Epidemiology and Biostatistics HIM 3200

1. Epidemiology and BiostatisticsHIM 3200 Session One Dr. Burton

2. Course Description The goals and objectives of epidemiology, its policy and procedure, and its foundation and support in health care information are the focus of this course. Investigation of an epidemic, measures of mortality, incidence and prevalence, measures of risk, biological variability, probability, screening, sampling, statistical significance, correlation, multiple regression, retrospective and prospective studies, and survival analysis are discussed. Advanced techniques for the statistical analysis of institutional case-mix and quality improvement data are presented.

3. Course ObjectivesStudents will be able to demonstrate through written assignments and testing the following: • Retrieve patient data from departmental databases. • Compute routine institutional statistics. • Design data tools for research studies to evaluate patient outcomes. • Assist in interpretation of data. • Prepare data for presentation. • Present data.Perform statistical analysis. • Design reports using database report generation. • Design department systems for analysis of patient data.

4. Measuring Student Progress 1.      Chapter Exercises & Review Questions 200 (20 points each) 2.      Progressive Mastery Exam 250 (Best Score of the three takes) 3.      Midterm Exam 250 4.      Epidemiologic Analysis 250 Written report (100) Group Presentation (100) Peer Evaluation (50) 5. Final Exam 50 TOTAL 1000

5. CHAPTER 1 Statistics and How They Are Used

6. OUTLINE 1.1The Meaning of Statistics Formally defines the term statistics and illustrates by describing what a statistic does 1.2 The uses of statistics Shows how descriptive statistics are used to describe data and how inferential statistics are used to reach conclusions from the analysis of data. 1.3 Why study statistics? Explains how the study of statistics is important for research, for writing publishable reports, for understanding scientific journals, and for discriminating between appropriate and inappropriate uses of statistics. 1.4 Sources of Data Discusses surveys and experiments, two main sources of data, and further classifies surveys as retrospective or prospective and as descriptive or analytical. 1.5 Clinical Trials Describes the use of a clinical trial to determine the value of a new drug procedure. 1.6 Planning of Surveys Previews some hints on how to maximize the value of survey data. 1.7 How to Succeed in Statistics Offers some tips on getting the most out of class and other resources.

7. LEARNING OBJECTIVES • 1.Define statistics • 2.List several reasons for studying statistics • 3.Distinguish clearly between • a.descriptive and inferential statistics • b.surveys and experiments • c.retrospective and prospective studies • d.descriptive and analytical surveys • 4.Define bias • 5.Describe the purpose and components of a clinical trial

8. THE MEANING OF STATISTICS • A.What Does Statistics Mean? • 1.Refers to a recorded number • 2.Denotes characteristics calculated for a set of data • a.Standard deviation • b.Correlation coefficient • 3.A body of techniques and procedures dealing with the collection, organization, analysis, interpretation, and presentation of information that can be stated numerically • B.What Do Statisticians Do? • 1.Works on challenging scientific tasks • 2.Primarily concerned with developing and applying methods that can be used in collecting and analyzing data • 3.Tasks are as follows • a.To guide the design of an experiment or survey • b.To analyze data • c.To present and interpret results

9. THE USES OF STATISTICS A.Descriptive Statistics – deals with the enumeration, organization, and graphical representation of data  Example: Census  B.Inferential Statistics – concerned with reaching conclusions from incomplete information – generalizing from the specific  Example: Opinion Poll (Gallup Poll)  C.Statistical methods provide a logical basis for making decisions in a variety of areas when incomplete information is available

10. WHY STUDY STATISTICS? A.Essential for both understanding and conducting research B.Used to analyze data C.Can help to discriminate between fact and fiction D.Helpful in knowing when, and for what purpose, a statistician should be consulted

11. SOURCES OF DATA A.Surveys B.Experiments C.Retrospective Studies (case-control studies) 1.Disadvantage – usually collected for other purposes and may be incomplete 2.Advantages a. economical b. answers usually obtained relatively quickly

12. SOURCES OF DATA D. Prospective Studies (cohort studies) 1. Advantages a.collect relevant data b.collect data under uniform conditions and for specific reasons c.better opportunities to draw appropriate conclusions or make appropriate comparisons while limiting or controlling the amount of bias 2.Disadvantage – typically not used to establish or “prove” a causal relationship because variables cannot be randomly assigned or manipulated

13. SOURCES OF DATA E.Comparison of Ratios F.Descriptive Surveys – provide estimates of a populations characteristics G.Analytical Surveys – Seek to determine the degree of association between a variable and a factor in the population

14. CLINICAL TRIALS A.Definition: a carefully designed experiment that is generally considered to be the best method for evaluating the effectiveness of a new drug or treatment B.Protocol 1. Describes in detail the design of proposed research 2.Clearly defined hypothesis 3.Detailed delineation of inclusion and exclusion criteria for study subjects 4.Descriptions of the proposed interventions and the randomization process 5.Detailed explanation of how bias may be minimized 6. Description of the procedures to minimize errors in the collection and analysis of data

