Epidemiology Flashcards

1
Q

Define epidemiology

A

The study of the distribution and determinants of health-related states and events in human populations (not individuals).

The application of this study to disease control.

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2
Q

What are some characteristics of epidemiological study?

A

data driven

systematic and unbiased approach

relies on careful observation and valid comparison between groups

draws on methods from other scientific fields

  • biology
  • economics
  • social
  • behavioural
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3
Q

Describe ‘distribution’.

A

the frequency and pattern of events

frequency:

  • number of events (counts)
  • number of events in comparison to the size of the population (rates)

pattern:

  • time patterns e.g., annual, weekly, monthly, daily
  • place patterns e.g., geographic location, urban/rural differences, work/school
  • personal patterns e.g., age, gender, sexual orientation, disability
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4
Q

Describe ‘determinants’.

A

the causes or other factors that influence the occurrence of disease/other health related events.

helps to investigate the hows and whys of disease.

helps to assess the difference between different population groups and occurrence of disease.

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5
Q

What are the 5 different health related states/events?

A
communicable disease
non-communicable disease
birth outcomes 
mobidity 
mortality
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6
Q

Describe the applications of epidemiology.

A

Diagnosing the health of a community.

Giving practical and appropriate public health advice/interventions to control and prevent disease in the community.

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7
Q

What are the 3 aims of epidemiology?

A
  • Describe the pattern, distribution and severity of disease within a community
  • Understand why disease is more common in some groups than others
  • provide information necessary to provide interventions to control, prevent and treat disease
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8
Q

Define the term ‘infection’.

A

infection: the replication of organisms in a host tissue, which may cause disease.

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9
Q

Define the term ‘infectious disease’.

A

Disease caused by a pathogenic organism, which can be transmitted from one infected living organism (person or animal, or contaminated object, to a susceptible host’

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10
Q

Define ‘non-communicable disease’.

A
  • chronic diseases e.g. diabetes
  • tend to last a long duration of time
  • usually the result of multiple genetic, physiological, social and behavioural factors.
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11
Q

Define the term ‘sporadic disease’.

A

disease that occurs infrequently and sporadically.

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12
Q

What is the difference between endemic, epidemic, and pandemic disease?

A

endemic - consistently present in a certain region/population. Low spread.

epidemic - sudden increase in cases spreading through a large population/region e.g., whole country.

pandemic - sudden increase in cases spreading through multiple regions/countries/continents.

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13
Q

Define the term ‘mortality’.

A

The number of deaths in a certain group of people over a certain period of time.

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14
Q

Define the term ‘morbidity’.

A

Having the disease, or symptoms of a disease.

Also refers to the amount of disease within a population.

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15
Q

What are the different types of risk factors in epidemiology?

A
  • Fixed marker
  • Variable risk factor
  • Variable marker
  • Causal risk factor
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16
Q

Describe the term ‘fixed marker’.

A

Risk factors that cannot change e.g., sex, age, ethnicity.

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17
Q

Define the term ‘variable risk factor’.

A

A risk factor that can change spontaneously or as a result of an intervention.

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18
Q

Define the term ‘variable marker’.

A

A risk factor, that even when manipulated, doesn’t change the outcome.

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19
Q

Describe the term ‘rates’ and why they are usual as a measure of disease?

A

Rates are a measure of the number of cases in a given period of time (usually per year), compared to the size of the population being measured.

they are useful as they allow the comparison of the occurrence of disease in populations that differ in size. E.g., comparing the rates of COVID in the UK and Australia.

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20
Q

What is the difference between incidence and prevalence?

A

Incidence - the number of new cases occurring in a given period of time.

Prevalence - the total number of cases existing within a given period of time.

21
Q

Describe the two methods of reporting prevalence.

A

Point prevalence - the proportion of a population that has a disease within a specific point in time.

Period prevalence - the proportion of the population that has had the disease over a specific time frame e.g., past 12 months.

22
Q

How is point prevalence rate measured?

A

no. existing cases at a given point in time / total population X 10,100,1000 etc..

23
Q

How is period prevalence rate measured?

A

no. of cases during a given time frame / average population during that time X 10,100,1000 etc..

24
Q

Describe the two methods of reporting incidence.

A
  • incidence proportion

- incidence rate

25
Q

Describe incidence proportion.

How is it calculated?

A

the proportion of an initially disease-free population, that develops the disease, or dies within a given time frame.

No. new cases in a population in a given period of time / no. of disease free people in the populated at the start of the time frame.

26
Q

Describe incidence rate.

How is it calculated?

A

Also known as person-time rate.

No. of new cases across a given time period / time each person was observed, totalled for each person.

