EXERCISE 1

Incidence and prevalence are two different measures used in epidemiology to describe the occurrence of health-related events in a
population. Here's how each scenario is related to incidence or prevalence:

1. Number of campers who developed gastroenteritis within a few days after eating potato salad at the dining hall:
 Related to Incidence: This scenario is more closely related to incidence because it involves the number of new
cases (campers who developed gastroenteritis) within a specific time frame after a particular event (eating
potato salad).
2. Number of persons who reported having diabetes as part of the National Health Interview Survey:
 Related to Prevalence: This scenario is more closely related to prevalence because it involves the total number
of individuals who currently have diabetes (regardless of when they were diagnosed) at a specific point in time
(when the survey was conducted).
3. Occurrence of acute myocardial infarction (heart attack) among participants during the first 10 years of follow-up
of the Framingham Study:
 Related to Incidence: This scenario is related to incidence because it focuses on the number of new cases
(occurrence of heart attacks) within a specific time frame (the first 10 years of follow-up).
4. Number of children who have immunity to measles, either because they had the disease or because they received
the vaccine:
 Related to Prevalence: This scenario is more closely related to prevalence because it involves the total number
of individuals (children) with immunity to measles at a specific point in time, regardless of when they acquired
immunity (whether through having the disease or vaccination).

In each of the following conditions, let's determine whether incidence (per 1,000 persons per year) or prevalence (per 1,000 persons
on July 1st) is likely to be higher:

5. Rabies (occurs rarely and has a short duration, e.g., death within one week):
 Likely Higher Incidence: Rabies occurs rarely, and it has a short duration. Therefore, the number of new cases
within a year (incidence) is likely to be higher compared to the number of people currently having rabies on July
1st (prevalence).
6. Multiple sclerosis (rare occurrence, long duration [many years]):
 Likely Higher Prevalence: Multiple sclerosis is a rare occurrence but has a long duration. Given its long
duration, the number of individuals currently living with multiple sclerosis on July 1st (prevalence) is likely to be
higher compared to the number of new cases within a year (incidence).
7. Influenza (common but winter-seasonal occurrence, short duration):
 Likely Higher Incidence: Influenza is a common but seasonally occurring disease with a short duration. Since
the survey was conducted on July 1st, the prevalence may be lower, and the incidence (new cases per year) is
likely to be higher.
8. Poison ivy dermatitis (common spring/summer/fall occurrence, 2-week duration):
 Likely Higher Incidence: Poison ivy dermatitis is a common occurrence during certain seasons with a short
duration. Similar to influenza, the prevalence may be lower on July 1st, and the incidence (new cases per year) is
likely to be higher.
9. High blood pressure (not uncommon occurrence, lifelong duration):
 Likely Higher Prevalence: High blood pressure is not an uncommon occurrence, and it typically has a lifelong
duration. Given its chronic nature, the number of individuals currently having high blood pressure on July 1st
(prevalence) is likely to be higher compared to the number of new cases within a year (incidence).
EXERCISE 2

1. Difference between Incidence and Prevalence Regarding the Numerator:

 Incidence: The numerator of incidence represents the number of new cases of a disease that occur within a
specified time period. It focuses on individuals who develop the disease during that time frame. The numerator
includes only new cases, and individuals may contribute to the numerator only once during the specified time
period.
  Prevalence: The numerator of prevalence represents the total number of existing cases of a disease at a specific
point in time or over a specific period. It includes both new and pre-existing cases. Individuals in the numerator
may have developed the disease at any time, and they can contribute to the numerator multiple times if the
disease is recurring.
2. Calculating Prevalence and Comparing with 1-Year Incidence:
 Prevalence at the Second Survey:
 Initial prevalence = Number of people with antibodies in the first survey = 25
 During the second survey, 35 people had antibodies, including the original 25.
 So, the additional cases = 35 - 25 = 10 (new cases in the 12 months between the surveys).
 Prevalence at the second survey = Initial prevalence + Additional cases = 25 + 10 = 35.
 1-Year Incidence:
 Number of new cases in the 12 months between the surveys = 10.
 Incidence rate per 1,000 persons = (Number of new cases / Total population surveyed) * 1,000
 Incidence rate = (10 / 5,000) * 1,000 = 2 per 1,000 persons.
 Comparison:
 Prevalence at the second survey (35) includes both existing and new cases.
 1-Year Incidence (2 per 1,000 persons) represents only the new cases during the 12 months.
 Prevalence is higher than 1-Year Incidence because it includes both pre-existing and new cases.
EXERCISE 4

