Professional Documents
Culture Documents
SOUTH
CAROLINA AHEC
OBJECTIVES
SOUTH
CAROLINA AHEC
Assessing Risk and Burden of
Disease
● Relative Risk
● Odds Ratio
● Attributable Risk
SOUTH
CAROLINA AHEC
Relative Risk
SOUTH
CAROLINA AHEC
Epidemiology in Action
SOUTH
CAROLINA AHEC
Outbreaks and Clusters
SOUTH
CAROLINA AHEC
Characteristics of Cluster
Investigations
● Non-infectious disease or condition
● Often unknown or combined etiologic
agents
● Longer time frame for investigation
(weeks or months)
● Weak to moderate effect estimates
● Low exposure levels
SOUTH
CAROLINA AHEC
Characteristics of Cluster
Investigations, cont.
● Chronic exposure period (years or
decades)
● Laboratory confirmation uncommon
● Low possibility of establishing cause
and effect
● Most common study design: case-
control
SOUTH
CAROLINA AHEC
Challenges of Cluster
Investigations
● Active or passive approach
● Epidemiology or public health education
● Data sources and denominators
● Costs and yields
SOUTH
CAROLINA AHEC
Public Health Surveillance
SOUTH
CAROLINA AHEC
Sources of Surveillance Data
SOUTH
CAROLINA AHEC
Community Screening
Programs
● Defining the target population
● Setting priorities among diseases and
conditions
● Choosing effective screening tests
● Assessing the effectiveness of
screening programs
SOUTH
CAROLINA AHEC
Screening Tests
Disease Status
Test
Positive Negative Total
Results
A B
Positive A+B
true (+) false (+)
C D
Negative C+D
false (-) true (-)
Total A+C B+D
SOUTH
CAROLINA AHEC
Hypothetical Example
Disease Status
Test
Positive Negative Total
Results
Positive 900 4,950 5,850
Negative 100 94,050 94,150
Total 1,000 99,000 100,000
SOUTH
CAROLINA AHEC
Sample Data
● AIDS
● Syphilis
● Diabetes
SOUTH
CAROLINA AHEC
Estimated Incidence of AIDS and Deaths of Adults
with AIDS*, 1985 - June 1998, United States
25,000
AIDS 1993 definition
implementation
Number of Cases/Deaths
20,000 Deaths
15,000
10,000
5,000
0
1985 1986 19871988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
*Adjusted for reporting Quarter-Year
delays of Diagnosis/Death
SOUTH
CAROLINA AHEC
AIDS Cases by Age and Sex
Reported 1981-1998, United States
35,000
30,000
Male N=574,783
Number of Cases
15,000
10,000
5,000
0
0 10 20 30 40 50 60 70 80 90
Age at Diagnosis
SOUTH
CAROLINA AHEC
3
Estimated Number of Persons Living with AIDS
1993 -1998, by Sex, United States
250
200
Men
Thousands
150
100
50
Women
0
1993 1994 1995 1996 1997 1998
Year SOUTH
CAROLINA AHEC
Estimated Number of Persons Living with AIDS
1993 - 1998, by Race/Ethnicity, United States
140
120
Thousands
60
Hispanic
40
American Indian/
20 Alaska Native
Asian/Pacific Islander
0
1993 1994 1995 1996 1997 1998
Year SOUTH
CAROLINA AHEC
Estimated Number of Persons Living with AIDS
1993 - 1998, by Race/Ethnicity, United States
2,500
2,000
Persons
Asian/Pacific Islander
1,500
American Indian/
1,000 Alaska Native
500
0
1993 1994 1995 1996 1997 1998
Year SOUTH
CAROLINA AHEC
Estimated Number of Persons Living with AIDS
1993 -1998, by Region, United States
12
0
10
0
Thousands
8 South
0 Northeast
6
0
4
0
West
Midwest
2
0 U.S. dependencies and possessions
0
1993 1994 1995 1996 1997 1998
Year SOUTH
CAROLINA AHEC
Proportion of AIDS Cases, by Race/Ethnicity
Year of Report,1985-1998, United States
70
50
30
Hispanic
20
10 American Indian/
Asian/Pacific Islander
Alaska Native
0
1985 1987 1989 1991 1993 1995 1997
Year of Report
SOUTH
CAROLINA AHEC
AIDS Cases by Exposure Category and
Year of Report, 1985-1998, United States
8
0
7
Men who have sex with men (MSM)
Percent of Cases
0
6
0
5
0
4 Injection drug use (IDU)
0
3
0
2 Heterosexual contact
0
1 MSM & IDU
0
0
1985 1987 1989 1991 1993 1995 1997
Year of Report
udes cases with other or unreported risk pending medical record review and reclassification.
