Epidemiology and Community Medicine Questions
Epidemiology and Community Medicine Questions
This is a question about Epidemiology and Community Medicine. It will not be difficult. There are only 10 questions, and most of them are multiple-choice questions. There may be one or two fill-in-the-blank questions, as long as the score is above 80.HMP 501:Epidemiology Week 7: In-Class Lecture Crude, Specific and Adjusted Rates Agenda • • • • • Review Crude, specific and adjusted rates Proportional Mortality Rate (PMR) Standardized Mortality Rate (SMR) Community Health Assessment In-Class Activity (Rate, Proportions and Ratios) Considering a career in the health field? Health Management and Policy will get you there! Fall 2020 Information Sessions Thursdays @ 1PM via ZOOM https://unh.zoom.us/j/99406602081 September 10 September 17 September 24 October 1 October 8 October 15 October 22 HMP October 29 November 5 November 12 November 19 December 3 December 10 December 17 is the place to be! Undergraduate Programs: • BS inHealth Management and Policy • Minors in Public Health and Health Management Graduate Programs • Master of Public Health • Public Health Grad Certificate • Master of Health Data Science Contact TracingCheck-in with your neighbors Make sure your wildcat pass is valid Covid-19 Update at UNH Crude Rate • A crude rate is the number of new cases (or deaths) occurring in a specified population per year, usually expressed as the number of cases per 100,000 population at risk. • It is a real number • However because it is out of the total population it may be misleading, or not as helpful as a specific rate. Specific Rate • A specific rate is the number of cases (or deaths) that occur from a subsection of a whole. • A specific rate is a real number. • It breaks the crude rate into “categories” for better comparisons or understanding For example • Pennsylvania’s crude birth rate expressed as the number of resident live births per 1,000 total population has shown a gradual increase from 12.9 in 1978 to 13.6 in 1982. • The age-specific birth rates for each of those years (i.e. the number of live births per 1,000 total women for each five year age group 10-44), you will discover a significant decrease in the age-specific birth rates among women under 25 with corresponding significant increases for women 25 and over. An adjusted rate is an artificially created figure that enables comparison across time and space. Adjusted Rates A “standard” population distribution is used to adjust crude rates. The age-adjusted rates are rates that would have existed if the population under study had the same age distribution as the “standard” population. Therefore, they are summary measures adjusted for differences in age distributions. Mortality Rates • Crude Rate: #deaths/total population • CAUSE-SPECIFIC DEATH RATE is the number of deaths from a specified cause per 100,000 person-years at risk. The numerator is typically restricted to resident deaths in a specific geographic area (country, state, county, etc.) Proportional Mortality Rate (Ratio) • Proportional mortality describes the proportion of deaths in a specified population over a period of time attributable to different causes. • Each cause is expressed as a percentage of all deaths, and the sum of the causes must add to 100%. Proportional Mortality Ratio (PMR) % Example: PMR (%) for HIV among the 25- to 34-year-old group 1,588/41,300 = 3.8% • Indicates relative importance of a specific cause of death • not a measure of the risk of dying of a particular cause. Standardized Mortality Ratio • The standardized mortality ratio is the ratio of observed deaths in the study group to expected deaths in the general population. This ratio can be expressed as a percentage simply by multiplying by 100. • The SMR may be quoted as either a ratio or a percentage. Standardized Mortality Ratio (SMR) Interpretation of SMR • If the observed and expected numbers are the same, the SMR would be 1.0, indicating that observed mortality is not unusual. • An SMR of 2.0 means that the death rate in the study population is two times greater than expected. Community Health Assessments • A community health assessment (CHA), or community health needs assessment (CHNA), refers to a health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis. Process Questions? In-Class Activity • Work in groups of 3-4 (Please maintain social distancing) • As a group, work through the problem set together (20-30 minutes) • We will go through the answers as a class (20 minutes) HMP 501: Epidemiology Sources of Data for Use in Epidemiology Week 7-Online Lecture Agenda • • • • Privacy and Confidentiality Data Strategies What can you find? Strengths and Weaknesses Data Where to find it and what to look out for? Criteria for choosing quality Epidemiologic Data • Nature of the data • Availability of the data • Completeness of population coverage • Representativeness • Generalizability (external validity) • Thoroughness • Strengths versus limitations Nature of the Data • Refers to the source of data • Examples: • vital