USE OF STATISTICS IN EPIDEMIOLOGY QUANTIFYING DISEASE BURDEN

Submitted by: Group F

Birav Pradhan (13) Khadka Khil B. Thapa (16) Nisha Shrestha (23) Reecha Piya (27) Santoshi Poudel (08)

Submitted to:
Mr. Anil

CONTENTS
INTRODUCTION Background Objective of the study METHODOLOGY FINDINGS AND DISCUSSIONS Rate, Ratio and proportions Measures of Central Tendency Measures of Dispersion Hypothesis Testing CONCLUSION

INTRODUCTION
Epidemiology is the study of the distribution and determinants of health related states or events in a specified population and the application of this study to the control of health problems.
Two types: Analytical epidemiology Descriptive epidemiology

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Makes use of various statistical tools to draw valuable inferences on the health related issues Calculating statistics helps us to: - Describe risk - Make comparisons among communities and smaller definable groups - Identify high-risk groups - Develop hypotheses about the cause(s) of disease

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Disease burden needs to be measured because of the following reasons: - Prioritizing actions in health and the environment - Planning for preventive action - Assessing performance of healthcare systems - Comparing action and health gain - Identifying high-risk populations - Planning for future needs - Setting priorities in health research

 General Objective - To determine the uses of biostatistics in epidemiology for quantifying the disease burden Specific Objective To identify different statistical tools used in epidemiology To know about the applications of rate, ratio and proportion in epidemiology To know the uses of central tendency (mean and median) in epidemiology. To know about the application of Dispersion (Standard Deviation) To summarize the application of estimation and hypothesis testing in epidemiology.

OBJECTIVE OF OUR STUDY

METHODOLOGY
Study Duration - The study was conducted from September 14- September 22nd, 2012. Study design - Our study is Descriptive cross-sectional type. Data Collection tools and procedure - Data was collected through the internet, journals and text books. Data Processing - Data was processed via MS-Word 2007 and MS-PowerPoint 2007. Data Presentation - The data presented in our study is secondary data. Limitation - Our study is solely based on secondary data.

FINDINGS AND DISCUSSIONS

A) Rate - An expression of the frequency with which an event occurs in a defined population during a specified time. - Mathematically, expressed in the form of (x/y)*k - Three types: Crude Rate: actual observed rates such as birth and death rates Specific rates: actual observed rates due to specific causes Standardized rates: to compare the health status of two or more places in terms of mortality

Rate, Ratio and Proportions:

Crude Rate
Crude Death Rate (CDR): - Number of deaths (from all causes) per 1000 estimated mid-year population in one year, in a given place. Calculated as: CDR = Number of death during the year X 1000 Mid-year population

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Crude Birth Rate (CBR): - Ratio of total live births to total population in a specified community or area over a specified period of time.

- Birth rate often expressed as number of live births per 1,000 of the population per year; also called natality. - Calculated by following formula: Total number of live birth during a year X 1000 Population at midyear or average population

 Infant Mortality Rate (IMR): - Number of death of child under one year age out of 1000 live birth during a year in a given place. - Calculated by following formula: Number of death of child under one year age X 1000 Total live birth during the same year

Specific rates

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Child Mortality Rate (CMR): - Proportion of death of children below 5 years of age in per 1000 population of children of same age
- Calculated as:

No. of children death of the age group 1 to 5 years in a year X 1000 Total no. of children of the age group 1 to 5 years during the same year

 Maternal Mortality Rate (MMR): - Number of death of pregnant and postnatal (42 days) mother due to pregnancy related cause (not death by other cause i.e. accident, injury etc) out of per 100000 live birth. - Calculated by following formula: Number of deaths of pregnant and postnatal mother X100000 Total live birth during the same year

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Other Rates include:

Cause Specific Death Rate (CSDR) Case Fatality Rate (CFR) Age Specific Death Rate (ASDR) Still Birth Rate (SBR) Perinatal mortality rate (PNMR) Neonatal Mortality Rate (NNMR) Post Neonatal Mortality Rate (PNNMR) Under Five Mortality Rate (U5MR)