27
Q

Describe some factors that can increase disease prevalence

A
  • longer duration of disease
  • immigration of diseased people e.g., global travel
  • emigration of healthy people
  • improved diagnostics
  • prolongation of life
28
Q

Describe some factors that can decrease disease prevalence

A
  • shorter duration of disease
  • highly fatal disease
  • development of cure e.g., vaccination
  • immigration of diseased people
  • emigration of healthy people
29
Q

What are the two kinds of epidemiological study?

A
  • Descriptive (allows a hypothesis to be tested)

- Analytic (allows for the generation of a hypothesis)

30
Q

Describe the 5 W’s of epidemiology and which type of study they relate to.

A

What - death, symptoms, hospitalisation etc.
Who - who affected e.g., age, gender, race, ethnicity.
Where - where did it occur?
When - when was the pop. affected? time, day, month, year, term, season?

  • descriptive

Why/How - causation, risk factors etc.

  • analytic
31
Q

Describe the categories of epidemiological study.

A

Experimental

  • randomised
  • non-randomised controlled trial

Observational

  • descriptive
  • analytic (cohort, case control, cross sectional)
32
Q

Describe the hierarchy of epidemiological study designs (from top, to bottom)

A
randomised clinical trials 
prospective cohort 
retrospective cohort 
case-control studies 
cross sectional study
ecological study 
case series 
case report
33
Q

Describe cross sectional studies

A

A snap shot of the population at a given time

Measures prevalence of health outcomes and investigates risk factors/exposure

34
Q

Describe case control studies

A

compares groups with a specific health outcome with groups that do not have the outcome e.g., group of women with breast cancer compared to group of women without breast cancer.

looks at differences in history of exposures.

35
Q

Describe cohort studies

A

Subjects investigated over a longer period of time with repeated monitoring

Can be both retrospective and prospective

Examines the relationship between exposure and outcomes within the cohort

36
Q

Describe ecological studies

A

assesses overall rates of disease/health outcomes in a population
allows for larger scale comparison e.g., obesity rates between UK & USA

37
Q

What is a strength and weakness of ecological study?

A

Strength
- quick and easy as uses pre-existing data

Weakness
- ecological bias as doesn’t represent individual variation amongst the population or inter-population e.g., variables in the uK may be different to those in the USA.

38
Q

What is a strength and weakness of cohort study?

A

strength
- can infer a cause/effect relationship between exposure and health outcome

weakness
- impractical as time consuming and expensive - high drop out rate

39
Q

What is a strength and weakness of cross sectional study?

A

strength
- quick and inexpensive and no follow up required

limitation

  • difficult to infer cause/effect relationship between exposure and outcome
  • data may become invalid due to frequent changes in disease
40
Q

What is a strength and weakness of case-control study?

A

strength
- ideal for rare outcomes or diseases that have no clear aetiology as multiple exposures can be investigated.

weakness
- prone to various types of bias as requires recall of information in both groups

41
Q

Describe the term ‘measure of association’.

A

A measure of association quantifies the relationship between exposure and outcome amongst two groups (in experimental study).

42
Q

Describe Relative risk/risk ratio (RR)

A

RR compares the risk of a health outcome in one group with that of another group.

Allows the quantification of risk level between two groups, e.g., an exposed group and a non-exposed group.

There will be a differentiating factor between the two groups.

43
Q

How do you calculate RR?

What does the RR score indicate?

A

Risk of disease in group of primary interest (e.g., exposed group)
/
Risk of disease in comparison group

RR of 1.0 indicates identical risk
RR of less than 1.0 indicates decreased risk for the exposed group
RR of greater than 1.0 indicates increased risk for the exposed group

44
Q

A group of people (10,000) have been recruited for a study.
There were 3000 smokers and 7000 non-smokers

410 smokers developed heart disease
300 non smokers developed heart disease

Calculate the RR and interpret the result

A

risk of disease in the exposed group = 410/3000
- 0.137

risk of disease in the non-exposed group = 300/7000
- 0.043

RR = 0.137/0.0043
- 3.19

3.19 = 2.19 increased RR (or 219% increase) in the exposed group compared to non exposed group.

45
Q

Describe odds ratio.

A

Tells us how much higher the odds of exposure are among case-patients than among controls.

Higher odds ratio = risk factor for outcome

46
Q

How is odds ratio calculated?

A

odds that a case was exposed / odds that a control was exposed

A X D / B X C = odds ratio

odds ratio of 1.0 = identical risk
odds ratio greater than 1.0 = exposure increases risk
odds ratio less than 1.0 = exposure decreased risk (or even is a protective factor)

47
Q

Describe hazard ratio

A

estimates the effect of treatment
used when presenting results after a clinical trial

hazard ratio = hazard in exposed group / hazard in unexposed group.

48
Q

Describe confident interval.

A

Measure/indication of precision.