15. CLINICAL TRIALS C.Two key features 1.Blinding – study subjects and/or the investigators do not know who is in the control group and who is in the experimental group with the purpose of reducing bias 2.Randomization – subjects are randomly assigned to either the experimental or control group

16. Disease status Present Absent Total Present a b a + b Risk Factor Status Absent c d c + d a + c b + d a+b+c+d Total Standard 2 X 2 table a = subjects with both the risk factor and the disease b = subjects with the risk factor but not the disease c = subjects with the disease but not the risk factor d = subjects with neither the risk factor nor the disease a + b = all subjects with the risk factor c + d = all subjects without the risk factor a + c = all subjects with the disease b + d = all subjects without the disease a + b + c + d = all study subjects

17. PLANNING SURVEYS • A.Formulate a clear plan of action before starting a survey • B.Outline major steps to be followed

18. HOW TO SUCCEED IN STATISTICS • A.Scan the chapter outline • B.Read the conclusion and vocabulary list • C.Review the learning objectives before coming to class • D.After class learn relevant terms, concepts, principles, and formulas • E.After doing the assigned exercises, try to reformulate the objectives as questions and then answer them • F.Read essays dealing with the application of statistics to a variety of fields

19. CONCLUSION A statistician designs efficient and unbiased investigations that provide data that he or she then analyzes, interprets, and presents to others so that decisions can be made. To do this work the statistician uses techniques that are collectively called “statistics.”

20. HAS 3200Intro to Epidemiology Session One Dr. Burton

21. What is epidemiology? Webster: “a branch of medical science that deals with the incidence, distribution and control of diseases in a population.” The scientific study and understanding of disease. Dictionary of Epidemiology: “the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems.” (Last, 1995)

22. Factors involved in the natural history of disease Agent Host Vector Host Environment

23. Host The human body “Susceptible individual” Carriers: Active (infected) Incubatory (early stages) Convalescent (recovering) Intermittent (Occasional transmission)

24. “Web of Causation” “A number of interrelated causes…and… the relationship is not necessarily a simple, linear, cause-effect progression.”

25. Biologic Chemical Physical Social & psychological stressors Agents Sometimes called pathogens: Characterized by Virulence (strength) Invasiveness (ability to enter the host) Communicability (ease of the agent’s spread from one host to the next)

26. Vectors Insects (mosquitos) Arthropods (ticks) Animals

27. Other terminology • Fomites: inanimate objects within the environment such as soiled linen or doorknobs. • Common vehicle: water or tainted food. • Serial transfer: STDs from one host to the next.

28. Social Weather Reservoirs Political Economic Environment

29. Factors • Host (Individual susceptible) • Agent • Biologic • Chemical • Physical • Social & psychological stressors • Vectors • Transmitter (animal, insect, humans, objects) • Environment

30. Definitions • Epidemic: • An acute outbreak of disease that reaches levels greater than normal. • Pandemic: • Global or widespread outbreaks. • Endemic: • Higher normal levels of disease in certain populations

31. BEINGS ModelPreventable causes of disease Biologic factors and Behavioral factors Environmental factors Immunologic factors Nutritional factors Genetic factors Services, Social factors, and Spiritual factors

32. Behavioral Factors • Life Style: • High risk behaviors

33. Repeat after me: I will never complain about MY kids again ... I will never complain about MY kids again ... I will never complain about MY kids again ... I will never complain about MY kids again ... I will never complain about MY kids again ...

35. Environmental Factors

36. STRESS

37. Immunologic Factors Herd Immunity By immunizing members of the “herd” the chain of transmission to unimmunized members is disrupted.

38. Nutritional factors • Denis Burkitt: • “By world standards, the entire US is constipated.” • “Don’t diagnose appendicitis in Africa unless the patient speaks English.” • “African medical students go through 5 years of training without seeing coronary heart disease or appendicitis.” • “Populations with large stools have small hospitals. Those with small stools have large hospitals.” • Diseases Rare in indigenous Africans: • Appendicitis • Breast cancer • Colon cancer • Coronary heart disease • Diabetes mellitus • Diverticulitis • Gallstones • Hemorrhoids • Hiatal hernia • Vericose viens

39. Genetic Factors “ …population gene frequencies appear to be stable.”

40. Services, Social Factors, and Spiritual Factors Medical Services “Iatrogenic illness and injury” • Social Factors “Support” • Family • Friends • Networks • Memberships Spiritual

41. Causal Research • Two fundamental distinctions • Those who do not have the risk factor (independent variable) • Those who do have the risk factor (dependent variable) • Measurement of contrast • Cohort studies • Persons exposed to a risk factor • Persons not exposed to a risk factor • Case-control studies • Case subjects • Control subjects