Review

BASIC CONCEPTS OF EPIDEMIOLOGY

Frequency
Measures
Ratios, proportions and rates
Ratio
◦ a/b ,where – a is not a part of b
Proportion:
◦ a/b , where – a IS included in b
◦ Percentage = proportion x 100
Rate – special type of proportion, represents a defined population-at-
risk over a specified time
Probability vs. Odds
Odds
◦ Ratio of the event occurring: not occurring
odds = prob / (1-prob)
prob = odds / (1+odds)
◦ 1 in 10 probability = 1 : 9 odds
Descriptive v. Analytic
Descriptive
◦ Studies frequency and occurrence of disease in a SINGLE groups
◦ Ex. prevalence, incidence, mortality rate

Analytic
◦ Comparison of frequency and occurrence of disease between TWO OR
MORE groups
◦ Ex. – Risk Ratio, Odds Ratio
Incidence vs. Prevalence
Prevalence
◦ How many people had type II diabetes in 2010?

Incidence
◦ How many people GOT type II diabetes in 2010?

Why does this matter?

Incidence vs. Prevalence

Prevalence = Incidence x Duration of disease

Think about how these can all interplay with each

other…
Prevalence vs. Incidence
Prevalence
◦ How many people had type II diabetes in 2010?

Incidence
◦ How many people GOT type II diabetes in 2010?

Why does this matter?

Incidence vs. Prevalence
▪Prevalence = Incidence x Duration of disease
Incidence Measures
Cumulative Incidence Rate (CIR)

◦ Case-fatality rate and Attack Rate are specific types of CIR

Incidence Density Rate (IDR)

◦ Person-time is taken into account

Case Fatality vs. Mortality
Mortality
◦ How many people died of pancreatic cancer in 2010 out of the general
population?

Case Fatality
◦ How many people died of pancreatic cancer in 2010 out of pancreatic cancer
patients?

What is the deadliest virus in the world?

◦ Mortality=lower respiratory infections
◦ Fatality= rabies
Example

▪What is the point prevalence on the 28th of February?

▪What is the incidence rate in February?

Practice
Questions 11-15 The figure below depicts the occurrence of the
condition “epidemiologitis” in a population of 200 medical school
students over a 3 year period. “Epidemiologitis” is a painful and
distressing condition that everyone eventually recovers from. You can
only get “epidemiologitis” once – after recovery you are immune to
repeat infections. There has never been a fatal case of the disease. The
symbol [ indicates the date of diagnosis, the end of the line indicates
when the student recovered. During the observation period, the
population remains stable (i.e., no students dropout, move away, or
refuse to participate in the study). For questions 11, 12 and 13 provide
values for both the numerator and denominator.
Questions (1-3)
What is the prevalence of "epidemiologitis" in January 1989?

What was the attack rate of "epidemiologitis" during 1989 (Jan 1 to

Dec31)?

What is the two-year cumulative incidence rate of "epidemiologitis" for

the period Jan 1 1990 to Dec 31 1991?
Answer
Q11: 5/200= 0.025= 2.5%

Q12: 3/195= 0.015= 1.5%

Q13: 12/192= 0.063= 6.3%

Q-4
Estimate the total person time (in months) contributed by the at-risk
population during the one-year period between Jan 1 1989 and Dec 31
1989. Show your work.
Answer
(2,314 months (this is calculated as (192 x 12)+ (2) + (3) + (5)), where
192 X 12 is the person time for the 192 subjects who were at-risk but
did not get sick, and 2, 3, and 5 months is the estimated disease free
time for the 3 cases that got sick during the year.)
Further thinking
Why do we need to differentiate the different indices (incidence vs
prevalence, cumulative incidence vs incidence density?)
Additional Practice
A large observational cohort study was done in China to determine if
Folic Acid supplementation during pregnancy would reduce the
incidence of neural tube defects in the newborns. In two southern
provinces a total of 111,392 women took folic acid during their
pregnancy and there were 77 neural tube defects in their children. A
total of 104,320 women in the same provinces did not take folic acid
and there were 86 neural tube defects in their children.
What was the cumulative incidence of neural tube defects among
mothers who took folic acid supplements?
What was the probability of neural tube defects among mothers who
did not take folic acid supplements?
What is the Relative Risk (RR) associated with folic acid supplements for
neural tube defects? What does it means?