Rates Widely Used to Quantify the Disease Burden

Incidence rate: - No. of new cases of a disease that occur during a specified time period among the population, who are at the risk of developing the disease. - Calculated by following formula:

Total new cases of a disease that occur during sp. period of time X 100 Total population at risk during that period

 Attack rate: - Form of incidence that measures the proportion of persons in a population who experience an acute health event during a limited period (e.g., during an outbreak). - Two types of attack rate: Primary and Secondary - Calculated as: No. of new cases of a health problem during an outbreak X 100 Population size at the beginning of the period

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 Prevalence rate: - Proportion of people in a population who have a particular disease at a specified point in time, or over a specified period of time. - Calculated as: Numbers of existing or current cases X 100 Population at that time or average population

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Two types of Prevalence rate

 Point prevalence: - Total number of all current/existing cases (new and old) of a disease in the defined population in one point of time. - Calculated by cross-sectional survey as one time study. Period prevalence: - Total number of all current cases (new and old) of a disease during a defined period of time in a specified population (i.e. annual prevalence). - Less commonly used measure of prevalence and calculated by surveillance, several time studies.

Continued

B) Ratio

- Expression of the relationship between numerator and denominator. - Mathematically, Ratio =X\Y *k Where, X=no of events Y=total no of events - Measurement of association Relative Risk= Incidence in exposed group Incidence in non-exposed group Odds ratio= Odds of cases exposed or AD/BC Odds of control exposed

C) Proportion
- It is a type of ratio in which the numerator is always included in the denominator. - Mathematically, it is expressed in the form of(x/x+y)*100.

Measures of Central Tendency

A) Mean: The mean (or average) is the most popular and well known measure of central tendency. It can be used with both discrete and continuous data, although its use is most often with continuous data.

B) Median: The median is the middle score for a set of data that has been arranged in order of magnitude. It divides the series into two equal parts. Median is the positional average.

The position of median in a series is such that 50% of the observation lies above the median and another 50% lies below the median.

Measures of Dispersion
Standard deviation: - Standard deviation is an improvement over mean deviation as a major of dispersion and is used most commonly in statistical analysis. - A large standard deviation shows that the measurements of the frequency distributions are widely spread whereas small standard deviation means the observations are closely spread.

Hypothesis Testing
They are the procedures for making rational decisions about the reality of effects. Hypothesis may be defined simply as a statement about population parameter. The hypothesis that there were no effects is called null hypothesis (Ho). The Alternative hypothesis (H1), is a statement of what a statistical hypothesis is set up to establish. Statistical hypothesis testing is used to determine whether an experiment conducted provides enough evidence to reject a proposition.

A) Z-TEST :
A statistical test used to determine whether two population means are different when the variances are known and the sample size is large.

B) T-TEST
A statistic test used to determine whether there are differences between two means or between a target value and a calculated mean. It is commonly used when the variances of two normal distributions are unknown and when an experiment uses a small sample size.

C) ANOVA
A statistical method for making simultaneous comparisons between two or more means. Used to determine the impact independent variables have on the dependent variable in a regression analysis. There are two types of ANOVA: One way ANOVA : a technique used to compare means of two or more samples (using the F distribution). Two way ANOVA : statistical test to study the effect of two categorical independent variables on a continuous outcome variable.

D) CHI-SQUARE TEST
A statistical test commonly used for testing independence and goodness of fit. The data used in calculating a chi square statistic must be random, raw, mutually exclusive, drawn from independent variables and be drawn from a large enough sample. The chi-square test is most widely used to conduct tests of hypothesis that involve data that can be presented in a 2 table.

CONCLUSION
Biostatistics is applied in wide range of topics (health related states and events) in epidemiology in quantifying disease burden.
Different statistical tools are frequently used for measuring the pattern, frequency and distribution of health related problems in epidemiology. Biostatistics is the backbone for epidemiology in quantifying disease burden.

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