PHC 6000 Epidemiology for Public Health Professionals

PROBLEM SET # 1

(PLEASE SHOW-ALL WORK, FORMULAS AND CALCULATIONS, TO GET ANY CREDIT)

1. Using the information from the following table, calculate the age-specific death rate from CVD for both
Population A and Population B and the age-specific death rates.
Table 1
#of deaths per age /population per age x 1,000 = age specific death rate per 1,000
Population A Population B
Age Group Obs # Population Age-specific death Obs # Population Age-specific death rate
deaths rate per 1000 deaths per 1000
0-24 35 18000 1.94 30 13000 2.31
25-49 60 11000 5.45 50 7000 7.14
50-74 370 9000 41.11 400 11000 36.36
75+ 250 3000 83.33 380 4000 95.00
Total 715 41,000 860 35,000
Crude death 17.44 24.57
rate
total # of deaths/total population x 1,000 = CDR per 1,000

a. Does one population seem to have more CVD problems than the other? Yes, Population B has more CVD
problems than Population A as Population B has a higher crude death rate.

2. Direct Standardization: Using the information from tables 1 and 2, calculate the expected deaths for each
group using a reference population (i.e. US 2000 standard population) and complete the calculations below.

Table 2
Population A Population B
Age Reference Age-specific Expected Deaths Age-specific Expected Deaths
Group Population death rate per death rate per
1000 1000
0-24 11000 1.94 21.34 2.31 25.41
25-49 17000 5.45 92.65 7.14 121.38
50-74 20000 41.11 822.2 36.36 727.20
75+ 3000 83.33 249.99 95.00 285.00
Total 51000 1,186.18 1,158.99

# of expected deaths = reference population/1,000 x age specific death rate per 1,000
age-adjusted death rate = expected deaths total/reference population x 1000

a. Expected deaths for population A: 1,186.18

b. Expected deaths for population B: 1,158.99
c. Age adjusted death rate for population A: 23.26
d. Age adjusted death rate for population B: 22.72

3. Indirect Standardization: Using information from table 3 calculate the number of deaths due to heart
disease that would be expected in California and Alabama if the death rate experienced in the U.S. was
happening in each of these states. Include the formula you used and interpret the results.

Table 3
 Age Group US age-specific California Expected Deaths Alabama Expected Deaths
death rate due Population Population
to heart disease
per 1000
0-24 4 2000 8 1000 4
25-49 7 2500 17.5 1500 10.5
50-74 10 3500 35 2500 25
75+ 30 4500 135 1000 30
Total 12500 195.5 6000 69.5

Observed deaths in California = 120

Observed deaths in Alabama = 30

# of expected deaths = reference population/1,000 x age specific death rate per 1,000
SMR = observed deaths/expected deaths x 100

a. SMR for California = 61.38

b. SMR for Alabama = 43.17

4. Eighty-seven individuals of a town with 460 residents attended a Christmas party where a meal was
provided. Within a couple of days, 39 of those who attended the party became ill with Norovirus. What
was the attack rate among those who attended the party? Of the 39 cases, 25 were females and 14
were males.
a. What is the ratio of females to males affected? 25/14 = 1.8 = ratio of 1.8 female:1 male
(number of females/number of males) x 100
b. What proportion of those affected were males? (14/39) x 100 = 35.89% affected were males
(# of males/# of cases) x 100
c. What is the attack rate of the disease? (39/87) x 100 = 44.83% attack rate
(number of cases/number at risk) x 100

5. Macron County vital statistics records indicated that there were 4,000 resident live births in 2013
compared with 3917 resident live births in 2012. In 2013, there was one more neonatal death and seven
more infant deaths than in 2012. In 2012, there were 24 neonatal deaths and 34 infant deaths.
Calculate neonatal and infant mortality rates (per 1,000 live births) for Mosquito County in 2012 and
2013.

# live births # neonatal deaths # infant deaths

2012 3917 24 34
2013 4000 25 41
NMR = (#neonatal deaths/#live births) x 1000
IMR = (#infant deaths/#live births) x 1000

a. Neonatal Mortality Rate 2012 = (24/3917) x 1000 = 6.127 per 1,000 live births
b. Neonatal Mortality Rate 2013 = (25/4000) x 1000 = 6.25 per 1,000 live births
c. Infant Mortality Rate 2012 = (34/3917) x 1000 = 8.68 per 1,000 live births
d. Infant Mortality Rate 2013 = (41/4000) x 1000 = 10.25 per 1,000 live births

6. Seven cases of Hepatitis A were found among 70 college students attending one class. Each infected
student lived with their parents. The number of persons in the 7 households was 32. Two weeks later 5
family members of the 7 infected students also developed Hepatitis A. Calculate the attack rate among
the students and the secondary attack rate among contact of those cases and interpret the results.

a. Attack Rate: (7/70) x 100 = 10%

AR = (# of primary cases/# of persons at risk) x 100
 b. Secondary Attack Rate: (5/32 - 7) x 100 = 20%
SAR = (# of cases of contacts/total # of contacts - # of primary cases ) x 100

7. In the fictional town of Oakville, a new infectious disease named "Aurelia Fever" has emerged.
Researchers are conducting an epidemiological study to understand the impact of Aurelia Fever on the
population of 30,000 residents. Over the course of one year (365 days), the health department records
the following data: On January 1st, there were 50 individuals with Aurelia Fever. Throughout the year, a
total of 150 new cases of Aurelia Fever are identified. The town's population remains constant at 30,000
throughout the study period.

