Definitions in Epidemiology

The number of patients identified correctly as sick - True positive

The number of healthy people identified wrongly as sick- False positives
When healthy people are correctly identified as healthy -True negative
People who are sick have been wrongly identified as healthy - False negative
Few false negatives - High sensitivity
Many false negatives - Low sensitivity
Means few false positives - High specificity
Means many false positives - Low specificity

Mnemonic:

With regards to seNsitivity :- note false Negatives

With regards to sPecificity :- note false Positives

Relative risk (RR)

Is used to compare the risk in two different groups of people.

For example, consider the risk for blindness in a patient with diabetes over a
5-year period. If the risk for blindness is 4 in 100 (4%) in a group of patients
treated conventionally (control group) and 3 in 100 (3%) in patients treated
with a new drug (experimental group), the relative risk is the ratio of the two
risks: - 3% / 4% = 75% ( or 0.75)

Exam tip
Risk ratios are an important topic in PLAB as it is one of the main epidemiologic
questions asked.

A good formula to memorize for PLAB part 1 for Relative risk (RR) is:
Relative risk (RR) = Risk of disease in exposed / risk of disease in unexposed

Other clinical study related definitions

Case series and case reports.

These are reports of cases and use no control groups or patient groups to
compare outcomes in between them. They are comparable to writing a report
on a topic that you have read.

Case-control study.

This is a study in which patients who already have a definite condition are
compared with people who do not have that particular condition. These study
designs are observational, meaning that researches study but do not modify
what occurs. They look back in the past to assess if there was a significant
alteration in the rates of exposure to a defined risk factor between the groups.
Example, group X consist of patients with liver cancer and group Y consist of
patients without liver cancer. Information is collected observing at back at their
 alcohol history. The hypothesis would be that drinking alcohol would incur a
higher risk of liver cancer

Cohort study.

These studies identify a group of people who share a defining feature. This
group is then compared with a similar group of people with the same defining
feature. Cohort studies are simply observational and may be
Prospective(going forward in time) or retrospective ( going back in time).
Because these studies are observational, the researchers (similar in case-
control studies) do not interfere with the groups of people. Example of a
prospective cohort study, group X are patients who drink alcohol, group Y are
patients who do not drink alcohol. They are followed in time to determine who
develops liver cancer.

Difference between a case-control study and a retrospective cohort study are:-

In case-control, one starts with the outcomes and studies the exposure.
In retrospective cohort studies, one already has determined the exposure but
now needs to study the relationship of exposure to disease outcome.

Randomised controlled clinical trial.

These are experiments that introduce a treatment or exposure to study its

effect on real patients. It generally compares an active group with a control
group and employs methods such as randomization and blinding to reduce
bias. Normally, new drugs are tested this way. Example, a group of patients
with disease X who meet specific criteria, are randomly assigned to receive
either the experimental treatment or the control treatment (either the standard
treatment for disease X or a placebo). Both groups are then followed in time,
and the outcomes are observed.

Cross-sectional study.

This is a study that describes the relationship between diseases and other
factors at one point in time in a defined population. They are often used for
comparing diagnostic tests. A good example would be researchers conducting
a survey on a population to determine the relationship between increased
levels of serum cholesterol and electrocardiographic evidence of coronary
artery disease. Both the exposure and the disease outcome are taken at the
same point of time. It is similar to a snapshot of a population at a specific time.

Systematic review.

This focuses on a clinical topic and answers a specific question that surfaces

Meta-analysis.
 This is a study that examines a number of studies on a topic and
mathematically combines the results to report the results as if it were one
large study.

Risk reduction
An absolute risk (AR) is the number of diseased in treated or control groups,
divided by the number of people in that group
o For example, say you have a 1 in 10 risk of developing a certain
disease in your life. This can also be said to be a 10 % risk , or a 0.1
risk - depending on whether you use percentages or decimals.
Relative risk(RR) is: Incidence in exposed divided by incidence in non
exposed
Relative risk reduction (RRR) tells you how much the treatment reduced the
risk of developing the disease relative to the control group.

Absolute risk (AR) of events in the control group (ARC): A / (A + B)

Absolute risk (AR) of events in the treatment group (ART): X / (X + Y)
Absolute risk reduction (ARR): ARC - ART
Relative risk reduction (RRR): ( ARC - ART) / ARC

Calculations in Epidemiology

Positive predictive value

It is the proportion of positives that are true positives

Calculation :- X/ (X+Y)

Negative predictive value

It is the proportion of negatives that are true negatives

Calculation :- B/ ( A+B)

Accuracy

It is the probability that a patient will be correctly classified

 Calculation :- (X+B) / (X+Y+A+B)

Sensitivity

Correctly identifies when the patient is sick

Calculation :- X/ (X+A)

Specificity

Correctly identifies those who are Fit

Calculation :- B / ( B+ Y)