Standardization of rates by Dr. Basil TumainiBasil Tumaini
Standardization of rates by Dr. Basil Tumaini, presented during the residency at Muhimbili University of Health and Allied Sciences, Epidemiology class
Introduction to Epidemiology
At the end of this session the participants will be able to:
Discuss the historical evolution of epidemiology
Explain the usage of epidemiology
List the core epidemiological functions
Explain types of epidemiological studies
Understanding epidemiology study in medical statisticsLaud Randy Amofah
What is an Epidemiology?
Epidemiology studies the distribution of diseases within populations of people and factors related to them. Epidemiologist analyzes what causes disease outbreaks in order to treat existing diseases and prevent future outbreaks.
Standardization of rates by Dr. Basil TumainiBasil Tumaini
Standardization of rates by Dr. Basil Tumaini, presented during the residency at Muhimbili University of Health and Allied Sciences, Epidemiology class
Introduction to Epidemiology
At the end of this session the participants will be able to:
Discuss the historical evolution of epidemiology
Explain the usage of epidemiology
List the core epidemiological functions
Explain types of epidemiological studies
Understanding epidemiology study in medical statisticsLaud Randy Amofah
What is an Epidemiology?
Epidemiology studies the distribution of diseases within populations of people and factors related to them. Epidemiologist analyzes what causes disease outbreaks in order to treat existing diseases and prevent future outbreaks.
Periodontal disease is a widely prevalent disease worldwide which often gets unnoticed or it often ignored due to its slowly progressive nature. It is of concern since it can cause irrepairable damage to tooth supporting structures if not early diagnosed or treated.
Chapter 3Measures of Morbidity and Mortality Used in EpidemiolEstelaJeffery653
Chapter 3
Measures of Morbidity and Mortality Used in Epidemiology
Learning Objectives
Define and distinguish among ratios, proportions, and rates
Explain the term population at risk
Identify and calculate commonly used rates for morbidity, mortality, and natality
State the meanings and applications of incidence rates and prevalence
Learning Objectives (cont’d)
Discuss limitations of crude rates and alternative measures for crude rates
Apply direct and indirect methods to adjust rates
List situations where direct and indirect adjustment should be used
Overview of Epidemiologic Measures
Count
The simplest and most frequently performed quantitative measure in epidemiology.
Refers to the number of cases of a disease or other health phenomenon being studied.
Examples of Counts
Cases of influenza reported in Westchester County, New York, during January of a particular year.
Traffic fatalities in Manhattan in a 24-hour time period
College dorm students who had mono
Foreign-born stomach cancer patients
Ratio
The value obtained by dividing one quantity by another.
Consists of a numerator and a denominator.
The most general form has no specified relationship between numerator and denominator.
Rates, proportions, and percentages are also ratios.
Example of a
Simple Sex Ratio Calculation
A ratio may be expressed at = X/Y
Simple sex ratio (data from textbook)
Of 1,000 motorcycle fatalities, 950 victims are men and 50 are women.
Number of male cases 950
Number of female cases 50
19:1 male to female
=
=
Example of a
Demographic Sex Ratio Calculation
This ratio refers to the number of males per 100 females. In the U.S., the sex ratio in 2010 for the entire population was 96.7, indicating more females than males.
Number of male cases 151,781,326
Number of female cases 156,964,212
96.7
X 100 =
=
X 100
Example of a
Sex Ratio at Birth Calculation
The sex ratio at birth is defined as: (the number of male births divided by the number of female births) multiplied by 1,000.
Number of male births
Number of female births
X 1,000
Definition of Proportion
A measure that states a count relative to the size of the group.
A ratio in which the numerator is part of the denominator.
May be expressed as a percentage.
Uses of Proportions
Can demonstrate the magnitude of a problem.
Example: 10 dormitory students develop hepatitis. How important is this problem?
If only 20 students live in the dorm, 50% are ill.
If 500 students live in the dorm, 2% are ill.
Example of a Proportion
Calculate the proportion of African-American male deaths among African-American and white boys aged 5 to 14 years.
Rate
Definition: a ratio that consists of a numerator and a denominator and in which time forms part of the denominator.
