13-10-22 - Epidemiology of Coronary Heart Disease

Question 1

Learning outcomes

Answer 1

• Put epidemiology in context
• Demonstrate the basics of an epidemiological approach
• Use this framework to provide epidemiological information about coronary heart disease
• Demonstrate the relevance to clinical practice

Question 2

What is epidemiology?

Answer 2

• 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’

Question 3

What are social determinants of health?

What are 5 different types of factors of social determinants?

Answer 3

• Social health determinants of health are the economic and social conditions that influence individual and group differences in health status e.g education, family income, and housing
• Different types of factors of social determinants:

1) General socio-economic, cultural and environmental conditions

2) Living and working conditions e.g education, work environment, housing

3) Social and community networks

4) Individual lifestyle factors

5) Age, sex, and constitutional factors

Question 4

How epidemiology be used in diagnosis.

What is epidemiology a good source of?

What 5 things might we want to know from epidemiological data and studies?

What is mortality?

What is morbidity?

What is incidence?

What is prevalence?

What are determinants?

Answer 4

• How can epidemiology be used in diagnosis:
• Epidemiology is a good source of data, intelligence, and analysis
• This can be used as evidence, which can be evaluated and interpreted
• 5 things might we want to know from epidemiological data and studies:

1) Mortality?
* Death

2) Morbidity?
* Diseases state or symptom

3) Incidence?
* measure of the probability of occurrence of a given medical condition in a population within a specified period of time.

4) Prevalence?
* the proportion of a particular population found to be affected by a medical condition at a specific time

5) Determinants – risk, odds?
* “determinants” generally includes the causes (including agents), risk factors (including exposure to sources), and modes of transmission, but does not include the resulting public health action.

Question 5

What are 4 different types of epidemiological studies might we look through?

How do these fit in on the hierarch of evidence?

Answer 5

• Different types of epidemiological studies might we look through:
  1) Surveillance
  2) Cohort - Longitudinal – Prospective or Retrospective?
  3) Ecological / cross sectional?
  4) Case / Control?

Question 6

What 4 things should we consider when appraising data?

Answer 6

• 4 things should we consider when appraising data?
  1) What are the caveats and weaknesses?
  2) Sources – representative population, sample?
  3) Reliability and validity?
  4) Bias / confounding?

Question 7

What are 3 non-modifiable risk factors for CVD? What are personal (6) / social / environmental (6) modifiable risk factors for CVD?

Answer 7

• Non-modifiable risk factors for CVD:
  1) Age
  2) Sex
  3) Genetic factors
• Personal modifiable factors for CVD:
  1) Smoking
  2) Diet
  3) Physical activity
  4) Obesity
  5) High blood pressure
  6) Diabetes
• Social / environmental modifiable factors for CVD:
  1) Deprivation
  2) Income
  3) Employment
  4) Education
  5) Housing
  6) Air quality.

Question 8

What does the Prevention Paradox – Geoffrey Rose 1981 deal with?

What is an example of this?

Answer 8

• Prevention Paradox – Geoffrey Rose 1981 deals with if there should be Population-based interventions or high-risk individual targets.
• There is a “prevention paradox”, which shows that interventions can achieve large overall health gains for whole populations but might offer only small advantages to each individual.
• An example of this is the covid vaccine, where it might have offered little individual advantage, but offered herd immunity to the overall population