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Epidemiology I

Review questions for first exam

1. A prevalence survey was conducted from January 1 through December 31, 2003 in a city of 2
million persons. On January 1, 2003, 995 people reported that they had schizophrenia. By
August 1, 2003, 3 people in the population had developed schizophrenia. At the end of the
study in December, 5 new cases in total had been reported over the course of the year.

a) How many new cases of schizophrenia developed between August 1, 2003 and December
31, 2003 in this population?

2 new cases (5 cases in December – 3 cases in August)

b) What was the cumulative incidence of schizophrenia on August 1, 2003? (per 100,000)

Incidence = # new cases / population at risk = 3 / (2,000,000 – 995) = 0.15 per 100,000

c) What was the cumulative incidence of schizophrenia for the year on December 31, 2003?
(per 100,000)

Incidence = # new cases / population at risk = 5 / (2,000,000 – 995) = 0.25 per 100,000

d) What was the prevalence of schizophrenia on January 1, 2003? (per 100,000)

Prevalence = # cases / population = 995 / 2,000,000 = 49.75 per 100,000

e) What was the prevalence of schizophrenia on December 31, 2003? (per 1,000)

Prevalence = # cases / population = 1,000 / 2,000,000 = 50 per 100,000 or 0.5 per 1,000

2. What would be the effect on age-specific incidence rates for uterine cancer if women with
hysterectomies were excluded from the denominator of calculations, assuming that there are
some women in each age group who have had hysterectomies?

o a. the rates would remain the same


o b. the rates would tend to decrease
o c. the rates would tend to increase
o d. the rates would increase in older groups and decrease in younger groups
o e. it cannot be determined whether the rates would increase or decrease
3. Use the table below to calculate crude and age-specific death rates per 1,000 population in
the Florida county of Leon in 1988.

Table 1: Leon County, 1988

Age N for the # of Age-specific death rate per N for Age-adjusted death
group populatio deaths 1,000 hypothetical rate per 1,000
(years) n population
(midyear) (midyear)
≤ 24 83,471 92 92/83,471*1000=1.1/1000 1,200 1.1/1000 x 0.25 =
0.27/1000
25 – 44 57,877 78 78/57877*1000=1.35/1000 1,200 1.35/1000 x 0.25
=0.33/1000
45 – 64 27,745 196 196/27745*1000=7.06/1000 1,200 7.06/1000 x 0.25 =
1.76/1000
≥ 65 14,251 711 711/14251*1000=49.9/1000 1,200 49.9/1000 x 0.25 =
12.47/1000
Total 183, 344 1,077 1077/183344*1000= 4,800 Sum of all the age-
5.87/1000 adjusted death rates:
CRUDE DEATH RATE 14.83/1000
AGE ADJUSTED
RATE

a) Fill in age-specific death rate per 1,000 in table 1

b) Now calculate the crude death rate (CDR) per 1,000 and age-adjusted death rate per
1,000 for Leon county

For questions 6 and 7, use the information below:

 Population of the city of Atlantis on March 30, 2003 = 183,000


 No. of new active cases of TB occurring between January 1 and June 30, 2003 = 26
 No. of active TB cases according to the city register on January 1, 2003 = 264

6. The incidence rate of active cases of TB for the 6-month period was:

o a. 7 per 100,000 population


o b. 14 per 100,000 population 26/(183,000 – 264) = 14.23 per 100,000
o c. 26 per 100,000 population
o d. 28 per 100,000 population
o e. 130 per 100,000 population

7. The prevalence rate of active TB as of June 30, 2003, was:

o a. 14 per 100,000 population


o b. 130 per 100,000 population
o c. 158 per 100,000 population (26+264)/183,000 = 158.47 per 100,000
o d. 264 per 100,000 population
o e. none of the above

8. In an Asian country with a population of 6 million people, 60,000 deaths occurred during the
year ending December 31, 1995. These included 30,000 deaths from cholera in 100,000 people
who were sick with cholera.

a) What was the cause-specific mortality rate from cholera in 1995? (per 100,000)

30,000/6,000,000 x 100,000  500/100,000

b) Calculate and interpret the case-fatality rate from cholera in 1995? (Please portray
as a percent)

30,000/100,000  0.3 = 30%

30% of individuals in an Asian country who became ill from cholera died from cholera.

Refer to table 2 to answer questions 10-15

Table 2. Eating fish and stroke

Exposure status (Eating fish) Cases of Stroke Non-cases of Stroke TOTAL

Exposed (Never eating fish) 82 1549 1631

Unexposed (Eating fish almost daily) 23 779 802

TOTAL 105 2328 2433

9. Calculate cumulative incidence in exposed (per 1000)

RE = 82/1631=.0503 or 50.3 per 1000

10. Calculate incidence in the unexposed (per 1000)

RU = 23/802=.0287 or 28.7 per 1000

11. Calculate and interpret attributable risk (per 1000)

RE – RU = 50.3-28.7=21.6 per 1000

If those who don’t eat fish change their eating habits and begin to eat fish (almost daily), their incidence of
stroke will decrease by 21.6 per 1000 individuals.
12. Calculate and interpret attributable risk percent ( also known as the attributable risk
proportion or etiologic fraction)

Attributable risk / RE = 2.16/5.03*100=43%

This will represent that 43% of stroke cases among the exposed are attributable to not eating fish.

