EPIDEMIOLOGY Lecture 2: Measuring Disease FrequencyWhat did we learn in Lecture 1? A quick Recap * Definition of epidemiology — “The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the prevention and control of health problems” * The Epidemiological Approach — Asking Questions — Making comparisons * The aims of epidemiology — Describe disease — Distribution, frequency = Identify etiological factors = Provide data for planning and implementation and for priority settingLecture Objectives By the end of this lecture, the student will be able to: 1. Describe the tools of measurements in epidemiology. 2. Enumerate the FIVE elements in a rate. 3. Define and differentiate between incidence and prevalence. 4. Enumerate types of prevalence. 5. Calculate the prevalence of a disease/health- related behavior in a population.* Operational Definition: — “A definition embodying criteria used to identify and classify individual members of a set or concept to facilitate classification and counting.” * Population at risk: — “People who are potentially susceptible to the disease under study”. — “The group of people, healthy or sick, who would be counted as cases if they had the disease being studied”.Population at risk in a study of carcinoma of the cervix Total population All women Population at risk (age groups)we TelrelsRATIO * “The value obtained by dividing one quantity by another” * Example: Sex ratio, Child-woman ratioRATE * “the frequency with which an event occurs in a defined population, usually in a specified period of time”. * Example: Incidence ratePROPORTION * “The ratio of a part to the whole, expressed as a “decimal fraction” (e.g., 0.2), as a “common fraction” (1/5), or as a percentage (20%)”. The proportion is a dimensionless quantity. * Example: Proportion of diabetics in a population.The FIVE elements (or components) of arate > Population events in a specified ulation during a specified i Rate = = - —= Average population during the period : Time rarer elsINCIDENCE — WHAT IS IT? * “the number of new health-related events in a defined population within a specified period of time. It may be measured as a frequency count, a rate, or a proportion”. The incidence of disease represents the rate of occurrence of new cases arising ina given period in a specified populationPREVALENCE — WHAT IS IT? * “total number of individuals who have an attribute or disease at a particular time (it may be a particular period) divided by the population at risk of having prevalence is the frequency of existing cases in a defined population at a given point in time. population who have a disease or condition. * When used without qualification, the term usually refers to the situation at a specified point in time (point prevalence). * Itis a proportion, not a rate.Table 2.2. Differences between incidence and prevalence Incidence Prevalence Numerator Number of new cases of disease Number of existing cases of disease during a specified period of time at a given point of time Denominator Population at risk Population at risk Focus Whether the event isanewcase Presence or absence of a disease Time of onset of the disease Time period is arbitrary; rather a “snapshot” in time Uses Expresses the risk of becoming ill Estimates the probability of the ‘The main measure of acute population being ill at the period of diseases or conditions, but also _—time being studied. used for chronic diseases More useful for studies of causation Useful in the study of the burden of chronic diseases and implication for health services Note: If incident cases are not resolved, but continue over time, then they become existing (prevalent) cases. In this sense, prevalence = incidence x duration.* “total number of individuals who have an attribute or disease at a particular time (it may be a particular period) divided by the population at risk of having the attribute or disease at that time or midway through the period”, * A measure of occurrence or disease frequency, often used to refer to the proportion of individuals in a population who have a disease or condition. * It refers to NEW+OLD cases of the disease.How is prevalence calculated? ia Number of people with the disease or condition at a specified time Prevalence = : - - (x100) Number of people in the population at risk at the specified time a* Point prevalence — The proportion of individuals with a disease or an attribute at a specified point in time.* Period prevalence * The proportion of individuals with a disease or an attribute at a specified period of time. * To calculate a period prevalence, the denominator used most commonly is the ‘population at risk midway through the period’ (e.g., mid-year population)* Lifetime prevalence — The proportion of individuals who have had the disease or condition for at least part of their lives at any time during their lifecourse.Increased by: Longer duration of the disease Prolongation of life of patients without cure Increase in new cases (increase in incidence) In-migration of cases Out-migration of healthy people In-migration of susceptible people Improved diagnostic facilities (better reporting) ———— Decreased by: Shorter duration of the disease High case-fatality rate from disease Decrease in new cases (decrease in incidence) In-migration of healthy people Out-migration of cases Improved cure rate of cases* Estimate the magnitude of health/disease problems in the community and identify potential high-risk population groups. Assessing the need for preventive action, healthcare and the planning of health services. Prevalence is a useful measure of the occurrence of conditions for which the onset of disease may be gradual, such as hypertension, diabetes or rheumatoid arthritis.* Prevalence studies do not usually provide strong evidence of causality.EXERCISES * Calculate the prevalence of disease in the given situations. * SITUATION 1: * Ina population of 30000, 200 adolescents girls are anemic. Calculate the prevalence of anemia among adolescent girls if adolescent girls comprise 10% of the population?* SITUATION 2: Dec 31, Population at risk =200 (on 1 July, 2013)