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Population Health > Quiz 1 Epidemiology > Flashcards

Quiz 1 Epidemiology Flashcards

1
Q

Top 5 leading causes of death in 2010

A
  1. heart disease
  2. cancer
  3. COPD
  4. cerebrovascular disease
  5. unintentional injuries
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2
Q

Top 5 leading causes of death in 1900

A
  1. pneumonia
  2. tuberculosis
  3. diarrhea, enteritis
  4. heart disease
  5. liver disease
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3
Q

Major population/community-based strategies to prevent disease and improve health

A 
sanitation
immunization
legislation
education
litigation
early identification (screening)
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4
Q

4 main goals of Healthy People 2020

A
  1. increase quality + years of life
  2. eliminate health disparities (healthy equity)
  3. create environments that promote health
  4. promote healthy behavior across life stages
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5
Q

Major social determinants of health

A 
socio-economic status
occupation
physical environment
transportation
housing
social environment
discrimination
access to care and services
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6
Q

what percentage of health care is paid for by private insurance?

A

35%

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7
Q

what percentage of U.S. population is uninsured?

A

13%
46-51 million uninsured
25 million underinsured

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8
Q

how much does private sector contribute to total expenditure of health care?

A

more than half

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9
Q

what are methods of payment for U.S. healthcare?

A

out-of-pocket payment, individual private insurance, employee-based private insurance, and government financing

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10
Q

Medicare?

A
  • federal insurance program (govt. contracts for HCPs for range of health benefits)
  • social program - individual has contributed to his/her coverage
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11
Q

4 parts of Medicare?

A

Part A - hospital insurance
Part B - professional services (outpatient)
Part C - Medicare Advantage plans
Part D - prescription drug coverage

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12
Q

Medicaid?

A

joint federal-state insurance program to provide basic medical care to economically indigent populations

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13
Q

Medicaid percentage covered?

A

16% of population (2009)

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14
Q

Medicaid eligibility?

A
  • pregnant women and children under age 6 with family incomes below 133% FPL
  • children under 19 with family income up to 100% FPL
  • disabled children and adults covered under SSI program
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15
Q

New Medicaid expansion?

A

all non-Medicare eligible individuals under age 65 with incomes up to 133% FPL

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16
Q

Major cost drivers in U.S.?

A
  • demographic changes
  • technology and intensity of healthcare
  • increased insurance coverage
  • obesity rate
  • income of population medical care price increase
  • medical malpractice premiums
  • rise/fall of HMOs
  • reduced market competition as a result of consolidation in hospital sector and managed care insurer mergers
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17
Q

barriers to healthcare access?

A
  • rural areas lack full access to providers/institutions

- some providers do not accept Medicaid and sometimes Medicare

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18
Q

percentage of U.S. health insurance coverage that is employer-sponsored?

A

53%

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19
Q

measures of morbidity?

A

incidence, prevalence

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20
Q

measures of mortality?

A

mortality
case fatality
years of potential life lost (YPLL)
life expectancy

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21
Q

types of measurements?

A
  • crude
  • adjusted
  • quality-adjusted life years (QALYs)
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22
Q

3 rate types used in epidemiology?

A
  • crude (biased but real and easy to calculate, difficult to interpret)
  • specific (for subgroup)
  • adjusted/standardized (unbiased, using standard population, fictional)
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23
Q

Absolute risk?

A

= calculated from incidence! (exposed risk - unexposed risk)

-determined from cohort studies (esp. prospective) comparing exposed and non-exposed people

24
Q

Relative risk?

A

= by how many times exposure to certain risk factor increases risk of contracting disease
= (incidence of exposed)/(incidence of unexposed)

25
Q

Relative risk reduction?

A

= 1 - relative risk

26
Q

Risk ratio/odds ratio interpretation?

A

= 1, no association

> 1, positive association

27
Q

Number needed to treat (NNT)?

A

= 100/(absolute risk reduction)

28
Q

Absolute risk reduction?

A

= (unexposed risk - exposed risk)

= -(absolute risk)

29
Q

Odds ratio?

A

= p/(1-p)

= (probability of event)/(probability of NOT event)

30
Q

hierarchy of evidence?

