Measurement in Epidemiology
Ye Minn Htun
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Cumulative Incidence
(attack rate, risk, probability of getting
disease, and incidence proportion)
No. of new cases of a disease occurring in the
population during a specified period of time
Incidence =
No. of persons at risk of developing the
disease during that period of time
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Incidence Rate
No. of new cases of a disease occurring in the
population during a specified period of time
Incidence rate =
Total person-time
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Prevalence
No. of cases of a disease present in the
population at a specified time
Prevalence =
No. of persons in the population at that
specified time
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Risk Ratio (Relative Risk)
Incidence/ Odds Odds
D +
D -
Prevalence (Cohort) (CC)
a a a
E+ a b a+b (a+b) b c
c c b
E -
c d c+d
(c+d) d d
Prevalence Ratio Relative Risk Odds Ratio Odds Ratio
(PR) (RR) (OR) Cohort (OR) CC
PrevE+ Inc E+ Odds E+ Odds D+
PrevE- Inc E- Odds E- Odds D-
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Risk Difference or
Attributable Risk
Attributable Risk in exposed individuals
Incidence among exposed – Incidence among unexposed
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Attributable Fraction
(Exposed)
In the exposed persons, how much of the total risk of
disease is actually due to exposure?
%ARexp = Incidence in the exposed - incidence in the non-exposed
incidence in exposed
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Attributable Fraction
(Population)
What proportion of the disease incidence in a total population
can be attributed to a specific exposure?
Incidence in total population- incidence in the non-exposed
Incidence in total population
Incidence in % smokers in Incidence in % non-smokers
smokers population + non-smokers in population
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Attack rate
exposed to a suspect food who became ill
Attack rate =
people who were exposed to that food
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Secondary Attack Rate
Number of cases among contacts of primary
cases
Secondary attack rate = × 100
Total number of contacts
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Problem 1
Assume that the horizontal lines in the diagram represent duration of
illness in 8 different people, out of a community of 700.
What is the prevalence of disease during July?
What is the incidence of disease during July?
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Problem 2
We were interested in the problem of diabetes in a nursing home with 800
residents. We would begin by doing blood tests on all residents to determine
which were diabetic, and 50 of the residents were diabetic. Over the next 12
months, 80 residents appear new cases, estimate the prevalence and
incidence of diabetes in this population.
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Problem 3
A comparison of pain relief with two analgesics
The "X"s indicate when subjects reported pain relief. The "O"s at the end indicate
subjects who did not report relief of pain.
· Which group appears to have had a greater incidence rate of pain relief?
· How did the cumulative incidence of pain relief compare? 13
Problem 4
Suppose we followed a population of 150 persons for one year, and 25 had
a disease of interest at the start of follow‐up and another 15 new cases
developed during the year.
1) What is the period prevalence for the year?
2) What is the point prevalence at the start of the period?
3) What is the cumulative incidence for the one year period?
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Problem 5
In a particular year health record, there were 1000 births. In
reviewing their birth certificates, you found that 72 had low
birthweights (<2500 gms), and 158 had mothers who smoked during
pregnancy. Of the mothers who smoked during pregnancy, 19 had
low birth weight babies. Find out the relationship between maternal
smoking and the occurrence of low birth weight.
LBW
Smoking during Pregnancy Yes No
Yes 19 139 158
No 53 789 842
72 928 1000
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Problem 6
• Within 10 days after attending a wedding, an outbreak
of cyclosporiasis occurred among attendees. All 120
were interviewed; 96 of the 120 were ill. After
interviewing, 45 of the 96 people who are ill and 5 of
the 24 who are healthy, ate wedding cake. Find attack
rate and food specific attack rate.
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Problem 7
Calculate the food specific attack rate. Which food will be most probable risk of
food poisoning?
Eat Not Eat
Food
ill well total ill well total
Lobster Tail 55 15 70 2 10 12
Steak 52 21 73 3 5 8
Corn on the
26 22 48 19 13 32
cob
Three bean
18 17 35 17 15 32
salad
Potato salad 38 14 52 16 12 28
Bread 32 13 45 23 13 36
Chocolate
30 41 71 4 9 13
Cake
Tea 28 15 43 27 11 3817
Problem 8
There was a church supper in a small town and 75 people attended that supper. 46
of the 75 people who attended supper developed gastrointestinal illness within
several hours. Examination of the number of individual who ate various foods at that
night was done and results were as follow,
• 10 of 68 people who ate cheese sandwiches became ill, 1 0f 7 who did not.
• 43 of 54 persons who ate vanilla ice cream became ill, 3 of 21 who did not.
• 11 of 70 persons who ate pudding became ill, 1 of 5 who did not.
(i) Calculate the attack rate for different food items.
(ii) Calculate the risk of getting illness after having each food item and which food
item is etiological agent of an acute outbreak.
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