FREQUENCY

Student Doctor Yazmine Lee, MD3

Washington University of Health and Science
PREVELANCE
VS
INCIDENCE
EQUAL OR UNEQUAL?
 PREVALENCE
is the fraction (proportion or percent) of
a group of people possessing a clinical condition oroutcome at a given point in time.

Prevalence is measured by surveying a defined population and counting the number of people with
and without the condition of interest.

◦ALL CASES
◦CHRONIC CONDITIONS
◦POINT OR PERIOD
 Point • measured at a single point in time for each person
(although actual measurements need not necessarily be
prevalence made at the same point in calendar time for all the
people in the population).

Period • describes cases that were present at any time during a

prevalence specified period of time.

TYPES OF PREVALENCE
 INCIDENCE
fraction or proportion of a group of
people initially free of the outcome of interest that develops the condition over a given period of time.

◦NEW CASES
◦ACUTE CONDITIONS
◦ATTACK RATE
 CHARACTERISTICSS OF
INCIDENCE & PREVALENCE
 PREVALENCE AND
INCIDENCE ARE
MEASURED BY ENTIRELY
DIFFERENT KINDS OF
STUDIES.
 people in a population are

examined for the presence of the

condition of interest.
PREVALENCE
STUDIES Some members of the population have
the condition

at that point in time, whereas others do

not
 The population under examination in an incidence
study is a cohort, which is defined as a group of
people having something in common when they are
first assembled and are then followed over time for
the development of outcome events.
INCIDENCE
STUDIES
For this reason, incidence studies are also called
cohort studies.
◦ To this point, the term “incidence” has been used
to describe the rate of new events in a group of
people of fixed size, all members of which are CUMULATOVE
observed over a period of time.
◦ This is called cumulative incidence because new
INCIDENCE
cases are accumulated over time.
 Incidence Density (Person-Years)

Another approach to studying

The incidence derived from
incidence is to measure the
studies of this type is called
number of new cases emerging
incidence density because it is,
in an ever-changing population,
figuratively speaking, the
one in which individuals are
density of new cases in time
under study and susceptible for
and place.
varying lengths of time.
 In an effort to keep the contribution of individual
patients commensurate with their follow-up interval,
the denominator of an incidence density measure is
not persons at risk for a specific time period but
person-time at risk for the outcome event.

Incidence
Density The person-years approach is especially useful for
estimating the incidence of disease in dynamic
populations, those in which some individuals in the
population are entering and others leaving it as time
passes.

CONT…
This approach works because the proportion of
people who enter or leave is small, relative to the
population as a whole so the population is likely to be
relatively stable over short periods of time.
 THE PERSON-YEARS APPROACH IS ESPECIALLY USEFUL FOR ESTIMATING THE
INCIDENCE OF DISEASE IN, DYNAMIC POPULATIONS THOSE IN WHICH SOME
INDIVIDUALS IN THE POPULATION ARE ENTERING AND OTHERS LEAVING IT AS
TIME PASSES.
BASIC ELEMENTS OF
FREQUENCY
STUDIES
NUMERATOR CASE
DENOMINATOR POPULATION
 DEFINITIONS
sampling fraction:
the fraction of all Over sample: randomly
members of each select a larger fraction
subgroup included in the
sample.

grab samples:
investigators just
convenience samples:
grabbed patients
convenient to obtain
wherever they could find
them
 An epidemic is a concentration of new cases in
time.

The term pandemic is used when a disease is

especially widespread, such as a global epidemic
TIME of particularly severe influenza (e.g., the one in
1918–1919) and the more slowly developing but
world-wide rise in HIV infection/AIDS.
The existence of an epidemic is recognized by
an epidemic curve that shows the rise and fall
of cases of a disease over time in a population.
 The geographic distribution of
cases indicates where a disease
causes a greater or less burden
of suffering and provides clues
to its causes.
PLACE
When a disease such as iodine
deficiency goiter or polio (after
global efforts to eradicate it) is
limited to certain places, the
disease is called endemic.
 ◦ When disease affects certain kinds of persons at the
same time and in the same places as other people
PERSON who are not affected, this provides clues to causes
and guidance on how health care efforts should be
deployed.
REVIEW QUESTIONS
Cancer registries report
40 new cases of A. Point prevalence
bladder cancer per
100,000 men per year.
Cases were from a B. Period prevalence
complete count of all
patients who developed
bladder cancer in C. Incidence density
several regions of the
United States, and the
number of men at risk D. Cumulative incidence
was estimated from
the census data in those
regions. Which rate E. Complication rate
is this an example of ?
 Sixty percent of
adults in the U.S.
population A. Point B. Complication C. Incidence
have a serum prevalence rate density
cholesterol
>200mg/dL (5.2
mmol/L). Which
rate is this an D. Cumulative
Incidence
E. Period
prevalence
example of ?
 You are reading a
study of the
◦ A. Participants are followed up for a sufficient period
prevalence of of time for anemia to occur.
uterine cervix ◦ B. The study is done on a representative sample of
infections and want the population.
to decide if ◦ C. All members of the population are women.
the study is ◦ D. Cervical infection is clearly defined.
scientifically sound. ◦ E. The study is done on a sample from a defined
population.
Which of the
following is not
important?
 A. Is invalidated by oversampling.

