3.disease Occurance

Disease Occurance
Acknowledgments
APTR wishes to acknowledge the following individuals
that developed this module:
• Kristina Simeonsson, MD, MSPH

Department of Public Health
Brody School of Medicine at East Carolina University
• Jeffrey Bethel, PhD

Department of Public Health
Brody School of Medicine at East Carolina University
This education module is made possible through the Centers for Disease Control and Prevention (CDC) and the
Association for Prevention Teaching and Research (APTR) Cooperative Agreement, No. 5U50CD300860. The module
represents the opinions of the author(s) and does not necessarily represent the views of the Centers for Disease
Control and Prevention or the Association for Prevention Teaching and Research.
Presentation Objectives
• Define epidemiology and recognize some of its uses
• Interpret distribution of disease according to person,
place, and time
• Calculate measures of disease occurrence and
severity
What is epidemiology, really?
• Study of health and disease among populations
• Basic science of public health

– What causes disease?
– How does disease spread?
– What prevents disease?
– How to control disease?
Uses of Epidemiology
• Identify etiology and risk factors
• Determine the extent of disease in a population
• Study natural history and prognosis
• Evaluate existing and new preventive and therapeutic

measures/modes of healthcare delivery
• Provide foundation for developing public policy and

regulatory decisions
Epidemiology
• The study of the distribution and determinants of
diseases or other health-related outcomes in
populations and the application of this study to
control health problems
Distribution of Disease
• Analysis of disease patterns
– Person
– Place
– Time
Acute Hepatitis B
Person
Source: National Notifiable Diseases Surveillance System, 2006.

Acute Hepatitis B
Place
Incidence of acute hepatitis B, by county—United States, 2007
Source: National Notifiable Diseases Surveillance System, 2007.

Acute Hepatitis B
Time
Measures of Morbidity and
Mortality
• Counts
• Proportions
– Prevalence
• Rates
– Incidence
– Attack rate
– Mortality rate
– Case fatality rate
– Infant mortality rate
Counts
• Measure of disease frequency
• Number of cases or other health outcome being
studied
Cholera
Number of reported cases, 2008
CDC, MMWR Summary of Notifiable Diseases, US 2008

Prevalence
• Answers the question: How common is it?
– Burden of disease in a population
• A slice through the population at a point in time at
which it is determined who has the disease and who
does not
• Often stated as a percentage (i.e. per 100)
Prevalence
# of cases of a disease present in the population

at a specified time
# of persons in the population

at that specified time
Prevalence
• Don’t know when disease developed or the duration
• Numerator is a mix of people with different
durations of disease
– Do not have a measure of risk
• Prevalence is appropriate measure of the burden of a
relatively stable chronic condition
– Diabetes
– Hypertension
• Useful for allocating health resources
Obesity Trends*Among US Adults
(*BMI≥30, or about 30 lbs. overweight for 5’4” person)
1990 1999
2009
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
CDC, BRFSS, 1990, 1999, 2009

Age-adjusted Percentage of U.S.
Adults who had Diagnosed Diabetes
1994 1999
2009
CDC’s Division of Diabetes Translation. National Diabetes

Surveillance System
Incidence
• Measures change from non-disease to disease
– Can provide a measure of risk
• Also known as incidence rate
• Often stated per 100,000 population per year

Incidence
# of new cases of a disease

during a specified period of
time
Total number of people at
risk during that period of
time
Incidence
Department of Health and Human Services, Centers for

Disease Control and Prevention, and National Cancer
Institute, 2010
Incidence
Department of Health and Human Services, Centers for

Disease Control and Prevention, and National Cancer
Institute, 2010
Incidence
• Monitor changes over time

• Comparisons between groups
– Age-specific rates
– Sex-specific rates
• Goal setting
– Healthy People 2020 Objectives
Attack Rate
• Similar to incidence (rate)
• Used when nature of the disease is such that
population is observed for a short time period, often
as a result of specific exposure
– Foodborne outbreaks
• Compares the risk of disease in groups with different
exposures
Attack Rate
# of people who ate potato salad

who developed gastroenteritis
Total # of people who ate

potato salad
Relationship Between Incidence
and Prevalence
• Prevalence = incidence x duration of disease
• An increased prevalence may reflect

