Lung CancerMeasures of mortality 1) CSDR 2) ASDR 3) Standardized CSDR 4) IMR – infant mortality rateCause-specific rates 1) 1,000*PDCSDRii= 2) 1,000*PDACSDRxixix= 3) ∑==X1xxixi1,000*PDCSDR, ∑∑===I1iX1xxix1,000*PDCDRMeasures of early life mortality Conception birth 1 month 1 year fetal death stillbirth NEONATAL POST NEONATAL PERINATAL t1t-0tBDIMR =, t28t-0tBDNMR =, t1t-29tBDPNMR =, ttPNMRNMRIMRt+=tft7t-0fttBDDDPMR++= (perinatal mortality rate)Endogenous vs. exogenous factors 1) Relative importance at different stages of epidemiologic transition 2) Implications for calculation of IMR 3) Difficulty of separating the twosource: mmwrMeasures of morbidity - Prevalence vs. Incidence 1) Prevalence rate=(Y÷P)*100,000 a. Y=# possessing characteristic of interest, new and existing, P=mid-year population b. Point prevalence vs. period prevalence 2) Incidence rate= (Z÷P)*100,000 a. Z=# experiencing event of interest in time period 3) May be very different for long-lived events/states a. Prevalence≈Incidence rate*average duration 4) May be very different for transient states when period of interest is long (e.g., lifetime)Source: Wilson (2006)Relative risk, risk ratios 0jk0j1jk1jkpzpzRR====÷= where k is some event/outcome of interest (e.g., death, diabetes, etc.), and j is some risk factor (e.g., smoker, divorced, worked in asbestos plant, etc.) Odds ratio: kzk0j0jk0jk1j1j1jkzpzzpRR======−÷−=Example Lung Cancer Person-years of observationSmoker Yes NoYes 640 3360 55,200No 200 9800 150,000Basics of epidemiology 1) Disease does not occur randomly 2) Focus not on individual cases/patients but on patterns of disease a. Geographic (e.g., Snow) b. Time c. Intergroup variation – focus on “risk factors” i. Behavioral ii. SocieconomicExample of geographic variationEducational Differentials in Mortality in the US0.0100.0200.0300.0400.0500.0600.0700.0LT 12 years 12 years GT 12 yearsCDR (per 100,000)All Causes Chronic Injuries
View Full Document
Unlocking...