epidemiology
DESCRIPTION
Epidemiology. October 21, 2014 II. Morbidity and Mortality. Morbidity תחלואה. הי ארע ות Incidence. Incidence per 1,000 = no. of new cases of disease occurring in the population during a specified period of time x1000 no. of persons at risk of developing - PowerPoint PPT PresentationTRANSCRIPT
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Epidemiology
October 21, 2014
II. Morbidity and Mortality
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Morbidity תחלואה
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ותארעהי Incidence
Incidence per 1,000 =
no. of new cases of disease
occurring in the population
during a specified period of time x1000
no. of persons at risk of developing
the disease during that period of time
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Annual age-specific incidence rates of reported cases of breast cancer, by
marital status
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Cumulative incidence
CI = number of people who develop
disease during a certain period
number of individuals in the
population at the beginning of the
period
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Cumulative incidence
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Incidence rate measures:
The rate at which new events occur in a population. Incidence rate/density is calculated by:
Number of persons who contract
the disease in a specified period x 10n
Sum of the length of time each
person in the population at risk
of contracting the disease
(person-time incidence)
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Example of calculation of disease occurrence
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Example of calculation of disease occurrence
Simple incidence:
3 cases in 7 individuals over 7 year
Yearly incidence:
3/7/7=0.06 cases per year (6%/yr)
Incidence density:
3/33 p.yr=0.09 cases per p.yr (9 per 100 p.y)
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Cumulative incidence
Is a simpler measure of the occurrence of a disease or new health status.
Unlike incidence rate, it measures the denominator at only one point in time.
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Prevalence ותמצאהיPrevalence rate is defined as:
The proportion of the population at risk affected by a disease at a specific point in time
Prevalence rate (P) is calculated by:
P= number of people with disease
or condition at a specific time x10n
number of people in the population
at risk at the specified time
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מחלות נבחרות - שיעור הימצאותן של מחלות מבוטחים על פי הרישום בתיקי 100ממושכות, ל-
1996הרופאים בקופת חולים הכללית,
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Random Sample of 1740 members of Clalit who visited their doctors at least three times in 2009
Dyslip
idem
ia
Any
chronic
disease
Diabet
es
Hyp
erte
nsio
n
Smok
ing
IHD
Ost
eopo
rosi
sC
ance
r
Ast
hma
Hyp
othy
roid
Pept
ic u
lcer
Dep
ress
ion
Obe
sity
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Israel – Results of social survey 2004 prevalence of:
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Prevalence of asthma among 17 year olds in Israel
Study population 159,243 consecutive 17-year-old military recruitsAsthma was documented in 8.5% of the male recruits and in 6.7% of the
female recruits
Farfel et al.Ann Allergy ,Asthma,Imm 2010;104:490-5
SES Family size
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Prevalence of obesity, OECD , 2011
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שיעור המעשנים בקרב המשתחררים 2004-1992מצה"ל, לפי מין,
ICDCדוח שר הבריאות על העישון בישראל, 2005
20
30
40
50
92 93 94 95 96 97 98 99 2000 2001 2002 2003 2004
שנה
חוזא
גבריםנשים
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Factors influencing observed prevalence rate
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Relationship between incidence and prevalence: I
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Relationship between incidence and prevalence: II
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Relationship between incidence and prevalence: IV
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AIDS היארעות המחלה, הימצאותה-- 1985, 100,000והתמותה ממנה (שיעור ל-
1996(
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Mortality תמותה
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Routine information Mortality (death) data:
(coded according to the ICD)
Crude mortality rate (CMR)
CMR= total # people dying
total # people• Age-specific rates• Sex-specific rates• Cause-specific rates• Age-standardized rates (also called age-adjusted
rates)
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Routine informationתמותת תינוקות
Infant mortality rate:
Death rate up to one year per 1000 live births
Often used as an indicator of “quality” of the health care system
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תמותת תינוקות , ישראל
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Case fatality rate
Case fatality rate (percent) =
no. of individuals dying during a
specified period of time after
disease onset or diagnosis x 100
no. of individuals with the specified
disease
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Comparison of a mortality rate and case-fatality rate
Assume a population of 100,000 people of whom 20 are sick with disease “X” and in 1 year, 18 die from disease “X”
The mortality rate in that year from disease “X” =
18 = .00018 = .018%
100,000
The case fatality rate from disease “X” =
18 = .9 = 90%
20
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Relationship between incidence and mortality CFR
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Case Fatality EbolaVariation by time and place
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Gap between incidence and mortality rates may reflect case fatality
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Definition:Life expectancy at birth and ages 40, 60, 65 and 80 is the average number of years that a person at that age can be expected to live, assuming that age-specific mortality levels remain constant
תוחלת החיים
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Life expectancy
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Israel Health Stats•Obesity (adult prevalence 2008) 26.2%•Maternal Mortality Rate: 7/100,000 live births•Infant Mortality: 4.03/1000•Life expectancy at birth :
Males-78.96 yFemales 83.49 y
•Health Expenditures: 7.8% of GNP
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Trends over time
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Gender Gap Life Expectancy at birth
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Quantifying Burden
YLL = Years of Life Lost
YLD = Years of Life lived with specified level of Disability (0,1)
DALY: Disability Adjusted Life Year: = 1 year lost of healthy life
DALY = YLL + YLD
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Health statistics are used for other purposes
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Sources of Israeli data• Central Bureau of Statistics למ"ס
• המרכז הלאומי לבקרת מחלות
• Research institutions (Brookdale)
• Academia
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One last point
Age matters!
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Prevalence of diabetes rate per 100,000 persons- International comparison
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Importance & Relevance DIABETES Prevalence
Worldwide
(OECD INDICATORS, ADULTS 20-79 YEARS, 2010)
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Prevalence rate of non-insulin-dependent diabetes mellitus in
selected populations
Location/population Age group (years) Prevalence rate(%)
Fiji IndiansIndonesiaIsraelMaltaMexican Americans(USA)NauruPima Indians (USA)USA
20+15+40-7015+25-64
20+25+20-74
13.51.715.97.717.0
24.325.56.9
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