A probability B. Is inferior to a random sample.

sample of a
defined C. Is not representative of the population.
population:
D. Results in a representative sample of the
population only if there are enough people
in the sample.
 The incidence of
A. 10 B. 25
rheumatoid arthritis is
about
40/100,000/year and
C. 33 D. 40
the prevalence is
about 1/100 persons.
On average, how
many
E. 50 years does the disease
persist?
 A. The proportion of patients with stomach cancer who
survive 5 years

Which of the B. The risk of developing diabetes mellitus in children

according to their weight

following
studies is not C. Complications of influenza vaccine among children
vaccinated in 2011

a cohort
study? D. The earlier course of disease in a group of patients now
under care in a clinic

E. Patients admitted to an intensive care unit and followed

up for whether they are still alive at the time of hospital
discharge
A. Stratified sample
A sample for a
study of incidence
B. Probability sample
of
medication errors is
obtained by
C. Convenience sample enrolling
every 10th patient
admitted to a
D. Random sample hospital.
What kind of
sample is this?
E. Oversample
 Cohort studies of
children with a first
A. Point prevalence
febrile
seizure have shown B. Complication rate
that they have a
one in C. Cumulative Incidence
three chance of
having another D. Period prevalence
seizure during
childhood. What
kind of rate is this?
E. Incidence density
A. More aggressive efforts to detect the
disease
Which of the
B. A true increase in incidence following
would not
C. A more sensitive way of detecting
the disease increase
the observed
D. A lowering of the threshold for
diagnosis of disease incidence of
disease?
E. Studying a larger sample of the
population
 Infection with a
fungus, A. Endemic
coccidioidomycosis,
is common in the B. Pandemic
deserts of the
southwestern
United States and in C. Incident
Mexico, but
uncommon
elsewhere. Which of D. Epidemic
the following best
describes this E. Prevalent
infection?
 Twenty-six percent of adults report having
experienced back pain lasting at least a day in
the prior 3 months. Which of the following
best describes this rate?

A. CUMULATIVE B. INCIDENCE C. POINT D. E. PERIOD

INCIDENCE DENSITY PREVALENCE COMPLICATION PREVALENCE
RATE
 A. It is rapidly increasing in size.

Which of the
following B. It is uniquely suited for cohort studies.

best C. People are continually entering and leaving the

describes a
population.

“dynamic D. It is the basis for measuring cumulative

ncidence.

population”?
E. It is the best kind of population for a random
sample.
 For a study of the A. Children born in North Carolina in 2012 and
incidence of examined for scoliosis until they are adults
idiopathic
B. Children who were referred to an orthopedic
scoliosis (a surgeon for treatment
deformity of the
spine that becomes C. Children who were found to have scoliosis in a
survey of children in North Carolina
apparent after
birth, most often in D. Children who have scoliosis and are available for
study
adolescence),
which would be an E. Children who were randomly sampled from the
appropriate population of North Carolina in the spring of 2012
cohort?
Which of the A. Describing the
incidence of disease
B. Studying diseases
that resolve rapidly

following are
prevalence C. Estimating the
D. Describing the
proportion of people
studies
duration of disease
in a

especially
useful for?
defined population
E. Establishing cause
with the condition of
and effect
interest
 Last year,
800,000
Americans died
of heart A. Incidence
density
B. Point
prevalence
C. Cumulative
Incidence
disease or stoke.
Which of the
following best D. Period E. None of
describes this prevalence the above

statistic?