Investigators enrolled 2,100 men in a study and followed them over 4 years to determine the rate of heart disease. The follow-up
data are provided below. We will calculate the incidence rate of disease. We assume that persons diagnosed with disease and those
lost to follow-up were diseasefree for half of the year, and thus contribute 1/2 year to the denominator. Initial enrollment: 2,100 men
free of disease After 1 year: 2,000 disease-free, 0 with disease, 100 lost to follow-up After 2 years: 1,900 disease-free, 1 with disease,
99 lost to follow-up After 3 years: 1,100 disease-free, 7 with disease, 793 lost to follow-up After 4 years: 700 disease-free, 8 with
disease, 392 lost to follow-up 1. Identify the number of cases diagnosed; 2. Calculate the total person-years; 3. Calculate the
incidence rate.
Let's calculate the incidence rate using the provided follow-up data. As mentioned, we assume that persons diagnosed with the
disease and those lost to follow-up were disease-free for half of the year and thus contribute 1/2 year to the denominator.

1. Identify the number of cases diagnosed:

 After 1 year: 0 cases
 After 2 years: 1 case
 After 3 years: 7 cases
 After 4 years: 8 cases
 Total number of cases diagnosed = 0 + 1 + 7 + 8 = 16 cases.
2. Calculate the total person-years:
 Initial enrollment: 2,100 men for 4 years = 2,100 * 4 = 8,400 person-years
 After 1 year: 2,000 men for 3.5 years (assuming 1/2 year for 100 lost to follow-up) = 2,000 * 3.5 = 7,000 person-
years
 After 2 years: 1,900 men for 3 years (assuming 1/2 year for 99 lost to follow-up) = 1,900 * 3 = 5,700 person-
years
 After 3 years: 1,100 men for 2.5 years (assuming 1/2 year for 793 lost to follow-up) = 1,100 * 2.5 = 2,750 person-
years
 After 4 years: 700 men for 2 years (assuming 1/2 year for 392 lost to follow-up) = 700 * 2 = 1,400 person-years
 Total person-years = 8,400 + 7,000 + 5,700 + 2,750 + 1,400 = 25,250 person-years
3. Calculate the incidence rate:
 Incidence rate = (Number of cases diagnosed / Total person-years) * 1,000
 Incidence rate = (16 / 25,250) * 1,000 ≈ 0.634 cases per 100 person-years.

Therefore, the estimated incidence rate of heart disease in this study is approximately 0.634 cases per 100 person-years.

EXECISE 5
 1. Meaning of the Statement:
 The statement "The 10-year risk that a 45-year-old male will develop prostate cancer is 5%" means that, based
on available data or risk assessment models, there is an estimated probability of 5% that a 45-year-old male will
develop prostate cancer within the next 10 years. This probability is a measure of the likelihood of the event
occurring over the specified time period. In terms of assumptions, this estimate relies on statistical models,
population data, and assumptions about the stability of risk factors over the given time frame.
2. Comparison of 5-Year and 10-Year Risk:
 The 5-year risk for the same person is typically expected to be smaller than the 10-year risk. This is because,
over a shorter time frame (5 years), the cumulative probability of developing prostate cancer is lower compared
to the longer time frame of 10 years. The risk estimates are influenced by various factors, and a shorter time
period generally implies a lower cumulative risk. However, the specific values would depend on the risk factors
and assumptions used in the risk assessment model.
Exercise 6

Let's calculate the cumulative incidence rate ratio for females versus males using the provided data, and then calculate the
cumulative incidence ratio for mill workers versus non-mill workers.

1. Cumulative Incidence Rate Ratio for Females vs. Males:

The formula for Cumulative Incidence Rate Ratio (CIRR) is:

����=Cumulative Incidence Rate in FemalesCumulative Incidence Rate in MalesCIRR=Cumulative Incidence Rate in MalesCumulative Inc
idence Rate in Females

First, calculate the cumulative incidence rates for females and males:

 Cumulative Incidence Rate in Females:

Number of Females with PellagraTotal Population of Females×1000Total Population of FemalesNumber of Females with Pellagra
×1000
 Cumulative Incidence Rate in Males:
Number of Males with PellagraTotal Population of Males×1000Total Population of MalesNumber of Males with Pellagra×1000

Then, use these rates to calculate the Cumulative Incidence Rate Ratio.

2. Cumulative Incidence Ratio for Mill Workers vs. Non-Mill Workers:

The formula for Cumulative Incidence Ratio (CIR) is:

���=Cumulative Incidence Rate among Mill WorkersCumulative Incidence Rate among Non-Mill WorkersCIR=Cumulative Incidence Rate a
mong Non-Mill WorkersCumulative Incidence Rate among Mill Workers

Given risk percentages:

 Cumulative Incidence Rate among Mill Workers = 0.9%

 Cumulative Incidence Rate among Non-Mill Workers = 4.4%

Calculate the Cumulative Incidence Ratio.

