CLS351 3*LectureOutline + Describing basic measurements in epidemiology. + Recognizing case definitions. + Defining ratio, proportion and rate and their uses. + Sources of epidemiological data.4, ea Basic Measures of Disease Frequency o Counts/Frequencies The simplest method to express frequency is to count persons with a particular disease. However, counting is rarely enough! * Because the number of cases may vary from place to place according to the number of people living in. + i.e. three cases of cancer per year from a city of 1,000 people is very different from three cases per year from a city of 100,000 people. o Therefore, its best to link the frequency (the numerator) to an appropriate population (the denominator). The importance of understanding “numerator” and the “denominator” is by measured by: Proportions, rates, ratios.1.Ratio * Itis a relationship between two numbers (one is divided by the other). * Those included in the numerator are not included in the denominator. Examples: Number of males Sex Ratio: Number of females Number of physicians Physicians to patients ratio: Number of patientsExample: In the nursing college, there is a total of 120 students, 40 male and 80 female calculate the sex ratio in this college. Sex Ratio = Number offemales) _ 80 Number af Vales 40 5.4Sex Ratio = Female/ Male 80/40 =2 So the RATIO is Female nursing student: Male is 2:1 Solution: We can simplify the ratio 80 : 40 by dividing both terms by the greatest common factor (GCF). The GCF of 80 and 40 is 40. Divide both terms by 40. 80+40=2 40+40=1 Therefore: 80:40=2:1 Note that Order Matters.2» proportion It is a special measurement where the numerator is a subset of the denominator Examples: Proportion of male births = Number of male births ————_ Total number of births oe It may be expressed as a number between 0 and 1 (0.1, 0.2,...etc), OR as a percentage (10%, 20%,...etc). {>=Proportion of persons with a specific disease (usually termed: prevalence) = Number of persons with a specific disease 5 opulation being consideredExamples: Distribution of cases of type | diabetes: * AgeO0-4 =70cases * Age5-9 =73cases * Age 10-14 = 75 cases i of type | diabetes in children less than 5 years 70 70 = = en X0.32 (32%) 70+73+75 2183.Rate — It is a measure that relates thé number of case8 > during a certain-period of timeéxto the size of the population. s+ * i.e. number of persons (diseased or dead) per unit of population per unit of time. The numerator is a subset of the denominator = alatb3.Rate Rate = Number of events (disease or death) in a specified period XK Number of population at risk of these events in the same period K is a constant used to get a whole number to avoid fraction « the rate is multiplied by 1,000, 10,000 or 100,000 for ease of interpretation.(6 Example: in 2004, 44,108 new cases of AIDS were reported in the United States, the estimated 2004 mid-year population (290,810,000). So, the rate of AIDS in the USA during 2004 = VY Ws OG ay” 44,108 Se 100 0007 000 15.2 en woo or, wn 290,810,000\ a 3.Rate For surveillance purposes, + the period of time is usually a calendar year, * numerator is the number of cases reported that year, ¢ denominator is the estimated mid-year population. As the denominator population is growing or shrinking during the period of time, it is customary to use the population size at the midpoint of the time interval.3.Rate Rates are useful for: c= a)Comparing disease occurrence: + In different locations whose populations differ in size. + During different periods of time. Example, + 19.5 cases of chickenpox per 100,000 in 2001, + But, 135.8 cases per 100,000 in 1991. b)Identifying high-risk groups. * to identify the risk factors of the disease, so special interventions can be directed to them. aIs numerator included in denominator? f=] [ex] Is time included in denominator? Ratio _ Example: Incidence rate Prevalence rate Matemal mortality ratio ] Figure 3: Algorithm for distingulshing rates, proportions, and ratlos\4 Sources of epidemiological data Can be categorized into: * Routine data and non-routine data. Non-routine data are data collected for their primary purpose, could be from survey, clinical trial, a registry, a biobank, and various kinds of quantitative or qualitative research study.