24 cases of HIV per 100,000

women in 2013.

Question number seven

Age adjusted rates are applied to rates of disease, death injuries or other health outcomes

which allow communities with different age structures to be compared (health.ny.gov).

Adjusting ages is usually used to show what the most common health problem in a community

is. Older populations would have higher rates of cancer than younger populations. While

younger populations may have more deaths due to accidents and injuries.

So according the question asked in the book if the prevalence of the number of women is

40/1000 and the prevalence among men is 20/1000 the risk of developing the disease is two
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times higher among women than among men. Women would have a higher mortality rate than

males if the age specific death rates were standardized. Age adjustment is one of the key tools

that can be used to control for the changing age distribution of the population, and can be used to

make meaningful death comparisons of vital rates over time and between groups (Friis, 2014. Pg

146). It is safe to assume if the age is adjusted according to the standardized observed rates of a

disease in the population that any observed differences that remain are not simply a reflection of

the differences in population structures (Friis, 2014. Pg. 147).

In order to compare age adjustment rates the same standard population must have been

used. Therefore, if the adjusted number of males was calculated using the population in 1998

and the age-adjustment rate of women was calculated using the population in 2000 there would

be major differences in the rates and not comparable. However, if the measure of the age

specific deaths rates of a population are not known because the rates to be standardized are based

on a small population one must come up with the expected number of deaths (Friis, 2014. Pg.

149).

Question number twelve

The differences between the sex ratio at birth and the sex ratio in the United States can be

explained by a number of different factors. One of the most important aspects in comparing the

sex ratio is the age of the population being looked at. The differences can be contributed to the

ages of males and females during their lifetime,

In 2014, the global sex ratio at birth was estimated at 107 boys to 100 girls or 1000 boys

per 934 girls (Sex ratio, 2016). The population sex ratio refers to the total number of males for

every 100 females in the population and depends on three different factors, the sex ratio at birth,

the different mortality rates between the sexes at different ages, and losses and gains through
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migration (pnas.org.). Women tend to live longer than men because of environmental, social,

and economic factors. Men tend to engage in riskier behavior than women do which lowers their

life expectancy. Men are the ones that go to war, have more jobs that are physical in nature and

tend to wear down the joints and muscles, contributing to more injuries and health problems later

in life. Whereas women contract less cases of disease than men and live longer resulting in a

higher number of females than males later in life.

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References

Department of Health Information for a healthy New York. (1999). Age-Adjusted Rates-

Statistics Teaching Tools. Retrieved from:http://www.health.ny.gov/diseases/chronic/ageadj.htm

Friis, R., & Sellers, T. (2014). History and Scope of Epidemiology. Epidemiology for

Public Health Practice (5th ed., pgs., 107-151). Burlington, Massachusetts: Michael Brown.

Heskth, T. & Xing Z. (2006, March, 20). Abnormal sex ratios in human populations:

Causes and consequences. Retrieved from:

Human sex ratio. (2016, January 10). In Wikipedia, The Free Encyclopedia. Retrieved

09:33, January 11, 2016, from https://en.wikipedia.org/w/index.php?

title=Human_sex_ratio&oldid=699099676
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