Interpretation:

 A CIRR greater than 1 indicates a higher risk of pellagra in females compared to males.
 A CIR less than 1 indicates a lower risk of pellagra among mill workers compared to non-mill workers.

Let's proceed with the calculations:

1. Cumulative Incidence Rate Ratio for Females vs. Males:

CIRR=(46/1,484)×1000(18/1,419)×1000CIRR=(18/1,419)×1000(46/1,484)×1000

2. Cumulative Incidence Ratio for Mill Workers vs. Non-Mill Workers:

CIR=0.94.4CIR=4.40.9

After calculating these values, we can interpret the results.

Exercise 7

o calculate the incidence rate ratios, we use the following formula:

Incidence Rate Ratio (IRR)=Incidence Rate in Exposed GroupIncidence Rate in Unexposed GroupIncidence Rate Ratio (IRR)=Incidence Rate in
Unexposed GroupIncidence Rate in Exposed Group

Let's calculate the incidence rate ratios based on the provided data:

1. Incidence Rate Ratio for Smokers of 1-14 cigarettes per day compared with nonsmokers:
���1−14=0.570.07IRR1−14=0.070.57
2. Incidence Rate Ratio for Smokers of 15-24 cigarettes per day compared with nonsmokers:
���15−24=1.390.07IRR15−24=0.071.39
3. Incidence Rate Ratio for Smokers of 25+ cigarettes per day compared with nonsmokers: ���25+=2.270.07IRR25+
=0.072.27

Now, let's calculate the values:

1. Incidence Rate Ratio for Smokers of 1-14 cigarettes per day compared with nonsmokers:
���1−14=0.570.07≈8.14IRR1−14=0.070.57≈8.14
2. Incidence Rate Ratio for Smokers of 15-24 cigarettes per day compared with nonsmokers:
���15−24=1.390.07≈19.86IRR15−24=0.071.39≈19.86
3. Incidence Rate Ratio for Smokers of 25+ cigarettes per day compared with nonsmokers:
���25+=2.270.07≈32.43IRR25+=0.072.27≈32.43

Interpretation:

 For smokers of 1-14 cigarettes per day, the incidence rate of lung cancer is approximately 8.14 times higher compared to
nonsmokers.
 For smokers of 15-24 cigarettes per day, the incidence rate of lung cancer is approximately 19.86 times higher compared
to nonsmokers.
 For smokers of 25+ cigarettes per day, the incidence rate of lung cancer is approximately 32.43 times higher compared to
nonsmokers.

Discussion:

The increasing incidence rate ratios with higher daily cigarette consumption suggest a dose-response relationship between cigarette
smoking and the risk of lung cancer. The data demonstrate a significantly elevated risk for lung cancer among individuals who
smoke, and the risk escalates with the intensity of smoking. This supports the strong association between smoking and lung cancer,
which has been widely established through epidemiological studies. The higher the daily cigarette consumption, the greater the risk
of developing lung cancer. These findings have been crucial in public health efforts to reduce smoking and prevent associated health
risks.
EXERCISE 8

he odds ratio (OR) is calculated as the ratio of the odds of an event in one group to the odds of the event in another group. In this
case, we want to calculate the odds ratio for having hay fever among children with eczema compared to those without eczema.

The formula for the odds ratio (OR) is given by:

��=Odds of hay fever in children with eczemaOdds of hay fever in children without eczemaOR=Odds of hay fever in children without eczema
Odds of hay fever in children with eczema

First, let's calculate the odds for each group:

Odds of hay fever in children with eczema=Number with hay fever and eczemaNumber with eczema but without hay feverOdds of hay fever in c
hildren with eczema=Number with eczema but without hay feverNumber with hay fever and eczema

Odds of hay fever in children without eczema=Number with hay fever but without eczemaNumber without eczema and without hay feverOdds of
hay fever in children without eczema=Number without eczema and without hay feverNumber with hay fever but without eczema

Now, plug these values into the odds ratio formula:

��=Odds of hay fever in children with eczemaOdds of hay fever in children without eczemaOR=Odds of hay fever in children without eczema
Odds of hay fever in children with eczema

��=141/420928/13,525OR=928/13,525141/420

Now, calculate the odds ratio.

��≈0.33570.0685OR≈0.06850.3357

��≈4.896OR≈4.896

So, the calculated odds ratio for having hay fever among 11-year-old children with eczema compared to those without eczema is
approximately 4.896.