\) Routine data * Are non-targeted information recorded for administrative or other purposes without any specific research question in mind usually obtained in a standardised manner. e.g. * Demographic data (census and population registers) * Health data and health determinants * Environmental exposures * Related terminology: “already collected data”, “existing data”, “national databases”, “mortality and cancer registry data”, etc.Why should I be interested in routine data ? Leese rine When might | use them? 1. Defining the scale of a problem. 2. Trends over time/ making projections. 3. Aetiological studies. Commentary: Comparison of time series and case-crossover analyses of air pollution and hospital admission data Shakoor Hajat(kt am Advantages/disadvantages of routine data Advantages Disadvantages Q Relatively cheap @ May not answer the research question @ Already collected Q = Incomplete ascertainment—. @ Standardized collection procedures Q Quality @ Relatively comprehensive Q Validity @ Available for past years Q Variations in disease labelling @@Coding differences @ Experience in use and interpretation @ Need careful interpretationSources of epidemiological data — routine data wh c= 1. Census: Size, composition and distribution of a population. @ Held every (6 to 12) years in the Saudi Arabia. @ Last Census in 2022. @ Used for denominators for rates, service planning, information on marital status, employment and education level. Not conducted in countries with complete population registries https://unstats.un.org/unsd/demographic/sources/popreg/popregmethods.htm1 5 ! ‘ 1 i i qooo oo oo ooo ooo ooo 4 4 [3] By o o ttn tt Ce Coo-| cri ae 0100) 0/00/01] 0 |0O}00)00) 0 | (CC |o}co 0100} 0) 00] 01] 0 |0o}oo oo) 6 | |G |o/oo 0100) 0/00/01 0 |0o}oo)) 0/8 | |o}m 0100} 0/00/01} 0 |0o}oo)) 0/8 |aT|o}m 0 00/0/00! 01/0 |05)o5/o0] 0/0 jot \o}m 0 100/0/00/ 010 |i) o}o oO} O100/ 0/00/01 0 |i io) o}o ‘o}co O00} 0/0010} 28 (OOo }o) 8 | 8 || oi I I Ic I I I) I oO (ooCor scpanin agen gee tac in pa oy C3 [ra] cI ttn - tn Lt OO {00 {00} 00 {Oo | Oe | Ge || os 0 /00/0/00/01/0 |}co\c/o/o o/c 0100/0} 00/01] 0 |0O}o0)o9) 6 | (Co |o/oo 0100} 0/00] 0} 0 |0O}00)00) 6 | 0 |G |o}oo Bjja 0100) 0/0010) 0 (00/00/00) 6/0 |G |o1co I I) I) Ic) ojo oo oe 1mA Ule ering) om Census -— latest census * The general population and housing census 2022 is the fifth census conducted in Saudi Arabia. (1974, 1992, 2004, 2010..) * This census will be linked with the national address, and electronically connected to many related entities such as national information center, ministry of education, ministry of housing, Saudi post, and many other sectors associated with data of citizens, residents, and housing. For more information: https://www.stats.gov.sa/en/13pep a . Population estimates: Population in inter-censual years. Computing morbidity &mortality rates. The difference between births and deaths every year is added to the population of the last census. Multiple methods for population forecasting or projection: Arithmetic, straight-line and geometric.HA A - Arithmetic method: If mid-year population for the year 1970 was 6.000.000 and mid-year population for the year 1980 was 13.000.000. The population increase over the 10 years was 7.000.000. If this increase was equally distributed over the 10 years, then the yearly increase would be: 7.000.000 + 10 = 700.000. =_ So, the mid-year population for year 1971 would be = 6.000.000+ 700.000 = 6.700.000AA _ B - The straight line method: It is used also for inter-census estimation of the population. Plot the two census values on graph paper and connect between the two dots by a straight line and extend this as far as required beyond the last census. The value opposite the given inter- census year represents its mid-year population. Estimated|population Population => Plotted Estimated | Time=> Time at which Population _) is requiredThe straight line method: Estimated world population 2000 - 2015, r T T t r t T T 1998 2000-2002» 2004-2006. 