Counting WhalesCounting a Disease

Counting WhalesCounting a Disease

Rates are the hallmark for epidemiology for they form the basis of comparisons between population groups Rose and Barker,1986 The Price of Health, like that

of liberty, is Eternal Vigilance An improvement in the treatment of disease, and any addition to medical science, will tend ultimately to the diminution of human suffering; but the registration of the causes of death is calculated to exercise a still more

direct influence upon public health. Diseases are more easily prevented than cured, and the first step to their prevention is the discovery of their exciting causes by numerical facts and measure the intensity of their influence. William Farr, 1839

Exclusively Rural Areas Doctors sent to rural areas Leper census, 1836 (5), 1845 (8), 1845 (11) Leprosy viewed as inheritable--sexual isolation, hospitals, prohibiting marriage No experience in setting up the registration Local Health officer

Royal Decree Problems with local registration (definition, deadlines, incomplete) Circular letters Chief Medical Officer travelling to each

area Over diagnosis initially (acne, scabies) Low prevalence areas, disease overlooked Undercount, Undercount, Undercount Isolation: Areas where isolation practiced, most rapid decline in disease

Definitions Prevention Reducing the incidence of disease (primary prevention) Reducing the prevalence of disease (second. prevent.) Control

Ongoing operations or programs aimed at reducing the incidence and/or prevalence of disease Last, Dictionary of Epidemiology General Motors sold 2,542,455 Automobiles World Wide

99 Billion Sold NCDs What is the incidence of Diabetes? What is the

incidence of CHD? What is the incidence of Cancer? Nobody Knows

Surveillance Health Dept. Continuous analysis, interpretation, and feedback of systematically collected data,

generalized using methods distinguished by their practicality, uniformity, and rapidity, rather than by accuracy or completeness. Last, Dictionary of Epidemiology CDC Comes in

120 Number of Cases 100 80

T otal Cases Reported Cases 60 T ypic al P attern

40 20 0 Month

TV says Flu Registry Academia

the term register is applied to the file of data concerning all cases of a particular disease or health -relevant condition in a defined population such that the cases can be related to a population base. Last, Dictionary of Epidemiology

Disease Monitoring Systems Surveillance Registries Disease Infectious

Chronic Coverage Large Small

Cost Low High

Speed Fast Slow Ascertainment

Low/Variable Presumed High Allegheny County Type I Diabetes Registry

1. 2. 3. 4. 5.

Diagnosed between 1/1/65 and 12/31/99 Age at onset <20 Diagnosis of Diabetes On Insulin at time of Hospital Discharge Resident of Allegheny County at Diagnosis Allegheny County Type I Diabetes Registry

16 /100,000 Undercount /100,000

Registry WHO DiaMond Project Epidemiologists Counting Disease

Prairie Chicken Biostatistics 1 2 3 4 5 6 7 8 9

Capture Mark RECAPTURE Capture-Recapture

Sample 1 Sample 2 N= M m n

(M+1)(n+1) N = Estimate of Number M =Number in First Sample n = Number in Second Sample m =Number of marked items

in Second Sample Var(N)= In Common (m+1)

-1 (M+1)(n+1)(M-m)(n-m) 2 (m+1) (m+2)

Capture-Recapture Methods Long history of use in Demography i.e. US Census The standard for estimating the abundance or shortage of wildlife

populations Fish Disease Net

List Tag Name/ Identifier

Recapture Duplicate Lower Extremity Amputation Study Adolescent Injuries Sports injuries

Dog Bites Optimal Lists to identify cases Independent Reasonable ascertainment Inexpensive

Comparison of lists to gold standard CR to Registry Good monitoring does not necessarily ensure the making of right decisions, but it reduces the risk of wrong ones.

Languimer, 1963 Public Health Cancer Incidence in Middle East Good monitoring does not necessarily

ensure the making of right decisions, but it reduces the risk of wrong ones. Languimer, 1963 Porpoises can teach Epidemiologists how to count

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