statistics, http://www.cdc.gov/nchs/nvss/index.htm) • case registries: • http://www.cdc.gov/sids/caseregistry.htm • https://training.seer.cancer.gov/registration/registry/ • Physicians’ records, • hospital and clinic cases • surveys of the general population • https://www.cdc.gov/nchs/nhis/ • https://www.cdc.gov/brfss/index.html Availability of the Data • Access to data • Public access • Permission • Identified/de-identified • For example, medical records and other data with personal identifiers may not be used without patients’ consent. Completeness of Population Coverage • Representativeness—the degree to which a sample resembles a parent population. • Generalizability (external validity)— ability to apply findings to a population that did not participate in the study. • Thoroughness—the care taken to identify all cases of a given disease. Weighing Strengths and Limitations • Think about how you want to use the data and what the data can truly give you. • Factors inherent in the data may limit their usefulness. • Incomplete diagnostic information • Case duplication Privacy and Confidentiality… Confidentiality • Privacy Act of 1974 • Prohibits the release of confidential data without the consent of the individual • Freedom of Information Act • Mandates the release of government information to the public, except for personal and medical files • The Public Health Service Act • Protects confidentiality of information collected by some federal agencies, e.g., NCHS The HIPAA Privacy Rule • Refers to the Health Insurance Portability and Accountability Act of 1996 • Sections of HIPAA “…require the Secretary of HHS to publicize standards for the electronic exchange, privacy and security of health information…” • Categories of protected health information pertain to individually identifiable data re: • The individual’s physical and mental health • Provision of health care to the individual • Payment for provision of health care Some data strategies Data Sharing • Data are not public but the primary investigator allows someone to use the data for a related but different study. • Refers to the voluntary release of information by one investigator or institution to another for the purpose of scientific research. • Can enhance data quality and increase knowledge from research. • Key issue is the primary investigator’s potential loss of control over information. Record Linkage • Joining data from two or more sources, e.g., employment records and mortality data. • Need one common variable (health ID number, student ID number, SS#) • Applications include genetic research, planning of health services, and chronic disease tracking. What can you find Statistics Derived from the Vital Registration System • Mortality statistics • http://www.cdc.gov/nchs/nvss.htm • https://wisdom.dhhs.nh.gov/wisdom/#main • Birth statistics: certificates of birth and fetal death. Mortality Statistics • Mortality data are nearly complete, as most deaths in the U.S. and other developed countries are reported. • Death certificates include demographic information about the deceased and cause of death (immediate cause and contributing factors). Limitations of Mortality Data • Certification of cause of death. • For example, in an elderly person with chronic illness, exact cause of death may be unclear. • Lack of standardization of diagnostic criteria. • Stigma associated with certain diseases, e.g., AIDS, may lead to inaccurate reporting. Limitations of Mortality Data (cont’d) • Errors in coding • Changes in coding • • Revisions in the (ICD) International Classification of Disease. Sudden increases or decreases in a particular cause of death may be due to changes in coding. Birth Statistics: Certificates of Birth and of Fetal Death • Birth certificate includes information that may affect the neonate, such as congenital malformations, birth weight, and length of gestation. • Possible sources of unreliability: • • Mothers’ recall of events during pregnancy may be inaccurate. Conditions that affect neonate may not be present at birth. Birth Statistics (cont’d) • Issues, continued: • Varying state requirements for fetal death certificates. • Both types of certificates have been used in studies of environmental influences upon congenital malformations. • Both provide nearly complete data. Reportable Disease Statistics • Federal and state statutes require health care providers to report those cases of diseases classified as reportable and notifiable. • Include infectious and communicable diseases that endanger a population, e.g., STDs, measles, foodborne illness. • http://www.cdc.gov/healthywater/statistics/surveilla nce/notifiable.html • http://www.cdc.gov/mmWr/preview/mmwrhtml/m m5953a1.htm Limitations of Reportable Disease Statistics • Possible incompleteness of population coverage. • For example, asymptomatic persons would not seek treatment. • Failure of physician to fill out required forms. • Unwillingness to report cases that carry a social stigma. Types of data Strengths and Weaknesses Screenings and Screening Surveys • Conducted to identify individuals who may have infectious or chronic