2008 «= 2010 2012. 20142016 Year*¢ - The geometric method: assumption that the percentage increase in population is constant Year Population Increase in Percentage increase in Poputation Population 1940 8,000 = 4000 1950 12,000 4,000 x 100=500% 1960 17,000 5,000 a aT 1970 22,500 $5,500 x100= 324% Total 14,500 124.1 Average per decade 4833 4137 Year Expected Populati Pt = Pa (Pb/Pa) 2 1980 22,5004 Go 4137 31,808: 1,808 = 44,967 1990 31808 += C3 1808 = 44,965 2000 44,967 +131 44,967 = 63570 100- The geometric method: — + In this method we realize that the population is growing by a constant percent using a certain formula: Pt = Pa (Pb/Pa) ‘2 « Where: ¢ Pt = population estimate at certain time ¢ Pa = population count in census one (e.g {45D ih, + Pb = population count in census two (e.g 1425)5 eta = number of years after cenguso ne (at which population estimate is needed) e.g 2 years (at 1417) ¢ ba = the inter-census period (10 years: So: : Burrs Pp 1415 (Pgne/P 1418) 20 4115 1417 26,000,000 (33,300,000/26,000,000) 26,000,000(1 .3) ¥ = 26.000.000 x 1.05 = 27,319,171 5AWorking example: co In Saudi Arabia, mid-year population for the year 1990 was 16,140,000 and mid-year population for the year 2000 was 20,050,000. Estimate mid-year population for year 1991 either using the arithmetic method or the geometric method. Using the arithmetic method: The population increase over the 10-year period was= 3,910,000;then the yearly increase would be 391,000.> So the mid-year population for the year 1991 wo = 16,140,000 + 391,000= 16,531,000)q4 Working example: — In Saudi Arabia, mid-year population for the year 1990 was 16,140,000 and mid-year population for the year 2000 was 20,050,000. Estimate mid -year population for year 1991 either using the arithmetic method or the geometric method. Using the geometric method: P1991= P 1990 (P2000/P1990) * (1/10) P1991= 16,140,000 (20,050,000/16,140,000) * (1/10) = 16,140,000 (1.24) *(0.1)= 16,140,000* 1.02= 16,462,800ASE Spada tly ante ‘ Poodation by Age Gos and Gnda door 208 Po ae Tani Popaion Se sa0s02r sasnase sama ‘nasi sans sana78 on 6.26 708 se. 77 0.88 “ors mare ere nase or ra 7 a0 ord sss ror oo arse serie ATR OTT TTT TEES EE https:/www.stats.gov.sa/ar/433. Vital records: Vital data are defined as major events in the population that are required by law to be reported to governmental authority. ¢ Births: important as a denominator for epidemiologists and as a numerator for demographers (birth rate — fertility rate). Also to adjust for population figures in inter-census years ¢ Deaths: the major outcome of interest for epidemiologists ( cause specific death rate).Avani jigail "(VS/v) iladeg Adal) Jip St Dalat ,iph ~ (Gatly dequc stl gigad ) Apathy 1D je yeast oO ooh es yO oe foi ceo ate PETS) Basta pal dats Cegagaae a Set eee PPT) yan ayant | aetna ee) cn) (a) ' Bath cally aps Pat Sasa ly Susie ale a py JP Ses py Cate tea! a a oe EP LETTE TT stirs estan aa Bt aati aot ee Tao daa mages aay ipa ‘aalyatt gains Ratt eat sett : aasticdy4. Morbidity data: ¢ Notification of infectious diseases (notifiable disease): - Fluctuation of occurrence of diseases. - Planning and evaluation of the control or preventive measures. ¢ Disease registers: major public problems. ¢ Hospital records: inpatient and outpatient records.Bo Section I: Infectious Diseases That Should Be Notified