Laboratory Exercise No.

1:
MEASURES OF DISEASE FREQUENCY

Objectives:

At the end of this laboratory exercise, the student should be able to:
1. Differentiate incidence and prevalence rates;
2. Use the appropriate formula for each problem, and;
3. Compute for the appropriate rates asked.

Introduction:

Measures of disease frequency quantify the burden and development of disease in populations.
Two common measures of disease frequency are prevalence and incidence. Prevalence provides
a snapshot of the amount of disease that is present at a specific point or period in time. Prevalence
data are useful for raising awareness of disease and allocating health resources but may be
insufficient for establishing temporal relationships between potential risk factors and disease.
Incidence describes the development of new disease over time. In a given population, the
prevalence of a disease is proportional to the incidence and the disease duration.

Problems:

1. Researchers examine the association of beta-carotene supplement use with diabetes. They
identify 20 patients who report regular use of beta-carotene from a local clinic and 20 patients
from the same clinic who do not report use of beta-carotene. The researchers determine
diabetes status at the start of the study and then annually over 5 years of follow-up by querying
the patients’ electronic medical records. Raw study data are presented below.

New
Diabetes
Beta- Follow-up diabetes Reason for
Patient present at
carotene time diagnosed leaving
Number the start of
use (months) during study
the study
follow up
1 Yes 44 No Yes New diabetes
diagnosis
2 Yes 60 No No Study ended
3 Yes 32 No No Dropout
4 Yes 4- Yes No Lost to follow-
up
5 Yes 60 No No Study ended
6 Yes 60 No No Study ended
7 Yes 18 No Yes New diabetes
diagnosis
8 Yes 60 Yes No Study ended
9 Yes 32 No Yes New diabetes
diagnosis
10 Yes 60 No No Study ended
11 Yes 60 No No Study ended
12 Yes 50 No No Dropout

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13 Yes 26 Yes No Lost to follow-
up
14 Yes 28 No No Lost to follow-
up
15 Yes 34 No No Dropout
16 Yes 8 No Yes New diabetes
diagnosis
17 Yes 60 No No Study ended
18 Yes 60 No No Study ended
19 Yes 40 No Yes New diabetes
diagnosis
20 Yes 60 Yes No Study ended
21 No 20 No Yes New diabetes
diagnosis
22 No 48 No No Lost to follow-
up
23 No 44 No Yes New diabetes
diagnosis
24 No 42 No No Dropout
25 No 6 No No Dropout
26 No 60 No No Study ended
27 No 60 No No Study ended
28 No 28 No No Lost to follow-
up
29 No 60 No No Dropout
30 No 12 No No Lost to follow-
up
31 No 22 No No Dropout
32 No 30 No Yes New diabetes
diagnosis
33 No 60 No No Lost to follow-
up
34 No 22 No Yes New diabetes
diagnosis
35 No 28 No No Lost to follow-
up
36 No 60 Yes No Study ended
37 No 60 Yes No Study ended
38 No 24 No Yes Dropout
39 No 20 No No Dropout
40 No 50 No No Lost to follow-
up

1.1. What is the prevalence of diabetes in this study population at the start of the study
(baseline)?

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 1.2. What is the incidence proportion of diabetes in this study population during follow-
up?

1.3. What is the incidence proportion of diabetes among patients who use beta-
carotene?

1.4. What is the incidence rate of diabetes among patients who use beta-carotene?

1.5. What is the incidence rate of diabetes among patients who do not use beta-
carotene?

2. Triple antiviral therapy has dramatically improved survival among patients with human
immunodeficiency virus (HIV) disease. If the incidence of HIV were to remain constant, what
is the expected impact of widespread triple antiviral therapy on the prevalence of HIV in the
population?
a. Increase
b. Decrease
c. Stay the same
3. The incidence of a disease is five times greater in men compared with women, yet there is no
difference in disease prevalence by sex. What is the best explanation for this finding?
a. Men receive more intensive medical care for the disease.
b. The mortality rate is greater among women.
c. The disease is less aggressive among women.
d. Women are older than men when they are diagnosed with the disease.
4. Anecdotal evidence suggests that anxiety disorder may contribute to the irritable bowel
syndrome (IBS), a condition characterized by nausea, alternating constipation and diarrhea,
and no identifiable gastrointestinal pathology. Researchers administer an online questionnaire
regarding IBS symptoms to 10,000 people who have an established diagnosis of anxiety
disorder in the United States, Canada, and Mexico. They administer the same questionnaire

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 to another 10,000 people from the same countries who do not have a diagnosis of anxiety
disorder. Their findings are tabulated below.

IBS symptoms No IBS symptoms

Anxiety disorder (N = 10,000) 4000 6000
No anxiety disorder (N = 1000 9000
10,000)

4.1. Which of the following is true?

a. The incidence proportion of IBS symptoms among people with anxiety dis-
order is 40%.
b. The incidence density of IBS symptoms among people with anxiety disorder is
40%.
c. The prevalence of IBS symptoms among people with anxiety disorder is 40%.
d. The relative risk of IBS symptoms among people with anxiety disorder is 40%.
4.2. Which of the following represents a reasonable next step based on the study
findings?
a. Provide access to educational materials about IBS to patients who have
anxiety disorder.
b. Increase the use of antianxiety medications to prevent symptoms of IBS.
c. Submit case reports describing patients who have a diagnosis of anxiety
disorder with concomitant IBS symptoms.
d. Perform laboratory work to investigate mechanisms by which anxiety disorder
might stimulate gastrointestinal nerve transmission.
5. A company consults you to assess the risk of carpal tunnel syndrome among its employees.
You interview 1000 employees to inquire about their work status and whether they developed
carpal tunnel syndrome since working for the company. Results are shown below.

Number of employees New instances of carpal

tunnel syndrome
Full-time employees 800 25
Part-time employees 200 6
Incidence proportion among all employees = (31 cases/1000 people) x 100% = 3.1 %

The CEO of the company is concerned that this amount of carpal tunnel syn- drome is
considerably higher than that of a competitor company.

5.1. Which denominator would permit the most accurate comparison of the incidence
of carpal tunnel syndrome between the two companies?
a. Number of employees
b. Number of sedentary hours
c. Number of person hours
d. Number of carpal tunnel syndrome cases

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