OCWEpidemiologyandBiostatistics,2010

J.Forrester,PhD
TuftsUniversitySchoolofMedicine

1SelfevaluationAnswers

1. Thetermepidemicrefersto:
a) Adiseasethathasalowrateofoccurrencebutthatisconstantlypresentina
population
b) Andiseasethatoccursinapopulationatarateinexcessof10per1000
population
c) Agreaterthannormaloccurrenceofadiseaseforthatpopulationatthattime
d) Diseasesoftherespiratorysystemthatoccurseasonally

2. Whenanewtreatmentisdevelopedthatpreventsdeathbutdoesnotproducerecovery
fromadisease,thefollowingwilloccur:
a) Theprevalenceofthediseasewilldecrease
b) Theprevalenceofthediseasewillincrease
c) Theincidenceofthediseasewilldecrease
d) Theincidenceofthediseasewillincrease
e) Theincidenceandprevalenceofthediseasewillbothdecrease

ThefollowinginformationisforQuestions35.
YouareaphysicianwhopracticesmedicineinHappyVille,acommunityof100,000persons.
During2009,therewere1,000deathsfromallcauses.Allcasesofcardiovasculardiseasewere
identified,andtheytotaled300.During2009,therewere60deathsfromcardiovascular
disease.

3. TheannualallcausemortalityrateinHappyVillein2009was:
a) 300per100,000
b) 60per1000
c) 100per1000
d) 10per1000

4. TheprevalenceofcardiovasculardiseaseinHappyVillein2009was:
a) 0.03%
b) 0.3%
c) 3.0%
d) 0.06%
e) 0.6%

5. ThecasefatalityrateforcardiovasculardiseaseinHappyVillein2009was:
a) 0.06%
b) 0.6%
c) 0.2%
d) 2%
e) 20%

6. Epidemiologicstudiesexaminingexposurediseaserelationshipsmaybeobservational
orinterventional.Whatistheessentialdifferencebetweenaninterventionalandan
observationalstudydesign?

Answer:Inaninterventionalstudydesigntheinvestigatorintervenestoassignan
exposuretoastudyvolunteer,suchatreatmentorprocedure(byrandomornon
randomassignment)whereasinanobservationalstudy,theinvestigatormerely
observestheexposureasitoccursinthevolunteerwithoutintervening.

7. Influenzaisspreadbyclosecontactbetweenaninfectedpersonandanuninfected
personwhohasnothadtheinfectionandthereforeisatrisk.Thereare10students
livingonyourdormfloor,whichisthesecondfloorofthebuilding.Oneofthestudents
hasreturnedonSundayevening,October3
rd
fromaweekendawayattendingafriends
wedding.OnthemorningofTuesday,October5
th
heshowsallthetypicalsymptomsof
influenzaincludingamildfeverandsorethroat.BytheendofthefollowingSunday,
October10
th
fourotherstudentsonthefloorareshowingidenticalsymptomsof
influenza.WhatisthecumulativeincidencerateforinfluenzafortheperiodOctober1
throughOctober10onthesecondfloorofthedorm?Youranswershouldbespecific.

Answer:Thetendaycumulativeincidenceforthesecondfloorofthedormis5/10or
50%.

8. Abigail,Bret,CindyandDennisaretheonlyfourstudentslivingonthethirdfloorofthe
building.Theyhearaboutthesickstudentsonthesecondfloorandareconcernedthat
influenzawillspreadtotheirfloor.Midtermexamsareapproachingandtheywantto
stayhealthy,atleastuntilaftertheexamsareover.Abigailpresentswithinfluenza
symptomsonthemorningofMonday,October11
th
,oneweekbeforemidtermexams
begin.BretandCindydecidetoleavethedormandstaywithfriendsuntilmidterm
examsareover.TheyleavefirstthingTuesdaymorning,October12
th
.Thursday
morning(October14
th
)Dennisisshowinginfluenzasymptoms.StartingfromMonday,
October1
st
,whatistheinfluenzaincidencedensityforthethirdfloor?

Answer:
The numerator is easy = 2 new cases of influenza (Abigail and Dennis).
Its the denominator that takes some thought:
Abigail contributes 10 person-days at risk before she gets sick (October 1
th
to 10
th
).
Bret and Cindy each contribute 11 person-days at risk (October 1
st
to 11
th
) before
they leave the dorm.
Dennis contributes 13 person days before he gets influenza (October 1
st
to 13
th
)
So, the total number of person days for the denominator is: 10+2(11)+13 = 45
The influenza incidence density for the third floor is 2/45 person-days. (Note the
time frame is embodied in the person-days)
You can understand why in large studies we leave the calculation to the computer!

ThefollowinginformationisforQuestions910.
Thecausesoflupusarepoorlyunderstoodbutmayinvolvemercury.Youreadastudyinwhich
aninvestigatormeasuredtheprevalenceoflupusinworkersinamercurybatteryfactoryand
comparedthistotheprevalenceoflupusinfactoryworkerswhomadewindgenerators,a
processthatdoesnotinvolvemercury.Lupuswaspresentin1%ofthebatteryworkersand
noneoftheworkersinthewindgeneratorfactor.

9. Whatistheexposure(riskfactor,predictor)inthisstudy?

Answer:Theexposureofinterestismercury.

10. Whatistheoutcome(endpoint,event)ofinterestinthisstudy?

Answer:Theoutcomeofinterestislupus.

Theanswerstoquestions9and10maysoundobvious,butitissometimesdifficultina
medicaljournalarticletoidentifytheexposureandoutcomeofinterestamongallthe
variablesexamined.Youshouldalwaysstartyouranalysisofajournalarticlebyidentifying
theprimaryexposure(s)andoutcome(s)ofinterest.