Epidemiology Review Session Exam 1

Definition of health (WHO) = dynamic state of complete physical, mental,

spiritual and social well-being, not merely the absence of disease or infirmity
Public health = what we as a society do collectively to assure the conditions
in which people can be healthy
o Prevents epidemics and spread of disease
o Protects against environmental hazards
o Prevents injuries
o .
Role of public health in reducing mortality rate from infectious disease
(graph)
Describe work of John Snow and Ignaz Semmelweiss (what they are famous
for and how they are important to epidemiology)
Epidemiology = study of the distribution and determination.
Morbidity definition
Steps in the disease process
o Healthy disease onset symptoms seek care diagnosis
treatment outcome
Sources of morbidity data
o Reportable disease data*
o Disease registries*
o Medical records
Hospital stays
Emergency department visits*
Outpatient clinics
o Health insurance
o Surveys*
o Comments on social media*
Case definition = the formal criteria for deciding what is a case
o Consistent case definition makes comparisons possible over time and
across different areas
Incident case = new case of disease
o Onset of symptoms, new diagnosis or development
Incidence rate = number of new events that occur over a given time in a
specific population
o (# new cases occurring in the population during specified period of
time)/(# people at risk) x 1,000
Person time
o Sum of the time periods of observation of each person who has been
observed for all or part of the entire time period
Prevalent case = people affected by a condition, regardless or when the
condition first occurred
Prevalence (rate)
o (# of cases of a disease present in the population at a specified time)/
(# of people in population) x 1,000
o Snapshot taken at one point in time

Prevalence = Incidence X Duration

Surveys = method of gathering data directly from a group of people thought
to be representative of some population
o Take a sample of people and try to generalize to the population
o Type of data gathered using surveys
Answers to questions
Collecting clinical specimen
o Direct interaction with the person whose information is being collected
How are surveys different from other data sources we have studied?
o Death/birth certificates, medical records, reportable disease
Intended to collect information on all people in the population
No direct interaction with the person whose information being
collected
Administering interviews 4 aspects of a survey
o Script
o Skip patterns
o Open and close ended questions
o Non-verbal communication
Important surveys in the US
o Behavioral Risk Factor Surveillance System phone survey, asks about
risk factors for chronic illness
o Youth Risk Behavior Surveillance Survey done in high schools, asks
about risky behavior (drug use, alcohol use, sexual behavior)
o National Health and Nutrition Survey does physical exam
Survey steps
o Identify a population of interest
o Take a sample of the population
o Gain consent to participation
o Collect info
o Analyze info
o Disseminate info
Population of interest = the group of people you want to describe
Sample of the population = a subset of the population of interest from which
you collect your information
o Why choose a sample?
Not feasible to ask everyone
Dont need to ask everyone (if you do survey correctly)
Ways of administering a questionnaire
o In-person interview, telephone, mail/email, internet
Survey questions and corresponding measures
o Are you a smoker? = prevalence of smoking
o Did you start smoking in the last year? = incidence of smoking
initiation in the last year
Mortality = death
Death certificate
o Content, process of filling it out, how single cause of death is
established, ICD 10 coding

o Cause of death is the last line in part 1

o Part 2 are the contributing underlying conditions
Sources of inaccuracy in the cause of death
o Mistake in assigning the cause
o Desire to hide the cause
o Mistake in assigning the numeric code
Verbal autopsy
o Definition
o Challenges relative may not have same concept of disease, may be
in mourning, may not want to tell the truth
Mortality rate = rate at which death occurs in a population (death rate)
Annual all cause mortality rate
Age-specific (annual all cause) mortality rate)
o Restriction to a specified age group (must be applied to numerator and
denominator)
Cause-specific annual mortality rate
Age adjustment
o If you want to understand the burden of disease in a population
independent of their age differences use age standardization
o Age adjusted mortality rate (AAMR)
o Non-age adjusted = crude
Direct age standardization
o Choice of standard population is arbitrary
US 2000 population
Combination of the populations being compared
o Should not be markedly different from populations being compared
Leading causes of death = list of causes of death ranked by number of deaths
for each cause
o Diseases of heart, cancer, respiratory disease ..
o Leading causes of death by age group*
Proportional mortality
o (# of deaths from disease X in a given population in a given year)/
(total # of deaths in that population in a given year) x 100
Years of potential life lost
o Measure of the burden of premature death
o Total numbers of years of life lost before age 75 in a population
o Can be all cause or cause specific
o Leading causes vs YPLL
Infant health
o Sources of info on infant health
Birth certificate (content, how it is completed)
Full term birth = a birth that occurs after 37 weeks completed pregnancy
Pre-term birth = birth before 37 weeks
o pre-term birth rate
Low birth weight
Infant mortality rate

o Infant death = death before age of 1

o (# of infant deaths)/(# live births) x 1,000
Infant mortality classification
Fetal mortality rate
o Fetal death = death prior to delivery, not matter length of gestation