a. Point Prevalence: Calculate the point prevalence of Aurelia Fever on January 1st.
(# sick at any given time/overall # in group) x 100
(50/30,000) x 100 = 0.166 or 0.17%
b. Period Prevalence: Calculate the period prevalence of Aurelia Fever for the entire year
(365 days).
(# initial cases + # new cases)/overall # in group x 100
(50+150/30,000) x 100 = 0.66 or or 0.7%
c. Incidence: Calculate the incidence rate of Aurelia Fever over the one-year study
period.
(# new cases/overall # in group) x 1000
(150/30,000) x 1000 = 5 cases per 1,000 people in one year

8. In the urban community of fictional Metropolis, a recent outbreak of a novel respiratory virus named
"Metropovirus" has prompted an in-depth epidemiological investigation. The study covers a period of
90 days, during which the health department meticulously records the occurrences of Metropovirus
among the 50,000 residents. The following data is collected:

● On Day 1, there are 20 individuals with Metropovirus.

● Over the course of the study, 120 new cases of Metropovirus are identified.
● The population remains constant at 50,000 throughout the study period.

Note: Incidence density involves considering the person-time at risk. In this scenario, the study period is
90 days, and the population remains constant. Consider this when calculating the incidence density.

Incidence Density: Calculate the incidence density of Metropovirus in the community of Metropolis
over the 90-day study period.

(# of new diseases/population x time period)

120/(50,000 x 90) = 0.0000267, approximately 0.000027

9. In the picturesque town of Serenity Valley, an epidemiological study is initiated to examine

reproductive health outcomes over the course of one year. The study involves a population of 500,000
residents, with a particular focus on maternal and fetal health. Why? There has been an increased
number of live births.

Fetal Death Rate: During the study period, there are 50 documented cases of fetal deaths (late fetal
deaths after 20 weeks of gestation). The total number of pregnancies after 20 weeks of gestation
include 50,000. It is crucial to consider these cases when calculating the fetal death rate.

Maternal Mortality Rate: Unfortunately, within a one-month period, there are three maternal deaths
related to pregnancy complications among 1200 live births during the same month. These cases are
carefully documented for analysis.

Fertility Rate: The total fertility rate is calculated by summing the age-specific fertility rates across
different age groups. In this scenario, the age-specific fertility rates for women aged 15-19, 20-24, 25-
 29, 30-34, 35-39, and 40-44 are provided as follows (per 1,000 women in each age group): 5, 40, 120,
200, 160, and 30. There are 47,828 women residents of childbearing age during the midpoint of the year
in Serenity Valley.

a. Fetal Death Rate: Calculate the fetal death rate in Serenity Valley for the given year.
FDR = (# of fetal deaths/# of PG > 20 wks) x 1000
FDR = (50/50,000) x 1000 = 0.001 x 1000 = 1 fetal death per 1,000 live births
b. Maternal Mortality Rate: Calculate the maternal mortality rate in Serenity Valley for
one month. Provide the formula and the calculation.
MMR = (# of maternal deaths/# of live births) x 1000
MMR = (3/1200) x 1000 = 0.0025 x 1,000 = 2.5 maternal deaths per 1,000 live births
that month
c. Fertility Rate: Calculate the total fertility rate in Serenity Valley for the given year
based on the provided age-specific fertility rates.
FR = (sum of age specific fertility rates/women of childbearing age) x 1,000
FR = (5+40+120+200+160+30)/47828 x 1000 = (555/47828) x 1000 = 11.60 children
born per 1,000 women of childbearing age

10. As a beginner epidemiology student, imagine you are tasked with investigating maternal and fetal
health outcomes in Serenity Valley. What are some initial steps you would take to understand and
address the issues identified in the town? Provide a basic outline, mentioning key aspects such as the
type of data you would collect, potential sources of information, and any specific factors you would
consider in designing your study. Additionally, briefly discuss the importance of collaboration with local
healthcare providers and community stakeholders in addressing maternal and fetal health challenges.

I. The first step would be the local health department for data including:
A. Community Health Assessments and Community Health Improvement Plans
B. Vital Statistics relative to maternal and infant morbidity and mortality including:
1. Birth weights
2. Maternal complications
3. SUIDS episodes and their causes
4. Breastfeeding rates of county
5. Socioeconomic status and connection to poor outcomes
6. Zip code mapping of poor outcomes…are there certain areas where this
problem is worse? Is there a connection to proximity to environmental
hazards?
7. Connection to health disparities, such as race, ethnicity,
II. Women, Infants, and Children (WIC) Program statistics and staff surveys to determine:
A. Cultural beliefs and how they affect health outcomes
B. Access to healthy food in the area
C. Other barriers to good outcomes
D. Breastfeeding rates of WIC clients
III. From there I would attempt to collect data from local hospitals, birth centers, and community
organizations by utilizing statistical data, anecdotal information, and surveys:
A. Prenatal care visits (total number and state of pregnancy in which they began)
B. Cultural beliefs and how they affect health outcomes
C. What issues are community organizations noticing?
D. Possibility of surveying patients/community groups and their families

Healthcare providers and other community organizations would offer insight regarding what specifically the
community needs to improve their rates. The possibility of collaborating would open the door to obtaining
grants, avoiding duplication of effort, and streamline the addressing of the needs of the community. They may
help with funding as well as have existing relationships with the policymakers who might directly address the
issues.