Epidemio l o gy

Measures of disease occurrence -an introduction

Pasi Penttinen

T Ancelle / A Bosman / D Coulombier / A Moren / P Sudre / M Valenciano/ P Penttinen

Objectives
Define and use
Risk Incidence - Cumulative incidence (CI) - Attack rate (AR) - Incidence rate (IR) Prevalence Odds

RISK

RISK
Non-technical definition
Vague, culture-dependent Unexpected, unusual, dangerous/negative events

Epidemiologic definition
Probability that an event will occur Estimated by:
Observing events among a population during a specified time

Cumulative Incidence (CI) (Incidence Proportion)

Number of NEW cases of disease during a period Population of interest during this period

Example of bilharziasis in Guadeloupe in 1979:

Population New cases Cumulative incidence 350,000 1,250 3.6/1000 during a year

Cumulative Incidence
CI assumes that entire population at risk followed up for specified time period

x
x x

x
x
Month 1

CI = 7/12 per year

= 0.58 per year

x
x disease onset

Month12

Attack Rate (AR)

Cumulative incidence during an outbreak
Usually expressed for the entire epidemic period, from the first to the last case

Not really a rate but a proportion! Ex: Outbreak of cholera in country X in March 1999
Number of cases = 490 Population at risk = 18,600 Attack rate = 2.6%

RISK

RISK = The probability that an event will occur

a proportion

= Cumulative incidence = Attack rate

Prevalence (point prevalence)

Number of cases of disease at a specific time Population of interest at that time Proportion of a population affected by a disease at a given time. Expressed as a percentage

Example of bilharziasis in Guadeloupe in 1979:

Population Cases Prevalence 350,000 96,200 27.6%

Person-time
90 91 92 93 94 95 96 97 98 99 00 Time at risk

A B

6.0

6.0

C
D E Total years at risk
-- time followed x disease onset

10.0
8.5

5.0 35.5

Incidence rate (IR) (Incidence density)

90 91 92 93 94 95 96 97 98 99 00 Time at risk

A B

6.0

6.0

C
D E Total years at risk
-- time followed x disease onset

10.0
8.5

5.0 35.5

IR = 2 / 35.5 person- years = 0.056 / person-year

Incidence rate

Number of NEW cases of disease during a period Total person-time of observation

Rate
Denominator: - is a measure of time - the sum of each individuals time at risk and free from disease

Incidence

Duration

Prevalence

Deaths, Cured, Lost...

Merci Jean-Luc Grenier - CEPIQ98

Odds
Probability that an event will happen

Probability that an event will not happen

Won Lost
EPIET facilitator team 1995-2004 14 1

Total
15

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14 / 15 Odds of winning = ------------1 / 15

Odds of winning Odds of not winning = = 14 : 1 = 14 1 : 14 = 0.07

Odds of a rare event ~ RISK

The number of goals made by teams during EPIET courses

Facilitators Participants Total -----------------------------------------------------------------------------------EPIET courses 140 1 141 1995-2004 ------------------------------------------------------------------------------------

Odds of a part. goal=

1 / 141 ------------140 / 141

= 0.007

Risk (CI) of a part. goal = 1/141 = 0.007

If its not clear

Epidemiology, an introduction. Rothman KJ. Epidemiology in Medicine. Henneckens CH, Buring JE. Edited by Mayrent SL. Modern infectious disease epidemiology. Giesecke J. Dictionary of epidemiology. Last J.