Annotated Answers to Gordis, Epidemiology, 4th Edition Questions

Chapter 3 1. The best answer is e. The inference is incorrect because a comparison of risk involves comparing measures of disease incidence. The example describes the prevalence of migraine headache in men and women of the same age group. Prevalence represents all cases of a disease in a population at the time of examination; therefore, it is influenced by the duration of time that individuals have a disease. Incidence is the total number of cases of a disease that develop during a specified time interval divided by the total number of persons at risk for the disease for the same time period. Since incidence measures the transition from nondiseased to diseased status, it is considered a measure of risk. Statement a is wrong as the inference is incorrect. Statement b is wrong because two prevalence ratios are presented; however, they do not describe risk. Statement c is wrong because the comparison is restricted to a single age group. Statement d is wrong because data are given to compare men and women; however, additional information is needed to describe risk. 2. To calculate the number of new cases in the population: = Number of new cases in a population over a given time period Number of people at risk during that time period * total population =5 1,000 * 2,000,000 = 100 new cases in 2003 To get the percent of newly diagnosed cases: = New cases in 2003 Total cases in 2003 = 100 1,000 = 0.10, or 10% 3. The best answer is c. Active surveillance denotes a system in which assigned staff make periodic visits to health care facilities to collect information for new cases of disease or other health outcomes. One advantage of active surveillance is the reduction of reporting burden for health care providers when they detect a new case of disease as this information will be collected by the surveillance staff who initiate contact with the facility. Statement a is not true since active surveillance requires designation of staff members specifically for disease reporting and staff size will increase with the number of diseases or the size of the population under surveillance. Statement b is incorrect since active surveillance also imposes a financial burden for hiring, training, and maintaining teams of persons to do these functions. Statement d is not true as surveillance reports depend on a

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Annotated Answers to Gordis, Epidemiology, 4th Edition Questions consistent case definition to identify disease events. Statement e is wrong since active surveillance systems require intense investments of time and resources. 4. The best answer is c. Since women who have had hysterectomies are not at risk for developing uterine cancer, the removal of these women from the denominator will cause the rates to increase, but the same number of age-specific incident cases will remain in the numerator for each rate calculation. Statement a is incorrect since the rates will change with the removal of women with hysterectomies from the denominator. Statement b is wrong since the rates would only decrease with a reduction in the number of uterine cancer cases, the numerator, or an increase in the number of women at risk, the denominator, which does not happen in this example. Statement d in incorrect because the premise of the question is that each age group contains women who have had hysterectomies; therefore, the denominator will decrease and thus rates increase in all age groups. Statement e is wrong because the removal of women with hysterectomies will affect the denominator only as no cases will occur in women who have had hysterectomies. Therefore it can be determined that the rate will decrease. 5. Statement b is the best answer. The interpretation is incorrect because the data presented only describe the percentage of persons diagnosed with hypertension. This reflects the prevalence of hypertension in the population and does not contain information on incidence which is necessary to describe risk. Incidence is calculated as the number of new cases of disease in a population in a specific time period divided by the number of persons at risk of disease in the population during the specific time period. This example lacks a specified time period. Thus only prevalence data are presented. Statement a is incorrect because the interpretation is wrong. Statement c is wrong because incidence rates do describe risk, but they are not given in this answer. Statement d is wrong because prevalence is an estimate of the number of cases in a population at risk. Since the table does not provide information concerning the size of the population in each age group, the prevalence of hypertension cannot be calculated. Statement e is incorrect because no comparisons are being made between populations. This is a requirement for age adjustment as this technique adjusts for differences in the age structures between two populations to compare disease rates between these populations. 6. The correct answer is b. To calculate incidence: = Number of new cases in a population over a given time period Number of people at risk during that time period = 26 new cases of TB Population of 183,000 during the 6-month period = 0.00014, or 14 per 100,000

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Annotated Answers to Gordis, Epidemiology, 4th Edition Questions 7. The correct answer is c. To calculate prevalence: = Number of cases in a population Population at the time of enumeration = 264 cases of TB Population of 183,000 during the 6-month period = 0.00144, or 144 per 100,000

authored by J. Morel Symons