16/11/2010

Overview of Epidemiology

Definition

Epidemiology 1

Purpose

The scientific study of the distribution of diseases and injuries in populations, and their causes and risk factors To identify things in people and their surroundings that affect the occurrence of disease or injury Characteristics or habits that are consistently more common in those who suffer from a disease than in those who do not

Occupational Epidemiology

Risk factors

Epidemiological Model (Injury)

Person Injured (host: characteristics and behaviours)

Occupational Epidemiology

Usually dealing with

Young or middle-aged adults Relatively healthy (well enough to work)

Agent of Injury (agent is energy: mechanical, chemical, physical) Environment (physical and social environment: place in which the host and the agent interact)

Important to remember

Occupational risk factors (hazards) Multi-causation

In this session

Epidemiology

Accident Statistics and Rates Disease Rates

Injury Epidemiology

Disease Epidemiology

Incidence and Prevalence

General approaches to conducting an epidemiological study

(3 of the 4) major types of study

Suicide Violence Road traffic Workplace

Measures of disease frequency Types of studies used in epidemiology

Cross-sectional Cohort Case Control (Randomised control trial session 2)

Interested in

Interested in

Mortality (fatality) Severity of injury

Mortality (fatality) Morbidity

16/11/2010

Rates

Numerator and Denominator

Commonest use is percent (out of 100) Can be out of any number

Numerator

With populations it is most often out of 10,000 or 100,000 With occupational populations it can be out of 1,000, 10,000 or 100,000 (employees) The out-of number is the bottom number in the fraction (denominator)
3 out of 4 is 75% is 75/100

Top number Always above the line , 3 is the numerator Usually the number of occurrences of the disease or injury

Denominator

Bottom number Always below the line , 4 is the denominator Denominator is usually a unit of exposure:

Numerator should only come from the population in the denominator

can be the number of people in the population at risk (e.g. employees) can be the number of man-hours worked

5 deaths -----------------------------10,000 employees

Denominator is usually multiplied by 100, 1,000, 10,000 or 100,000 to get the rate

Work-related fatalities 2009

There were 43 deaths -----------------------------There were 1,887,600 employed = 0.0000227 deaths for every 1 person employed

Better to choose a denominator that makes the numerator easier to deal with 43 deaths ---------------------- x 100,000 1,887,600 employed

= 2.27 deaths per 100,000 employed

Accident Rates: Incidence rate

Accident Rates: Incidence rate

No. of accidents (usually lost-time) Rate is expressed as a proportion of the number of employees (often the average employed) Unit of Usually worked out for a time period, e.g. year exposure Usually worked out per 1,000 employees
Numerator = Total no. of accidents ---------------------------------------------------X 1,000 Denominator = Total (or average) no. of employees Population at risk

An important rate Is essentially the risk With all rates, we are using patterns and trends from what happened in the past to attempt to predict the potential future Risk assessment by any other name!

16/11/2010

Accident Rates: Frequency Rate

Accident Rates: Severity Rate

Unit of

Frequency is the number accidents that occur

Usually lost-time accidents

Unit of exposure

Rate is expressed as a proportion of man-hours worked Usually worked out for a time period, e.g. month or year Usually worked out per 100,000 hours worked

exposure The total no. of days lost Rate is expressed as a proportion of number of man-hours worked Usually worked out for a time period, e.g. year Usually worked out per 1,000 hours worked

Numerator = Total no. of accidents (e.g. in a year) ---------------------------------------------------- X 100,000 Denominator = Total man-hours worked (e.g. in a year)

Numerator = Total no. of days lost ---------------------------------------------------X 1,000 Denominator = Total no. of man-hours worked

Accident Rates

Rate is 2 (!)

Fatality rate for work-related accidents in Ireland in 2009 was 2 per 100,000 employed

Mean duration rate

Mean number of days lost per accident

What rate? Need to know

Numerator = Total no. of days lost (as a result of X accidents) ------------------------------------------------------------------------- x 1,000 Denominator = X accidents

What the nominator represents What the denominator represents What the multiplier is gender age sector

Often see the rates provided by (distribution)

685,500 days lost ______________ 42,000 accidents

23.5 (mean no. of days lost per accident)

Remember rules for comparisons, compare like with like Performance measurement over time within a company or within a country

Some Typical (Accident) Variables

Typical accident distributions

Time of accident Day of week of accident Month of accident Location of accident Part of body injured Nature of injury Agent of injury Age of injured person Gender of injured person

Remember ESAW? Remember IR1 form?

Injury type by gender Injured body part by sector Non-fatal injuries by absence from work Reported fatal injuries by employment status Reported fatalities (worker and non-worker) by economic sector and age band See most recent HSA Report on Injury and Illness Statistics

16/11/2010

Relevance of injury rates

Measures of disease frequency

Help us to measure the risk of injury It gives us an estimate of what may happen in the future

Incidence and Prevalence

Different ways of measuring the occurrence or the frequency of disease Cases are counted and presented as rates (as a proportion of the total population at risk)

Incidence

Prevalence

Often expressed as a %

The rate at which new cases (of a disease) occur in a population during a specified time period
Unit of exposure

Numerator = No. of new cases over a time period --------------------------------------------------------------Denominator = Population at risk during the same time period

The number of people in a population that have a disease (cases) either

Numerator = No. of cases at a given time -----------------------------Denominator = Number at risk at that time Unit of exposure

At a particular point in time (point prevalence)