A

meta-analysis > systematic reviews > *randomized control trials > cohort studies > case control studies > case reports/series

31
Q

as you move up pyramid of hierarchy of evidence?

A
  • stronger methodology
  • less bias
  • controls for comparison
  • fewer studies
32
Q

primary studies?

A

factual, firsthand accounts of study written by person who was part of study
-collection of primary data collected by researcher

33
Q

descriptive/observational primary studies?

A
  • case reports/series
  • prevalence surveys
  • correlational/ecological studies
34
Q

analytic primary studies?

A
  • case control studies

- cohort studies (prospective/retrospective)

35
Q

secondary studies?

A

analysis and interpretation of primary research

-summary, collation, and/or synthesis of existing research

36
Q

gold standard of evidence for cause-and-effect relationships?

A

randomized controlled clinical trial (RCT)

37
Q

disadvantages of randomized clinical trials?

A
  • very expensive and time-consuming
  • may pose ethical problems
  • impractical if cause-and-effect relationship takes a long time to appear
38
Q

Phase I of clinical trial?

A

up to several months
STUDIES SAFETY OF TREATMENT
20-80 participants
70% success rate

39
Q

Phase II of clinical trial?

A

up to 2 years
STUDIES EFFICACY OF TREATMENT
100-300 participants
33% success rate

40
Q

Phase III of clinical trial?

A

1-4 years
STUDIES SAFETY, EFFICACY, AND DOSING
1000-3000 participants
25-30% success rate

41
Q

Phase IV of clinical trial?

A

1+ year
STUDIES LONG-TERM EFFECTIVENESS, COST-EFFECTIVENESS
thousands of participants
70-90% success rate

42
Q

Crossover design clinical trial?

A

half the patients receive active treatment for a period followed by placebo, while other half receives placebo first followed by experimental treatment
= within-subject design

43
Q

Non-inferiority trials?

A

seeks to show only that a new treatment is not inferior to an existing one
-null hypothesis = old treatment is more effective than new one being tested
-alternative hypothesis = new treatment is AT LEAST as effective as old one
= one-tailed statistical testing!

44
Q

2 categories of non-experimental studies?

A

descriptive + analytic

  • descriptive = indicate occurrence/distribution of disease
  • analytic = testing hypotheses or explanations about disease
45
Q

Cohort studies?

A

cohort does not have disease of interest, observed for outcome
-prospective = unbiased!

46
Q

Advantages of cohort studies?

A
  • best form of investigation when true experiment not feasible
  • only method that can establish absolute risk
  • assesses whether exposure is risk factor
47
Q

Disadvantages of cohort studies?

A
  • time-consuming, laborious, expensive

- may be impractical for rare diseases

48
Q

Case control studies?

A

compares people who do have disease (cases) to similar people who do not have disease (controls), assesses their relative exposures
-retrospective!

49
Q

Advantages of case control studies?

A
  • quick and cheap to perform, even for rare diseases that take a long time to appear
  • require comparatively few subjects
  • allow multiple potential causes of disease to be investigated
50
Q

Disadvantages of case control studies?

A
  • recall bias because retrospective
  • misses undiagnosed/asymptomatic cases
  • selection bias
  • cannot determine rate/risk of disease in exposed and non-exposed people
  • cannot prove cause-and-effect relationship
51
Q

Case series?

A

simply describes presentation of a disease in a number of patients
(commonly used to present new info for rare disease)
-no following of patients or control/comparison group
-no cause-and-effect relationships established

52
Q

Case report?

A

special form of case series with only one patient described

53
Q

Ecological studies?

A

study in which data is collected about a whole population (large group or community) and is analyzed at that level

  • no data analyzed about individuals
  • done quickly and inexpensively using existing bodies of data
54
Q

2 types of secondary studies?

A
  • systematic reviews

- meta-analyses

55
Q

Systematic review?

A

-objective, goal of enabling clinical decisions to be made on basis of all the good-quality studies that have been done

56
Q

Meta-analysis?

A
  • quantitative analysis of the results of a systematic review
  • validity depends on quality of review and underlying studies

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