Presentation Slides Webinar 4

Clinical Epidemiology
Abnormality, Risks, and

Assessment
Professor Daniel T Lackland, DrPH
Professor Michael A Weber, MD
Professor Paul K Whelton, MD
Disclaimer
The webinar series contents are the responsibility of the panel

speakers and do not necessarily represent the official position of the
CDC.
Learning Objectives
• Defining abnormal and risks
• Metrics of abnormal disease risks
• Quantification of abnormal and risks
Abnormality
• Major clinical and health research issue –
distinguish normal and abnormal
• This distinction can be levels of disease
risks and/or adverse conditions
Assessing Abnormality and
Risks
• To assess the importance of an individual
risk factor, it is necessary to compare the
risk of the outcome in the exposed group
with that in the non-exposed group.
• A comparison between risks in different
groups can be made by examining either
their ratio or the difference between them.
Risk Assessment Metrics
• Mortality rate
• Life expectancy
• Infant mortality rate
• Maternal mortality rate
• Prevalence of chronic diseases
• Disability-adjusted life years (DALYs)
• Prevalence of risk factors
Mortality Rate
• The mortality or death rate is the
proportion of a population who die of a
defined cause.
• The numerator is the number of
persons dying, and the denominator is
the total population in which the deaths
occurred.
Stroke Mortality
• 5 million die of stroke
annually.
Life expectancy
• Statistical measure of the estimate of
the average remaining years of life at a
given age.
• The most commonly used measure is
life expectancy at birth
Life Expectancy
• Life expectancy, averaging a person's
lifespan from birth to death, varies
globally due to factors like genetics,
lifestyle, and healthcare access.
• The global life expectancy in 2023 was

70.8 years for males and 76.0 for
females, with significant regional
variations, from 57.7 years in Western
Africa to 82.7 years in Western Europe.
Infant Mortality Rate
• The is defined as the number of deaths
of children under one year of age,
expressed per 1 000 live births.
Global Infant Mortality
Maternal Mortality Rate
• Death of a woman while pregnant or
within 42 days of termination of
pregnancy from any cause related to or
aggravated by the pregnancy or its
management.
Maternal Mortality
Disability-adjusted life years
(DALYs)
• One DALY represents the loss of the
equivalent of one year of full health.
• DALYs for a disease or health
condition are the sum of the years of
life lost to due to premature mortality
(YLLs) and the years lived with a
disability (YLDs) due to prevalent cases
of the disease or health condition in a
population
Figure 3
The Lancet Neurology 2021 20795-820DOI: (10.1016/S1474-4422(21)00252-0)

Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC
BY 4.0 license Terms and Conditions
2019 Stroke Metrics
• 12·2 million (95% UI 11·0–13·6) incident
cases of stroke,
• 101 million (93·2–111) prevalent cases
of stroke,
• 143 million (133–153) DALYs due to
stroke,
• 6·55 million (6·00–7·02) deaths from
stroke.
DOI:https://doi.org/10.1016/S1474-4422(21)00252-0
Assessing Risk Factors for
Disease Outcomes
What is this condition?
Potential Critical Questions
• Should this patient be diagnosed with
high risk abnormal overweight
category?
• Should this patient be intervened with
a weight loss program?
• Should the individual be evaluated with
weight loss in pounds, percent body
mass reductions , and/or changes in
categories of overweight?
Potential Negative Health Effects of Overweight and Obesity
Copyright © 2011 Pearson Education, Inc.

Options for weight-related risk
• Obese
• Overweight
• Excess visual fat
• Metabolic syndrome
• Diabetic
• Hypertensive
Assessment and Diagnosis for
Obesity
• Observation
• BMI
• Waist circumference
• Body Fat Percentage
Obesity by Observation
Body Mass Index
• Body Mass Index
(BMI) is a person's
weight in kilograms
divided by the
square of height in
meters
• Need scales and
height measurement
Waist Circumference
• Place a tape measure
around middle, just
above your hipbones.
• Make sure tape is
horizontal around the
waist.
• Keep the tape snug
around the waist, but
not compressing the
skin.
• Measure your waist just
after you breathe out.
Body Fat Percentage Measurement
• Skinfold Calipers
• Body Circumference Measurements
• Dual-Energy X-ray Absorptiometry
• Hydrostatic Weighing
• Air Displacement Plethysmography
• Bioelectrical Impedance Analysis (BIA)
• Bioimpedance Spectroscopy (BIS)
• Electrical Impedance Myography (EIM)
What is the trend in obesity?
• Self reported heights and weight
• Telephone survey
Obesity Rates for US and SC
US SC
35
30
Percent of Population
25
20
15
10
5
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Behavioral Risk Factor Surveillance System

Obesity Trends among U.S. Adults, 1988, 1998, and 2008
Copyright © 2011 Pearson Education, Inc.

