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Instructor: Kimberly Shea, PhD, MPH Talbot 425 East Phone: 617-638-7725 Email: kimshea@bu.edu
70
Years
60
50
40 30
38.3
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(1) Haines M. Vital Statistics. In Historical Statistics of the United States: Millennial Edition, Cambridge University Press, 2002. (2) Health, United States, 2010. National Center for Health Statistics. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, Maryland. 2011.
White Male
-2.0
Black Male
Health, United States, 2010. National Center for Health Statistics. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, Maryland. 2011.
United Nations (2007). World Population Prospects: The 2006 Revision, Highlights, Working Paper No. ESA/P/WP.202.
Course Objectives
To introduce basic principles & methods, and
demonstrate their applicability to public health and research
Very Important!
Multiple sessions of EP713 are not interchangeable
Course Resources
Required Textbook: Ann Aschengrau and George R.
Seage III. Essentials of Epidemiology in Public Health, 2nd Edition.
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TA Q&A Sessions: Wednesday 5:00 5:50 pm 670 Albany Street * Except Sept 19: Room 107/108
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Course Format
Specific learning objectives for each class session Lectures
o Notes available the day before class
Required readings
o Practice questions and answers in text
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Workshops
o 3 in-class workshops designed to help you master the material
Exams
o 3 quizzes/exams
6:00 7:00 pm November 7 6:00 7:00 pm December 19 6:00 8:00 pm o Can only be rescheduled by contacting me before the exam
October 3
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Assessment/Grading
% of Grade
10% 25% 15% 20% 30%
What 10 Pre-class online quizzes 8 Problem sets Quiz 1 Quiz 2 Final Exam
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The learning objectives are key Read before class Come to class Complete all the problem sets; ask for clarification
Keep up
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Learning Objectives
1. Define epidemiology 2. Define and generate a testable hypothesis 3. Describe the history of epidemiology and its current role in medicine
and public health
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1330s-1350s pandemic
Total breakdown of society 25-33% of the European population died
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o o o o
Miasmas: unseen vapors from swamps & cesspits Poisoning by the Jews Contact with lepers Walking in the hot sun
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L I N K
Exposure
Risk factors Determinants Independent variable
Outcome
Diseases Injuries Dependent variable
What is Epidemiology?
Epidemiology is Based on Two Fundamental Assumptions
1) Human disease does not occur at random; there are factors or determinants which can increase or decrease the likelihood of disease
2) The factors or determinants (some are causal and some are preventive) can be identified by systematic investigation of populations or subgroups within populations
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What is Epidemiology?
The study of the distribution and determinants of disease frequency in human populations and the application of this study to control health problems
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What is Epidemiology?
The study of the distribution and determinants of disease frequency in human populations and the application of this study to control health problems
A group of people with a common characteristic such as residence, age, gender, group membership, etc.
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What is Epidemiology?
The study of the distribution and determinants of disease frequency in human populations and the application of this study to control health problems
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What is Epidemiology?
The study of the distribution and determinants of disease frequency in human populations and the application of this study to control health problems
How is disease distributed throughout Counting the number of cases of a population? disease over the a specific time period Person: age, sex, SES, students Place: urban, US, near a school Time: June, annual, seasonal
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What is Epidemiology?
The study of the distribution and determinants of disease frequency in human populations and the application of this study to control health problems
The factors or things that cause some people to get disease when others do not. * We also call these exposures.
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What is Epidemiology?
The study of the distribution and determinants of disease frequency in human populations and the application of this study to control health problems
There is no point to collecting and analyzing data if it cannot be used for some purpose.
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Based on observation & reason, proposed a new hypothesis for how cholera was transmitted.
Tested his hypothesis by systematically collecting data & comparing groups of people. Established an association between drinking water from Broad St. pump and development of cholera.
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Conduct epidemiologic studies to measure relationship between exposure and disease Judge whether association may be causal, considering
Accumulated evidence Chance, bias, confounding + and of study design
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What is a Hypothesis?