13. Calculate and interpret population attributable risk (per 1000)

(RT – RU) = (105/2433 – 23/802) = 43.2-28.7=14.5 per 1000

RD*Pexposed = 21.6/100 *0.67 = 14.5 per 1000

A reduction of 14.5 new cases of stroke per 1000 individuals in this population is expected if everybody
eats fish almost daily. Alternatively, 1.45 new cases of stroke per 100 individuals in this population can be
attributed to not eating fish.

14. Calculate and interpret population attributable risk percent (also known as population
attributable proportion)

(RT – RU) / RT = 1.45/4.32*100=33.6%

If the exposure was removed from the population, there would be a 33.6% reduction in incidence of
stroke in the population. Or, 33.6% of stroke cases in the population are attributable to not eating fish
every day. Alternatively, 33.6% of stroke cases in the population could be prevented if everyone ate fish
almost every day.

15. For a disease such as pancreatic cancer, which is highly fatal and of short duration:

o a. Incidence rates and mortality rates will be similar


o b. Mortality rates will be much higher than incidence rates
o c. Incidence rates will be much higher than mortality rates
o d. Incidence rates will be unrelated to mortality rates
o e. None of the above

16. Which of the following is a good index of the severity of a short-term, acute disease?

o a. Cause-specific death rate


o b. 5-year survival
o c. Case-fatality rate
o d. Standardized mortality ratio
o e. None of the above

17. Of 2,872 persons who had received radiation treatment in childhood because of an enlarged
thymus, cancer of the thyroid developed in 24 and a benign thyroid tumor developed in 52. A
comparison group consisted of 5,055 children who had received no such treatment (brothers
and sisters of the children who had received radiation treatment). During the follow-up period,
none of the comparison group developed thyroid cancer, but benign thyroid tumors developed in
6. Fill in the 2x2 table below and use it to calculate the relative risk for benign thyroid tumors
between the comparison and control groups.

Benign thyroid No benign tumor TOTAL


tumor
Exposed (received 52 2,820 2,872
radiation)
Unexposed (no 6 5,049 5,055
radiation)
TOTAL 58 7,869 7,927

(52/2872)/(6/5055) = 15.2 RR

18. The results of a 10-year cohort study of smoking and coronary heart disease (CHD) are
shown below:

OUTCOME AFTER 10 YRS

At Beginning of Study CHD Developed CHD Did Not Develop

2,000 Healthy smokers 65 1,935

4,000 Healthy nonsmokers 20 3,980

Calculate the incidence of CHD in smokers that can be attributed to smoking.

(65/2000) – (20/4000) = 32.5/1000 – 5/1000 = 27.5/1000 people

19. What factors should be considered in measuring long-term changes in disease frequency
over time?

o a. Changes in diagnostic criteria


o b. Changes in the age distribution
o c. Changes in the fatal course of the condition
o d. All of the above
o e. None of the above

20. The risk of acquiring a given disease during a time period is best determined by:

o a. the mortality rate from that disease in the 0-4 age group.
o b. a spot map that records all cases of the disease in the past year.
o c. the period prevalence for that disease during the past year.
o d. the incidence rate (cumulative incidence) for that disease in a given period of time.
o e. the case fatality rate for the disease

21. An epidemiologic survey of roller-skating injuries in Metroville, a city with a population of 100,000
(during the midpoint of the year), produced the following data for a particular year:

 Number of skaters in Metroville during any given month 12,000


 Roller-skating injuries in Metroville 600
 Total number of residents injured from roller-skating 1,800
 Total number of deaths from roller-skating 90
 Total number of deaths from all causes 900

a) The crude death rate for all causes was:

o a. 90/600 × 100,000
o b. 900/100,000 × 100,000
o c. 90/1,800 × 100,000
o d. 90/900 × 100,000
o e. 600/10,000 x 100,000

b) The cause-specific mortality rate from roller-skating was:

o a. 90/600 × 100,000
o b. 90/100,000 × 100,000
o c. 90/1,800 × 100,000
o d. 90/900 × 100,000
o e. 600/10,000 x 100,000

True or false questions

22. The crude death rate is defined as the number of deaths in a given year divided by a reference
population (during mid-point of the year) multiplied by 100,000.

True

23. The point prevalence of a disease is defined as the number of persons ill divided by the total number
in the group at a point in time.

True

24. The cumulative incidence of a disease is defined as the number of new cases of the disease over a
time period divided by the total population (at risk) during the same time period times a multiplier (e.g.
100,000).

True

25. When the duration of a disease becomes short and the incidence is high, the prevalence becomes
similar to incidence.

True
26. For a chronic disease of low incidence and long duration, prevalence of the disease increases relative
to incidence.

True

27. The incidence rate of a disease is defined as the number of new cases of the disease over the
number of person years for the total population.

False – it is for the population at risk, not total population

28. At the initial examination in the Framingham study, coronary heart disease was found in 5 per 1000
men ages 30-44, and in 5 per 1000 women ages 30-44. The inference that in this age group men and
women have an equal risk of getting coronary heart disease is correct (Bonus: Why or why not?)

False– Because this is prevalence data, not incidence.

Use the abstract below to answer the following questions:

33. Identify what the exposure of interest is in this study

Breastfeeding duration

34. Identify what the outcome of interest is in this study

Metabolic syndrome

35. What is the population to which this study is generalizable?

Obese children aged 3-18 years old in the US (?)

36. What is the study sample?


123 Obese children aged 3-18 years visiting one pediatric outpatient clinic