Contains the following elements:
disease frequency
unit size of population
time period during which an event occurs
Crude death rate =
Number of deaths in a given y ...
tHESE SLIDES ARE PREPAREED TO UNDERSTAND about DISPOSAL OF WASTE IN EASY WAY Important links- NOTES- https://mynursingstudents.blogspot.com/ youtube channel https://www.youtube.com/c/MYSTUDENTSU... CHANEL PLAYLIST- ANATOMY AND PHYSIOLOGY-https://www.youtube.com/playlist?list=PL93S13oM2gAPM3VTGVUXIeswKJ3XGaD2p COMMUNITY HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPyslPNdIJoVjiXEDTVEDzs CHILD HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gANcslmv0DXg6BWmWN359Gvg FIRST AID- https://www.youtube.com/playlist?list=PL93S13oM2gAMvGqeqH2ZTklzFAZhOrvgP HCM- https://www.youtube.com/playlist?list=PL93S13oM2gAM7mZ1vZhQBHWbdLnLb-cH9 FUNDAMENTALS OF NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPFxu78NDLpGPaxEmK1fTao COMMUNICABLE DISEASES- https://www.youtube.com/playlist?list=PL93S13oM2gAOWo4IwNjLU_LCuhRN0ZLeb ENVIRONMENTAL HEALTH- https://www.youtube.com/playlist?list=PL93S13oM2gAPkI6LvfS8Zu1nm6mZi9FK6 MSN- https://www.youtube.com/playlist?list=PL93S13oM2gAOdyoHnDLAoR_o8M6ccqYBm HINDI ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAN4L-FJ3s_IEXgZCijGUA1A ENGLISH ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAMYv2a1hFcq4W1nBjTnRkHP facebook profile- https://www.facebook.com/suresh.kr.lrhs/ FACEBOOK PAGE- https://www.facebook.com/My-Student-S... facebook group NURSING NOTES- https://www.facebook.com/groups/24139... FOR MAKING EASY NOTES YOU CAN ALSO VISIT MY BLOG – BLOGGER- https://mynursingstudents.blogspot.com/ Instagram- https://www.instagram.com/mystudentsu... Twitter- https://twitter.com/student_system?s=08 #PEM, #ASHA,#EPIDEMIOLOGY,#ICDS,#nurses,#ASSESSMENT, #APPEARENCE,#PULSE,#GRIMACE,#REFLEX,#RESPIRATION,#RESUSCITATION,#NEWBORN,#BABY,#VIRGINIA, #CHILD, #OXYGEN,#CYANOSIS,#OPTICNERVE, #SARACHNA,#MYSTUDENTSUPPORTSYSTEM, #rashes,#nursingclasses, #communityhealthnursing,#ANM, #GNM, #BSCNURING,#NURSINGSTUDENTS, #WHO,#NURSINGINSTITUTION,#COLLEGEOFNURSING,#nursingofficer,#COMMUNITYHEALTHOFFICE
Under Pressure : Kenneth Kruk's StrategyKenneth Kruk
Kenneth Kruk's story of transforming challenges into opportunities by leading successful medical record transitions and bridging scientific knowledge gaps during COVID-19.
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
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Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
Feeding plate for a newborn with Cleft Palate.pptxSatvikaPrasad
A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
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2. GROUP-3
NAME ROLL
Md. Emdadul Haque ASH1708025M
Rakibul Hasan ASH1708027M
Md. Abdullah Al Mamun ASH1708029M
Shuvu Kumar Kundu ASH1708030M
Sofiul Alam ASH1708031M
Shuvro Ghosh ASH1708034M
Md. Iftekhar Uddin Ayesh ASH1708036M
Mahjerin Sumaiya BFH1708037F
3. EPIDEMIOLOGY
Epidemiology is the basic science of prevention
and social Medicine.
Epidemiology is the study of the distribution and
determinants of health-related states or events in
specified populations, and the application of this
study to the control of health problems.
5. DESCRIPTIVE EPIDEMIOLOGY:
It is the first step or initial enquiry into a new topic, event,
disease or condition.
Examining the distribution of a disease in a population, and
observing the basic features of its distribution in terms of
time, place, and person.
The 5W’s of descriptive epidemiology:
1. What = health issue of concern
2. Who = person
3. Where = place
4. When = time
5. Why/how = causes, risk factors, modes of transmission
6. Advantages of Descriptive Epidemiology
1. It is generally relatively quick, easy and
cheap to conduct.
2. Exposure data often only available at the
area level.
3. It is more easily examined.
4. Utilization of geographical information
systems to examine the spatial framework
of disease and exposure.
7. Disadvantages of Descriptive Epidemiology
1. Are time-consuming and costly
(especially prospective studies);
2. Can study only those risk factors
measured at the beginning of the study;
3. Can be used only for common diseases;
4. May have losses to follow-up.
8. ANALYTIC Epidemiology:
Analytic epidemiology is concerned with the
search for causes and effects, or the why and
the how.