A testable statement that tries to explain a set of observations that can be tentatively accepted or rejected through scientific research
People who smoke cigarettes have a higher incidence of lung cancer over a 10-year period than people who do not smoke cigarettes
Caregivers to relatives with dementia will have a higher incidence of high blood pressure than non-caregivers, mediated through higher levels of stress-related symptoms NOT: Caregivers to relatives with dementia will have high blood pressure
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Epidemiologic Milestones
Exposure
Contaminated water Niacin (B3) deficiency Water fluoridation Streptomycin Cigarettes Diethylstilbestrol (DES) Tampons
Outcome
Cholera Pellagra Cavities TB Lung cancer Vaginal Adenocarcinoma Toxic shock syndrome
Year
1854 1915 1940s 1940s 1950s 1971 1980s
Aspirin
Folate Sleeping on back
Reyes syndrome
Spina bifida SIDS
1980s
1980s 1990s
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So Whats Left?
HRT
Zoonoses
Genes
Asthma
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2 Types of Epidemiology
Descriptive Description of disease patterns
1. Monitor the publics health 2. Evaluate intervention programs 3. Generate hypotheses Identify and count disease in populations
Case Report Case-Series Cross-Sectional Study Ecologic Study
1. Evaluate hypotheses
Descriptive
Conduct epidemiologic studies to measure relationship between exposure and disease Judge whether Analytic association may be causal, considering
Accumulated evidence Chance, bias, confounding + and of study design
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PERSON
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703.5
710.7
372.5
*Rates are per 100,000 population, and age-adjusted to the 2000 US standard population
Massachusetts Deaths 2008. Bureau of Health Information, Statistics, Research, and Evaluation; MA Dept of Public Health, Aug 2010.
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534.8
400
200
190.8
*Rates are per 100,000 population, and age-adjusted to the 2000 US standard population
Massachusetts Deaths 2008. Bureau of Health Information, Statistics, Research, and Evaluation; MA Dept of Public Health, Aug 2010.
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Mortality Rates* by Education and Race/Ethnicity in Adults 24-65 Years, Massachusetts 2008
800
715.7
600
508.9 460.3
400
347.2 199.4
200
183.2
*Rates are per 100,000 population, and age-adjusted to the 2000 US standard population
Massachusetts Deaths 2008. Bureau of Health Information, Statistics, Research, and Evaluation; MA Dept of Public Health, Aug 2010.
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PLACE
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8.6 to 16.7 16.8 to 19.2 19.3 to 22.1 22.2 to 28.1 Did not meet data quality criteria
*Rates are per 100,000 population, and age-adjusted to the 2000 US standard population
U.S. Cancer Statistics Working Group. United States Cancer Statistics: 19992007 Incidence and Mortality Web-based Report.
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30 12 8
Buell P, Dunn JE. Cancer mortality among Japanese Issei and Nisei of California. Cancer 1965;18:656-64.
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TIME
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2004
2005
2006
2007
2008
2009
2010
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%
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Suicide by Time of Year and Day of Week Residents* of Sacramento County, CA; 1925 1983
* Adults <65 years Maldonado G et al., Suicide Life Threat Behav 1991 Summer;21(2):174-87. 50
15
10
0 Sleep 0-3 hrs 3-6 hrs 6-9 hrs 9-12 hrs 12-15 hrs >15 hrs
Waking
Willich SN et al., Am J Cardiol 1992;70:65-8
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Artifactual changes:
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Similarities: If a high frequency of disease is found in several different circumstances, and you can identify a common factor in the circumstance, the common factor may be responsible.
Correlations: If the frequency of disease varies in relation to some factor, presence or absence of that factor may be play a role.
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Mystery Epidemic
These data represent a true event
Children % Dead N
Total % Dead
High
Middle Low Unknown Total
173
160 454 875 1662
66.5
91.1 87.9 78.4 81.0
144
93 179 23 439
3.5
16.1 45.3 8.7 23.5
5
24 76 0 105
0.0
0.0 71.1 --51.4
322
277 709 898 2206
37.3
58.5 75.3 76.6 68.2
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1998:
After 8 years in persistent vegetative state, Terris husband petitioned courts to remove feeding tube Polarizing debate in the US
Feeding tube ultimately removed in March
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1998-2005:
2005:
CNN.com
GALLOP.com
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80 No treatment Treatment
50 40 30 20 10 0
40
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33% of mice responded well to the treatment and survived 33% of mice responded poorly and remained in a moribund condition The third mouse got away
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STRENGTHS
Already exist
o Low cost in terms of time and money
May have inaccurate information May not include the data you want Likely reporting delays May be very expensive May involve complicated methodology
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Summary
Epidemiology is the basic science of public health. Descriptive and analytic epidemiology are used to describe
the health status of a population, identify causes of diseases, and evaluate public health interventions.
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Next Week
Assignments
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