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UKURAN DAMPAK DALAM

EPIDEMIOLOGI
Measures of Public Health Impact

Attributable Risk (AR) Number


Attributable Risk Percent (AR%) Percentage
Population Attributable Risk (PAR) Number
Population Attributable Risk Percent
(PAR%) Percentage
Measures of Public Health Impact

IMPORTANT!

They all assume (require) that a cause-effect


relationship exists between the exposure and
the outcome.
Relative Risk vs. Attributable Risk

Relative Risk: Measure of the strength of


association, and indicator used to assess the
possibility of a causal relationship.
Attributable Risk: Measure of the potential
for prevention of disease if the exposure could
be eliminated (assuming a causal relationship).
Relative Risk vs. Attributable Risk

Relative Risk:
Etiology
Attributable Risk:
Policy decisions
Funding decisions
(e.g. prevention programs)
Tipe ukuran yang digunakan dalam epidemiologi

Ukuran efek/dampak
Merefleksikan dampak suatu faktor pada frekuensi
atau risiko dari suatu masalah (outcome)
kesehatan
Merefleksikan kelebihan jumlah kasus karena
suatu faktor (attributable) atau jumlah kasus yang
dapat dicegah oleh eksposur (pemajan)
Ukuran-ukuran dampak

Ukuran perbedaan dampak/efek


Perbedaan risiko = Risk Difference (RD) =
Attributable Risk (AR) = Excess Risk (ER) =
Absolute Risk (AR)
[Risiko pada kelompok terpajan] [Risiko pada
kelompok tidak terpajan]
Berguna untuk mengukur besarnya masalah kesehatan
masyarakat yang disebabkan oleh suatu pemajan
bermanfaat untuk penilaian prioritas untuk aksi
kesehatan masyarakat (Public Health Action)
Attributable Risk (AR)

Among the EXPOSED:


How much of the disease that occurs can be
attributed to a certain exposure?
AR
AR%
This is of primary interest to the practicing
clinician.
Attributable Risk (AR)
AR = Iexposed Inonexposed = Risk Difference

Develop CHD ISM = 84 / 3000


Smoke Yes No = 0.028 = 28.0 / 1000
Yes 84 2916 3000 INS = 87 / 5000
No 87 4913 5000 = 0.0174 = 17.4 / 1000
(background risk)

AR = (28.0 17.4) / 1000 = 10.6 / 1000


Attributable Risk (AR)
AR = (28.0 17.4) / 1000 = 10.6 / 1000

Among SMOKERS, 10.6 of the 28/1000


incident cases of CHD are attributed to the
fact that these people smoke
Among SMOKERS, 10.6 of the 28/1000
incident cases of CHD that occur could be
prevented if smoking were eliminated.
Ukuran-ukuran dampak

Ukuran perbedaan dampak/efek


Perbedaan insidens kumulatif = Cumulative Incidence
Difference= CID

[IK pada kelompok terpajan] - [IK pada kelompok tidak


terpajan]

IK = Insidens Kumulatif
Ukuran-ukuran dampak

Ukuran perbedaan efek


Perbedaan rate/ perbedaan densitas insidens (IDD =
Insidence Density Difference)
IDD =

[Densitas insidens dalam kelompok terpajan] - [Densitas


insidens pada kelompok tidak terpajan]
Ukuran-ukuran dampak

Ukuran perbedaan efek


Perbedaan prevalens (PD = Prevalence Differrence)

PD = [Prevalens dalam kelompok terpajan] - [Prevalens dalam


kelompok tidak terpajan]
Attributable Risk

Incidence

Iexposed - Iunexposed

Exposed Unexposed
Ukuran-ukuran dampak/efek

Ukuran perbedaan efek


Attributable Risk (AR) Percent = AR%

Insidens terpajan Insidens tidak terpajan


AR% x 100%
Insidens terpajan
Attributable Risk Percent (AR%)
AR% = (Iexposed Inonexposed) / Iexposed =
Etiologic fraction

Develop CHD ISM = 84 / 3000


Smoke Yes No = 0.028 = 28.0 / 1000
Yes 84 2916 3000 INS = 87 / 5000
No 87 4913 5000 = 0.0174 = 17.4 / 1000
(background risk)

AR% = (28.0 17.4) / 28.0 = 37.9%


Attributable Risk Percent (AR%)
AR% = (28.0 17.4) / 28.0 = 37.9%

Among SMOKERS, 38% of the morbidity from


CHD may be attributed to smoking
Among SMOKERS, 38% of the morbidity from
CHD could be prevented if smoking were
eliminated.
Attributable Risk Percent

Incidence

Iexposed Iunexposed RR - 1
------------------------------- = ------------ x 100%
Iexposed RR

Exposed Unexposed
Ukuran-ukuran dampak
Population Attributable Risk (PAR)
= Attributable Fraction (population) atau Etiologic
Fraction (population) = Population Attributable Risk
Proportion = Population Attributable Risk Fraction
Proporsi (atau fraksi) rate penyakit pada seluruh populasi
yang mewakili rate penyakit dalam kelompok terpajan

Rumus PAR

PAR Insidens populasi Insidens tidak terpajan


Ukuran-ukuran dampak
Population Attributable Risk Percent (PARP)
attributable fraction (population) atau etiologic
fraction (population)
Berarti proporsi kasus baru yang dapat dicegah jika pada semua
orang yang tidak terpajan
Rumus PAR%

Insidens populasi Insidens tidak terpajan


PAR% x 100%
Insidens populasi
Population Attributable Risk Percent
PAR% = (Itotal Inonexposed) / Itotal
IT = 1100 / 10000
Diabetes
Weight Yes No = 0.11 = 110 / 1000
INE = 250 / 5500
Obese 850 3650 4500
= 0.0455 = 45.5 / 1000
Slim 250 5250 5500
(background risk)
1100 8900 10000
PAR% = (110 45.5) / 110 = 58.6%
Population Attributable Risk Percent
PAR% = (110 45.5) / 110 = 58.6%

In Tampa, 59% of the cases of diabetes may


be attributed to obesity in the population
In Tampa, 59% of the cases of diabetes could
be prevented if Tampa residents lost
sufficient weight.
Prevented Fraction (PF)
If relative risk <1
Proportion of potential new cases which would
have occurred if the exposure had been absent
Proportion of potential cases prevented by the
exposure
Iunexposed - Iexposed
PF
Iunexposed

1 - RR
PF: Vaccine efficacy
Pop. Cases Cases/1000 RR
Vaccinated 301,545 150 0.49 0.28

Unvaccinated 298,655 515 1.72 Ref.

Total 600,200 665 1.11

1.72 - 0.49
PF 0.72
1.72

1 - 0.28 0.72