Analytic epidemiology provides sufficient
evidence to take appropriate control and
prevention measures.
Epidemiologists use analytic epidemiology to
quantify the association between exposures
and outcomes and to test hypotheses about
9. Advantages of Analytic Epidemiology
Allows the study of several different
etiological factors(smoking, physical
activity and personality etc.)
Risk factors can be identified.
Rational prevention and control program
can be established.
Suitable for investigate diseases which is
little known.
10. Disadvantages of Analytic
Epidemiology
Change to bias.
Expensive and time
consuming.
Selection of an appropriate
group may be difficult.
Possible to one or multiple
outcome.
11. Endemic describes a disease that is
present permanently in a region or
population.
e.g., chickenpox, malaria, dengue etc.
Dengue, first appeared in the Americans and Caribbea
Chickenpox in the UK.
Malaria that is endemic to Africa.
12. Epidemic is an outbreak that affects many
people at one time and can spread
through one or several community.
e.g., obesity.
Rise in obesity globally.
Zoonotic disease(moving from animals to human).
A genetic change (mutation) in the infectious
agent (bacteri, fungi or parasite) .
13. Pandemic is the term used
to describe an epidemic
when the spread is global.
e.g., corona virus disease.
14. Prevalence :
Prevalence is the number of new cases that have
occurred in a given time period over the number
of total people. It measures of disease burden.
Prevalence (a proportion): [(Cases of disease /
Total people) *100]
15. For example : In a population of Noakhali
1000 people where 75 people are
affected by COVID-19 disease.
So what is the prevalence of this disease
in this population?
The mathematical way to calculate this
would be:
(Cases of disease /Total people )* 100
So, 7.5% of population is affected by
COVID-19 in Noakhali
16. Incidence :
Incidence is the number of new cases that
have occurred in a given time period over
the number of people at risk in that given
time period. It measures of disease rate.
Incidence (a rate) : (New cases /people at
risk) *1000
in a given time frame
17. Let's see the example of a fictitious
population of ten women free from
disease. Four of these women develop
uterine Cancer during a given years.
So what is the incidence of this disease in
this population?
The mathematical way to calculate this
would be:
(New cases, 4,/people at risk,10, )*1000
So, incidence rate of 400 case per 1000
population per year.
18. Risk:
In epidemiology the definition of
risk is purely one of probability or
chance, as measured by the
occurrence of new cases of disease
in a defined population over a
defined period.
Risk = number of (new) observed
cases/number at risk (disease free)
at the start
19. Ratio: A ratio can be written as one number divided by
another (a
fraction) of the form a/b
Both a and b refer to the frequency of some event
or occurrence.
A proportion is a ratio in which the numerator is a
subset (or
part) of the denominator and can be written as a/(a+b)
A rate is a ratio of the form a*/ (a+b)
a* = the frequency of events during a certain time
20. Example
R = number of hospitals / (population
size)
„ R may be multiplied by k = 10,000
„ Units = hospitals per 10,000 people
„ Suppose
− R = 4 hospitals/20,000 people
= 0.0002 hospitals per person
− R*k = 0.0002 * 10,000
= 2 hospitals per 10,000 people
− Units = hospitals per 10,000
people]
21. Rate:
Rate is a proportion with the
specification of time. Rate must
include the unit of time used in final
expression.
(𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑛𝑒𝑤 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑑𝑖𝑠𝑒𝑎𝑠𝑒 𝑖𝑛 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑡𝑖𝑚𝑒 𝑝𝑒𝑟𝑖𝑜𝑑
)/(𝑡𝑜𝑡𝑎𝑙 𝑝𝑒𝑟𝑠𝑜𝑛−𝑡𝑖𝑚𝑒 𝑎𝑡 𝑟𝑖𝑠𝑘 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑒 𝑓𝑜𝑙𝑙𝑜𝑤 𝑢𝑝 𝑝𝑒𝑟𝑖𝑜𝑑)
Rate =
For example, if there had been 500 new cases of an
illness in a population of 30,000 in a year, the incidence
rate would be:
500/30000×1000=16.7/1000 per year
22. Proportion:
A proportion is a specific type of ratio in
which the numerator is included in the
denominator, and the result value is
expressed as a percentage. A proportion
may be expressed as a decimal, a fraction,
or a percentage.
(𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑝𝑒𝑟𝑠𝑜𝑛𝑠 𝑜𝑟 𝑒𝑣𝑒𝑛𝑡𝑠 𝑤𝑖𝑡ℎ 𝑎 𝑝𝑎𝑟𝑡𝑖𝑐𝑢𝑙𝑎
𝑟 𝑐ℎ𝑎𝑟𝑎𝑐𝑡𝑒𝑟𝑖𝑠𝑡𝑖𝑐)/(𝑡𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑝𝑒𝑟𝑠𝑜𝑛𝑠 𝑜
𝑟 𝑒𝑣𝑒𝑛𝑡𝑠 )×(10)^n
Proportion=
23. For example, the proportion of all births
that were male is:
(𝑚𝑎𝑙𝑒 𝑏𝑖𝑟𝑡ℎ𝑠)/(𝑚𝑎𝑙𝑒 𝑏𝑖𝑟𝑡ℎ𝑠+𝑓𝑒𝑚𝑎𝑙𝑒 𝑏𝑖𝑟𝑡ℎ𝑠)
= (179×〖10〗^4)/((179+170)×〖10〗^4
)×100
=51.3%
Absolute risk:
The absolute risk of an event is the
likelihood of occurrence of that event
in the population at risk.
24. Absolute risk = (𝑝𝑒𝑟𝑠𝑜𝑛𝑠 𝑤ℎ𝑜 𝑎𝑐𝑡𝑢𝑎𝑙𝑙𝑦 𝑒𝑥𝑝𝑒𝑟𝑖𝑒𝑛𝑐𝑒 𝑡ℎ
𝑒 𝑒𝑣𝑒𝑛𝑡)/(𝑡𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑝𝑒𝑟𝑠𝑜𝑛𝑠 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 𝑡𝑜 𝑡ℎ𝑒 𝑟𝑖𝑠
𝑘 𝑜𝑓 𝑡ℎ𝑎𝑡 𝑒𝑣𝑒𝑛𝑡 )
For example, 100,000 women using third
generation progestin's (desogestrel,
norgestimate), 30 people developed a VTE(venous
thromboembolic event) per year. So,
Absolute risk = 30 per 100,000 women per year
(.03%)
25. RELATIVE RISK
•It is the Ratio of incidence rate of disease
in exposed individuals to the incidence
rate of disease in non-exposed individuals
(from a cohort/prospective study)
26.
27.
28. So, Relative risk is
=
Incidence rate of disease among those with high BP
Incidence rate of disease among those with normal BP
=
𝑎
𝑎+𝑏
÷
𝑐
𝑐+𝑑
=
90/493
70/1271
= 3.31
It means that there is a positive association because,
RR > 1.
This means that people those with high BP is 3.31
times more likely to develop disease than those with
normal BP.
29. Attributable risk:
Attributable risk is the difference in the
probability of disease in exposed people
and the probability of disease in
unexposed people.
Attributable risk is a measure of how
much disease risk is attributed to a
certain exposure.
Attributable risk is useful in
determining how much disease can be
prevented.
It is useful for Public Health guidelines
and planning.
30. FORMULA FOR CONTINGENCY TABLES
Where,
a= Exposed cases
b= Exposed controls
c= Not Exposed cases
d= Not Exposed controls
33. ODDS RATIO (OR)
•It is a measure of association between an exposure
and an outcome
•It compares odds of exposure in cases to odds of
exposure in controls
ODDS: It means the of event chances occurring
divided by chance of event not occurring.
34.
35.
36. Example: A study looking at
osteoporosis in women
compared cases with non-
cases, and found that 45/100
cases did not use calcium
supplements compared with
55/100 of the non-cases.
37. 1. Develop a table to display the
data.
2. Calculate the odds of exposure
in cases and non-cases.
3. Calculate the odds ratio using
the cross-product ratio.
38.
39. 2. The odds of exposure in:
Cases group: a/c= 55/45 =
1.22
Controls group: b/d= 45/55 =
0.82
40. 3) The Odds Ratio:
Odds of exposure in cases
Odds of exposure in controls
1.22
0.82
=1.49
It means that the chances of osteoporosis on
women is 1.49 times more among the women
those are not used calcium supplemented.
41. Interpretation of odds ratio (OR):
1. OR of >1 indicates that the exposure is
associated with an increased risk of developing
the disease.
2. OR of <1 indicates that the exposure is
associated with the reduced risk of developing the
outcome.
3. The OR=1 exposure does not affect odds of
disease.
42. Uses of OR:
1.OR are appropriate measure of RR in case
control studies.
2.OR are commonly used in meta-analysis.
3.OR are the output of logistic regression
analysis.