– Increased risk of disease in the population
• Increased incidence
– Increased duration of illness
• Fewer deaths from the disease (increased survival)
• Fewer responses to treatment
Relationship Between Incidence
and Prevalence
• An increased prevalence may reflect
– Increased risk of disease in the population
• Increased incidence
• An increased prevalence may also reflect

– Increased duration of illness
• Fewer deaths from the disease (increased
survival)
• Fewer responses to treatment
Relationship between Incidence and
Prevalence
Prevalence
Prevalence
Prevalence
AIDS Incidence, Deaths, and
Prevalence
Measures of Mortality
• Mortality Rate
• Case Fatality Rate
• Infant Mortality Rate
Mortality Rate
# of all deaths in one year
# persons in the population at

midyear
Case Fatality Rate
# of persons dying during a specified

period after disease onset or
diagnosis
Total # of people with the

specified disease
Case Fatality Rate for Avian
Influenza A/H5N1
309 deaths from H5N1

CFR 59%
522 cases of H5N1
WHO website, accessed 2/25/2011

Mortality Rate versus Case Fatality
Rate
Rabies
Measles
TB
0% 20% 40% 60% 80% 100%

Inapparent Mild Moderate Severe Fatal
Mausner & Kramer, 1985

National Cancer Institute; A Snapshot of Pancreatic Cancer
Infant Mortality Rate
# of deaths under one year of age during

a specified time interval
# of live births reported during the

same time period
Expressed per 1,000

Summary
• Epidemiology is the basic science of public health
• Count, describe, divide, compare

– Must use rates to compare groups and assess risk
• Primary measures of disease occurrence

– Incidence
– Prevalence
• Primary measure of disease severity
– Case fatality rate
Collaborating Institutions
• Center for Public Health Continuing Education
University at Albany School of Public Health
• Department of Community & Family Medicine

Duke University School of Medicine
Advisory Committee
Mike Barry, CAE Denise Koo, MD, MPH
Lorrie Basnight, MD Suzanne Lazorick, MD, MPH
Nancy Bennett, MD, MS Rika Maeshiro, MD, MPH
Ruth Gaare Bernheim, JD, MPH Dan Mareck, MD
Amber Berrian, MPH Steve McCurdy, MD, MPH
James Cawley, MPH, PA-C Susan M. Meyer, PhD
Jack Dillenberg, DDS, MPH Sallie Rixey, MD, MEd
Kristine Gebbie, RN, DrPH Nawraz Shawir, MBBS
Asim Jani, MD, MPH, FACP
APTR
• Sharon Hull, MD, MPH
President
• Allison L. Lewis
Executive Director
• O. Kent Nordvig, MEd

Project Representative

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Disease Occurance

• Kristina Simeonsson, MD, MSPH

• Jeffrey Bethel, PhD

• Basic science of public health

• Determine the extent of disease in a population

• Study natural history and prognosis

• Evaluate existing and new preventive and therapeutic

• Provide foundation for developing public policy and

Source: National Notifiable Diseases Surveillance System, 2006.

Source: National Notifiable Diseases Surveillance System, 2007.

CDC, MMWR Summary of Notifiable Diseases, US 2008

# of cases of a disease present in the population

# of persons in the population

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

CDC, BRFSS, 1990, 1999, 2009

CDC’s Division of Diabetes Translation. National Diabetes

• Also known as incidence rate

• Often stated per 100,000 population per year

# of new cases of a disease

Department of Health and Human Services, Centers for

Department of Health and Human Services, Centers for

• Monitor changes over time

# of people who ate potato salad

Total # of people who ate

• An increased prevalence may reflect

• An increased prevalence may also reflect

# of all deaths in one year

# persons in the population at

# of persons dying during a specified

Total # of people with the

309 deaths from H5N1

WHO website, accessed 2/25/2011

0% 20% 40% 60% 80% 100%

Mausner & Kramer, 1985

# of deaths under one year of age during

# of live births reported during the

Expressed per 1,000

• Count, describe, divide, compare

• Primary measures of disease occurrence

• Department of Community & Family Medicine

• O. Kent Nordvig, MEd

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