diseases. Examples: breast cancer screenings, health fairs. • Clientele are highly selected. • • Self select Individuals who participate are concerned about the particular health issue. Multiphasic Screening • Administration of 2 or more screening tests during a single screening program (maybe pre/post) • Ongoing screening programs often are carried out at worksites. • Potential biases from worker attrition • Data can be useful for research on occupational health problems. • Data may not contain etiologic information. Disease Registries • Registry–a centralized database for collection of data about a disease • Coding algorithms are used to maintain patient confidentiality. • Applications of registries: • • • Patient tracking Identification of trends in rates of disease Case-control studies Surveillance, Epidemiology, and End Results (SEER) Program • Conducted by the National Cancer Institute (NCI) • Collects cancer data from different cancer registries across the U.S. • Provides information about trends in cancer incidence, mortality, and survival Morbidity Surveys of the General Population • Morbidity surveys collect data on the health status of a population group. • Obtain more comprehensive information than would be available from routinely collected data • Example: National Health Interview Survey, BRFSS, Youth Risk Behavior Survey (YRBSS) Example: National Health Survey • Authorized under the National Health Survey Act of 1956 to obtain information about the health of the U.S. population. • Conducted annually since 1957 • Representative Sample • 39,000 households • 97,200 individuals • Voluntary but 90% participate • Personal interviews Example: NCHS Survey Programs • National Health Interview Survey (NHIS) • Health Examination Survey (HES) • Various surveys of health resources • • • • National Hospital Discharge Survey National Ambulatory Medical Care Survey National Hospital Care Survey National Nursing Home survey Example: Behavioral Risk Factor Surveillance System (BRFSS) • Collects data on behaviorally related phenomena • Behavioral risks for chronic diseases • Preventive activities • Healthcare utilization • The largest telephone survey in the world • 350,000 interviews annually • Randomly selected households Insurance Data Sources include: • Social Security–provides data on disability benefits and Medicare. • Health insurance–provides data on those who receive care through a prepaid medical program. • Life insurance–provides information on causes of mortality; also provides results of physical examinations. Limitations of Insurance Data • Data may not be representative of entire population, as the uninsured are excluded. Clinical Data Sources • Hospital data • Diseases treated in special clinics and hospitals • Data from physicians’ practices Hospital Data • Consists of both inpatient and outpatient data • Deficiencies of data: • Not representative of any specific population • Different information collected on each patient • Settings may differ according to social class of patients; e.g., specialized clinics, emergency rooms Diseases Treated in Special Clinics and Hospitals • Data cannot be generalized because patients are a highly selected group. • Case-control studies can be done with unusual and rare diseases. • However, it is not possible to determine incidence and prevalence rates without knowing the size of the denominator. Data from Physicians’ Practices • Limited application due to: • • • Confidentiality of patient data Highly selected group of patients Lack of standardization of information collected • Useful for the purposes of: • • Verification of self-reports Source of exposure data Absenteeism Data • Records of absenteeism from work or school • Possible deficiencies: • • • Data omit people who neither work nor attend school. Not all people who are ill take time off. Those absent are not necessarily ill. • Useful for the study of rapidly spreading conditions School Health Programs • Provide information about immunizations, physical exams, and self-reports of illness • Have been used in studies of intelligence, developmental delays, and disease etiology • Paffenbarger, et al. used information from health records of college students to track causes of chronic diseases. Morbidity Data from the Armed Forces • Reports from physicals, hospitalizations, and selective service examinations • Data have been used for: • Studies of disease etiology. • Study of twins serving in Korean War or WWII to determine influence of “nature and nurture” on cause of disease. • Studies investigating genetic factors in obesity U.S. Bureau of the Census • Provides information on the general, social, and economic characteristics of the U.S. population • U.S. Census is administered every 10 years. • Attempts to account for every person and his or her residence • Characterizes population according to sex, age, family relationships, and other demographic variables • • https://www.census.gov/programs-surveys/acs/ https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml …
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