SOUTH
CAROLINA AHEC
AIDS Rates per 100,000 Population
Reported in1998
7.8
3.3 3.4 VT 2.5
0.9
6.2 4.0
2.6 NH 3.5
2.0 3.9 47.9 MA 15.0
1.2 7.3 RI 12.9
2.6 14.5 CT 20.3
14.8 4.3
8.2 6.1 NJ 26.3
6.6 10.8 DE 23.4
7.9 4.7
17.3 4.8 MD 31.9
14.7
8.1 7.1 DC 189.1
10.4
8.5 12.8
13.8 12.0
8.0 20.3
15.1 11.1 16.9
20.1
Rate per 100,000
21.8 36.5
<5
4.7 5 - 14.9
13.5 15+
PR 44.3 VI 29.6
SOUTH
CAROLINA AHEC
AIDS Cases Reported in 1998 and Estimated 1998
Population, by Race/Ethnicity, United States
AIDS Cases Population
N=48,269*
N=274,766,00
33% 71%
<1 1
45% 1
% %
4
20% %
13% %
12%
United States
Race/Ethnicity Cases Rate
White, not Hispanic 14,027 18
Black, not Hispanic 14,740 125
Hispanic 7,511 58
Asian/Pacific Islander 329 9
American Indian/
Alaska Native 117 16
Total* 36,886 34
North Central
N=4,317 76.3 14.4 9.3
South
N=19,474 75.6 13.5 10.9
West
N=8,121 86.7 8.2 5.0
CAROLINA AHEC
SOUTH
P r im a r y a n d s e c o n d a r y s y p h ilis - R a te s b y s ta te :
U n ite d S ta te s a n d o u tly in g a r e a s , 1 9 9 7
0 .3
0 .0 0 .0 0 .2
0 .3 0 .3 VT 0 .0
0 .1 N H 0 .0
0 .1 1 .7 0 .8 M A 1 .3
0 .0 1 .6 RI 0 .2
0 .3 0 .2 1 .0 C T 1 .9
0 .6 2 .0
0 .2 0 .4 3 .7 2 .6 NJ 1 .9
1 .2 0 .1 D E 3 .0
1 .1 2 .1 3 .5 3 .5
M D 1 7 .6
1 4 .0 9 .8
3 .0 3 .5
0 .5 6 .9 1 0 .2
G u a m 0 .0
R a te p e r 1 0 0 ,0 0 0
1 4 .4 9 .6 7 .0 p o p u la tio n
3 .5 < 4 (n = 4 2 )
0 .2 8 .4 4 .1 -1 2 (n = 7 )
2 .1 > 12 (n = 3 )
0 .1
V ir g in Is .
P u e r to R ic o 1 .8
N o t e : T h e t o t a l r a t e o f p r im a r y a n d s e c o n d a r y s y p h ilis f o r t h e U n it e d S t a t e s a n d o u t ly in g a r e a s 6 .7
( in c lu d in g G u a m , P u e r t o R ic o , a n d V ir g in I s la n d s ) w a s 3 . 3 p e r 1 0 0 , 0 0 0 p o p u la t io n .
T h e H e a lt h y P e o p le y e a r 2 0 0 0 o b je c t iv e is 4 . 0 p e r 1 0 0 , 0 0 0 p o p u la t io n
SOUTH
CAROLINA AHEC
P r im a r y a n d s e c o n d a r y s y p h ilis - C o u n tie s w ith r a te s a b o v e a n d c o u n tie s w ith
r a te s b e lo w th e H e a lth y P e o p le y e a r 2 0 0 0 o b je c tiv e : U n ite d S ta te s , 1 9 9 7
R a te p e r 1 0 0 ,0 0 0
p o p u la t io n
<4 (n = 2 ,7 0 2 )
>4 (n = 4 1 3 )
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CAROLINA AHEC
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CAROLINA AHEC
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CAROLINA AHEC
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CAROLINA AHEC