Epidemiology 27/7/2020 Notes

Epidemic = study of patterns and determinants of diseases pattern.

Endemic = Expected rate of disease over time
Hyperendemic = persistant, high level of disease occurance

Rate = Actual cases/Potential casestypically, actual cases per 100,000.Vital Stats are
usually presented as xases per 1000.

Incidence Rate - Rate at which new events occur in a popul.

High I.R = High Disease Risk.Numr = new cases (not preexisting cases)Denom = Popul. at
risk

In this question - new cases/popul. at risk= 5/200 = 0.025 cases per man yearso that mean
2,500 cases per 100,000 man years.But next year, our Denom. will be 195pervious 5 guys
have a preexisting condition.

in this question -100 Students, 35 - develop symp(over a year), 12students develop influ in
oct, 13- Nov and 10 in Dec.Incid for Oct = 12 cases/100Incidence for Nov = 13/88Incidence
for Dec = 10/75

Attack rate = the cumulative incidence of infection in a group of people over the course of the
epidemic. presented as a %age(if you get exposed - attack rate tells us what's the likelihood
of you getting the condition)

Prevelance - All individuals in a population who experience an event.Numr = all the indiv.
who have a particular attribute.Denom = population tt riskKeep in mind how the Denom
might be diff. incase they ask for sex specific diseases

Point prevelance - Like a snap shot view of a condition in a population. (Disease at one
time.)Period Prevelance - Gives us an idea about the burden of the Disease (over a given of
time)

From the population we can get New diseases = Incidence rate.and now the diseasew is
prevelant = Prevelance rate.The cases can either recover and Re-enter the Gen. Population
OR DIE = mortality rate.the longer a person is going to be diseased, they are going to
contribute to the prevelance rate

If we cure a disease - The patient will recover and re-enter the Gen popul. Prevelanee will
Dec. incidence (no change)With a Vaccine = Both Incidence and Prevelance will change.

If there is Inc. deaths due to a disease = Prevelance Dec.sMoney doesn't change anything.

Behav. Risk factors = lower incidnnce and prevl ratescontact bw infected person and non
infec person = for airborne = dec.s incidence and prevl.If Recovery form a disease occurs
more rapidly than it was 1 year ago - dec.s preval. not incidenceLong term survival rates for
diseases - due to better management for like diabetes or HIV doesnt chang incidence but
inc.s prvealance

Incidence for 2006 -> 4 newly diagnosed, 6 alive and disease free -> 4/6 = 0.67

3, 4, 6, 8, 9, and 10 are alive and disease free, and thus the denominator is 6.

Period prevalence in 2006 -> 7 with lung cancer in 2006, 9 in the population -> 7/9 = 78%

Pt number 2 is not included in period prevalence as they died prior to the period.

Pt prevalence on 1/1/2007 -> 4 with the condition, 6 people alive -> 4/6 = 67%

Crude rate -> whole population in denominatorSpecific rate -> subgroup (like age or sex) is
denominatorStandardized -> adjusted to make groups equal ex: controlled for smoking.

Primary Prevention -> person doesn't have disease and engages in risk modification or
health enhancement. Decreases incidence. Secondary -> person has preclinical disease.
Screening to detect disease and treat early. Tertiary -> patient has disease. Reduce
recurrence or slow progression.

Q: Study showed increased risk of pediatric leukemia when exposed to bisphenol-A. AAP
ran program targeted to new parents to inform them of risk. This is primary prevention.

Sensitivity -> probability of correctly identifying a case of diseaseSpecificity -> probability of

identifying a person without disease.

Sensitivity + False Neg Rate = 100%

SNOUT -> Negative results from highly sensitive test rules out disease.

ReKAP: Specificity (true negative rate)The proportion of individuals without a disease that
correctly test negative in a clinical test designed to identify that disease.

ReKAP: Unlike sensitivity and specificity, which rely solely on the diagnostic test itself,
predictive values are also influenced by disease prevalence.

ReKAP: PPV = TP / (TP + FP)SP = TN / (FP + TN)

ReKAP: NPVhe probability that an individual who tested negative is actually disease-free.SN
= TP / (TP + FN)NPV = TN / (FN + TN)

ReKAP: The negative predictive value decreases with increasing prevalence of the disease
in the population.

ReKAP: Point C is the most accurate test. Minimize both FN and FP.
ReKAP: ROC CurveA test is considered more accurate if the curve follows the y-axis. A test
is considered less accurate if the curve is closer to the diagonal.

Just a reminder that if you have been experiencing tech issues, the break is a good time to
restart your computer.

Reliability: represents the ability of a test to measure something consistently. -The precision
of a test.

Validity: represents the test ability to measure what is intended to measure.-In other word
measures the accuracy of a test.

Selection bias: represents nonrandom sampling or treatment allocation of subjects such that
study population is not representative of target population. Most commonly a sampling
bias.Selection Bias (Sampling Bias):•Berkson bias: study population selected from hospital is
less healthy than general population•Non-response bias: participating subjects differ from
nonrespondents in meaningful ways.

Selection Bias: is prevented by randomization of the sample.

Measurement Bias: Information is gathered in a systemically distorted manner.•Hawthorne

Effect (an example of measurement/procedural/ error bias): participants change behavior
upon awareness of being observed.

Measurement Bias: can be prevented by using objective, standardized, and previously

tested methods of data collection that are planned ahead of time.•Can also be prevented by
using a placebo group.

Lead-time bias: occurs when the early detection of a disease is confused with‚ an increased
survival rate.

Lead-Time Bias: can be prevented by adjusting the survival rate according to the severity of
disease at the time of diagnosis.

Cohort Study is used to compare a group with a given exposure or risk factor to a group
without such exposure.-It looks to see if exposure or risk factor is associated with later
development of disease and uses the Relative Risk to determine the association.