No. of new cases of occupational asthma over a time period -----------------------------No. of employees at risk during the same time period

OR Over a stated time period

No. of cases during a given time period -----------------------------Number at risk during that time period

Incidence and Prevalence

Amount of water coming out of a tap Incidence, new cases during a specified period of time

Incidence and Prevalence

Incidence, new cases during a specified period of time NEW Cases

Amount of water in the bath

Prevalence, number of existing cases at a point in time

Prevalence, number of existing cases at a point in time ALL Cases Prevalence influenced by leakage: People who recover People who die

16/11/2010

Incidence and Prevalence

Low Incidence High Prevalence

Uses of Incidence and Prevalence Rates

Information about future health needs (I) Information about continuing care needs (P) Estimates of need for specific interventions (I) Estimates of need for rehabilitation (P) Need for early emergency treatment (I) Need for rehabilitation (P) Estimates of demands for GP services (I)

Low Prevalence High Incidence

Chronic diseases

Short lived diseases

Few deaths but low cure Diabetes Multiple Sclerosis

Rapidly cured or rapidly fatal Ebola virus

Flu epidemic

More information about rates

2 Broad categories of Studies

Other important national rates

Observational

Birth rates Mortality rates

Researcher measures but does not intervene

Types of rates

Experimental

Crude rates (for the whole population) Specific rates (rates by age or gender) Standardised rates (more in Epidemiology 2)

Active attempt to change a determinant (an exposure or behaviour) or the progress of a disease through an intervention (treatment)

2 Broad categories of study

Observational

Some Typical (Disease) Variables

Experimental

Disease

Descriptive / Analytical Ecological Cross-sectional Case-Control Cohort

Intervention or experimental studies

Presence or absence Presence or absence Extent of exposure (dose-response relationships) Personal or biological monitoring data Air/Noise monitoring data

Exposure

Randomised Control Trials (RCTs)

Age Gender Occupation Location

Investigator passively observes as nature takes its course

Investigator actively decides which group gets intervention / treatment

More in Epidemiology 2

16/11/2010

Main Types of Observational Studies

1. 2.

1a Descriptive Studies

Descriptive and analytical Ecological Cross-sectional Case-Control Cohort

Description of the health of a population Often based on routinely available data

May be obtained in surveys

(e.g. HSA statistics) (e.g. QNHS)

3. 4. 5.

Describes patterns of disease by gender, age, geography, time (distribution) No attempt to analyse links between exposure and effect.

1b Analytical Studies

2. Ecological Studies

Analyses relationships between health status and other variables Explains and predicts population health Looks for an association between risk factors and outcomes

Looks at the strength of the association

Causation criteria will be covered in Epidemiology 2

Criteria needed to establish causation

Also known as correlational Units of analysis are populations (not individuals) Can compare populations in different places Can compare same population at different times

3. Cross-sectional study

3. Cross-sectional Studies

AKA Prevalence Studies Often involves a random sample of a population Measures exposure and effect at the same time Useful for assessing health-care needs Good for giving us information such as:

May give us information about associations between variablesbut do not tell us anything about causation

Prevalence of bone and joint pain in workers (QNHS) Prevalence of self-reported work-related stress in workers (QNHS)

Because exposure and effect data are collected at the same time, there is no way of telling how the exposure and effect are related in time

16/11/2010

4. Case-Control Study

4. Case-Control Studies

Includes cases (individuals with a particular disease) Includes controls (comparison group of individuals without the disease) Compares the occurrence of the possible cause by examining history of both cases and controls Collects data on disease occurrence at one point in time and on exposure occurrence at a previous point in time.

Can be done relatively quickly Good for investigating causes of rare diseases Good for diseases with long latency Retrospective study Can estimate the Relative Risk (RR) of Disease

4. Case Control Study

Direction of inquiry

4. Case-Control Study

Exposed Not exposed

Compare proportions with exposure

Selected on basis of Disease

Cases

Population Cases

Retrospective case control Refers to timing of data collection All data deal with the past

Exposed Not exposed

Time

Selected on basis of no Disease

Prospective case control Refers to timing of data collection Data collection continues with the passage of time

4. Case-Control Studies

5. Cohort Study

Typically calculate the odds of being a case among the exposed compared to the odds of being a case among the non-exposed. The ratio of these two odds is called the ODDS RATIO
a /b c /d

AKA follow-up studies, incidence studies, or longitudinal studies Cohort is a group with a common characteristic or experience Often referred to as prospective

Disease present Exposed Not exposed a c

Disease absent b d

Provide information about causation of disease

Will come back to this

Best where disease is relatively common

Risk factors are the suspected causes

16/11/2010

5. Cohort Study
Direction of inquiry

Purpose to determine cause of disease

Retrospective or Prospective???
Cohort study

Disease
Exposed to risk factor Population People without Disease

No Disease

Compare % with risk factor who get disease with % without risk factor who get disease

Not exposed to risk factor

Disease No Disease

Normally prospective (forward looking) However, data collection CAN be done retrospectively and it is then known as a historic or retrospective cohort Uses exposure data to determine cause of disease E.g. use company records to identify individuals with past exposure to a specific hazard

Time

Question

Bophal disaster 1984

What kind of study would have been appropriate for acute effects within a short time-frame of the incident? What kind of study might would have been appropriate for chronic effects that might emerge over the following years?

Summary

Accident rates and accident statistics Measures of disease frequency

Incidence and Prevalence Cross-sectional Case-control Cohort

Types of study