Immediately (within 24 H) By Fax or Phone Cholera 11. Acute 12. Meningococcal ‘SARS Plague Flaccid Meningitis Rabies Yellow Paralysis 13, Haemorrhagic Antrax Fever ~ Suspected fevers: Avian Flu Neonatal | Poliomyelitis + - Dengue fever MERS CoV. Tetanus |-Guillian += Riftvalley fever HINI critical Diphtheria | Baree + sLassa cases. Measles | - Transverse + + Ebola 21. Anyemerging Rubella | Myelitis ++ Crimean disease Congenital |- Other Congo 22. Any disease rubella | suspected + -alkhomra that 9. Mumps | Polio cases + +Other appears in 10. Pertussis haemorthagic | epidemic fevers even if itis not West Nile Virus included Fever in section | & IL 23. O fever moh.gov.sa3\ Section Il: Infectious Diseases That Should Be Notified Weekly to the Region and Then Monthly to the MOH 24. Chicken 28. Typhoidand 33. Pneumoccal 39. Tuberculosis. Pox paratyphoid meningitis 40. leprosy 25. Tetanus | 29. Brucellosis 34. Haemophalus 41. HIV. mn a 30. Amoebiasis | meningitis 42, STI aries 31. Salmonellosis | 25, Other meningitis | 43. STIsindromes. hepatitis | 32: Shigellosis | a. Hemolytic uremic | 44. Malaria -Hepatitis A sindrome 45. Leishmania, -Hepatitis B 37. Echinococcosis | 46. schitosomiasis - Hepatitis C 38. HINI - Hepatitis D - Hepatitis E Unspecified Hepatitis (other types moh.gov.sa¥ Hospital activity data ow) ae * Derived from hospital computer systems. * Every hospital has its own database. * Working on data linkage for all hospital databases in Saudi Arabia (not yet achieved but predicted to happen in the near future). 4. Bo A. aye)® & & oO ref bsg all gone nll esl gol palo all sal < ajaelloloslg logit! aibg! ig Roeper pee sagall pigyLSIW! gaa eAlall la gl as il bl etal ase Jo fits use ual Yor Jay pl lal ral el gordo hy! ig gar all J Jo gaa aS Ja tas sagll gig yo ell Ul i ue J gb Uy J ils lal & gel lal ool yeaa ig ll gh * ile alas ol allay al lg lb all ane * lope alg da lat + vial nal as agp uly ALS Al # == ba Spal ote oly JS al ols a ‘a dng 8 east peg a hl psme ltl tial it (gaa) dat gS gat ata seal git gon sopQe - a Uses of morbidity data * Medical care research: utilization pattern, organizational structure and characteristics of providers associated with level of care. * Rates of survival after treatment in a hospital. * Temporal trends in disease frequency. * Define priorities for allocation of resources based on patterns of mortality, symptomatic burden of illness to both individuals and society.Other sources of epidemiological data 2 tania) “ile Me alreracen fea Je eaiaes0 em stperston Demtygreminss (BY Cocetetne esa roa te Seale seater Sti as70 1198 o) 2489408 Poine ace 05%cee esc noaunes erouuneasovnay vecoaus ems ese y oe ieee comm = aan iano |M& FOREIGN TRADE ‘inoeay eserces: Hl Sa aoe “Survey of Small and Medium-sized Rodina, Services Guide. Indes ot Furign Tage Fnandlan irace series "onsen armani atc Sates sections ror cecal FE ae esac eae ae — eee rss anes ae ‘ulletin of Culture and Heuaheld ae —— os =o a — a = naw a aa tanto ee —— mong terete —aaisetn Meta eek General Authority for Statistics Gpuill dan awo Household Health Survey 2017Aull aabaally pl ge eal pn ase sl a 1) gal Population (18 yer and over by Reston for Smoking Cenation, ex, and Amitav Ares ‘ae ons 1387 2788 151057 1658 Mskish nolaramch 26a uso ae rane wean ar ‘anon verona a 7380 se aaa sue ayaa ‘Avoaszen ° ow 50 10198 1415 escat ston togen ae arse vw wae 2s200 sepa atu ve ° ans 200 vas 204 a perme Bees 6 ae sess ms 18 a pat aut oi 17 201 2 et ‘Source: amy Heath Survey 2017 Genel Authory for Statics nat aig IV Spl ga aAyanll aly yall papal aa dingo pally aaa (ila di 1) lal Population (15 yas and ove) who stor om A Cronk iseasby Name of Dagnozed Disease and Age Groups 15-19 20-38 se a 4400 aoe 30 338 10013 20 sonest reno 35.9 50-54 076 sme 0505 zone 50-56 ‘Source: amy Heath Survey 2017 GevarlAuthrty for tatiis saad gl FIV pad gaan aaEnd of 3" lecture