Types of data
• Nominal
• Ordinal
• Interval
Nominal Data
• Data that in categories without any
specific order.
• Examples – gender, race, blood type,
death.
• When nominal data is characterized in
two categories- dichotomous.
Examples- absence/presence;
dead/alive.
Ordinal data
• Data that is ordered in some manner
• Example – Blood pressure:
Normotensive. Prehypertension, Stage
1 hypertension, and Stage 2
Hypertension
• Cancer – cancer stage
Interval Data
• Inherent order equal intervals
• Continuous data and discrete data
• Quartiles, etc
Continuous
• Blood pressure
• Weight
• Creatinine
• Blood glucose
Discrete
• Specific data values
• Number of office visits
• Number of cigarettes
• Number of drinks
Decisions regarding the typer
data
• Available information
• Effort to gather information
• Examples: smoking, drinking, obesity
Critical Question – Is alcohol
intake associated with
cardiovascular disease OR
pescribed for cardio-protection?
Severity of Alcohol Problems
Dependent drinking/Alcoholism
Harmful drinking/Abuse
Risky/Hazardous drinking Severity
Safe drinking
Abstinent
Gentilello, L. (2008) Alcohol screening and intervention: tThe trauma surgery perspective. [Presentation]. Workshop presented at the State
Systems Development Program Conference. Washington, DC. Retrieved from http://ssdp.treatment.org/Presentations/Wednesday8-20-
08/Session%201--945-1145am/Funding/Gentilello,%20Larry.pdf
What is Low-Risk Drinking
• Anyone age 65 or over: no more than 7

drinks per week or consuming no more
than 3 drinks per occasion
National Institute on Alcohol Abuse and Alcoholism. (2013). Rethinking drinking: Alcohol and your health. What’s low-risk thinking?
Retrieved from http://rethinkingdrinking.niaaa.nih.gov/isyourdrinkingpatternrisky/whatslowriskdrinking.asp
https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.
Binge drinking
• Gefined as consuming 5 or more drinks
on an occasion for men or 4 or more
drinks on an occasion for women.
https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm
How Much?
What kind?
Alcohol intake and
cardiovascular protection
• Critical number and amount of drink –
in order to make a recommendation
Cigarette Smoking and Disease
Risk
Smoker definition
• Ever smoker – ever smoked 100
cigarettes
• Current smoker – smoke now
• Current a smoker – number of
cigarettes per day
Ecological Data –Cigarette
Consumption and Mortality
r = 0.74
(c) Gerstman 49
The Ecological Fallacy (aggregation bias)
• The ecological fallacy occurs when an
association seen in aggregate does not hold
for individuals or all populations
50
Are smoking risks the same?
• 45 yo male smokes 2 cigarettes per day
during morning and afternoon breaks
• 19 yo female smokes 10 cigarettes in
one hour each Friday night during the
years (n=52 Fridays)
• 50 yo male who smokes 2 packs per
day during the period from 18-25 years
and has not smoked sense
Cardiovascular Disease and Fat
Intake
French Paradox
• Apparently paradoxical epidemiological
observation that French people have a
relatively low incidence of coronary
heart disease (CHD), while having a diet
relatively rich in saturated fats, in
apparent contradiction to the widely
held belief that the high consumption
of such fats is a risk
54
French Paradox
Heart 2004;90:107–111
55
French Paradox
• A high intake of dietary cholesterol and saturated fat
but low CHD death rates define the French paradox
• Variability of CHD rates is the rule, and low CHD rates
are observed in southern European countries
• Classical risk factors do not embrace the totality of
CHD risk, particularly in France.
• Complex behavior concerning wine drinking and
attitudes to food could lower CHD incidence
• Promotion of primary prevention, based on an optimal
diet rich in fruit and vegetables, regular physical
exercise, and life without smoking, is worthwhile
• Incentive for more research in countries with low CHD
incidence and probably more protective CHD risk 56
factors
Cholera 1800’s
• There was a major outbreak of cholera in
London in 1849 which killed around
15,000 people.
• Early industrialization had made London
the most populous city in the world at the
time, and the River Thames was heavily
polluted with untreated sewage.
57
Cholera
• Hypothesized – altitude and vapors
58
William Farr, MD
• Farr subscribed to
the conventional
theory that cholera
was carried by
polluted air rather
than water – the
miasmic theory.
59
Farr’s Hypothesis
• In addition, through his analysis of several

variables and their association with death
from cholera, Farr held the belief that
elevation was the major contributor to the
occurrence of the disease.
• He also presented how topographical
features are able to prevent certain
diseases similarly to immunization.
60
Farr’s (1852) Faux Pas
Elevation
above sea
level &
cholera
mortality:
(supports
miasma
theory)
61
Farr’s faux pas
Confounded!
Exposure = elevation My “bad”!
Disease = cholera
Confounder ≡ proximity
to contaminated water
sources
62
Summary
• Caution regarding ecological study results
• Parameters under study should be
strongly critiqued
• Employed parameters should be based on
accuracy of measurement
63

Presentation Slides Webinar 4

Uploaded by

Copyright:

Available Formats

Presentation Slides Webinar 4

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Presentation Slides Webinar 4

Uploaded by

Copyright:

Available Formats

Clinical Epidemiology

Abnormality, Risks, and

The webinar series contents are the responsibility of the panel

• The global life expectancy in 2023 was

The Lancet Neurology 2021 20795-820DOI: (10.1016/S1474-4422(21)00252-0)

Copyright © 2011 Pearson Education, Inc.

Behavioral Risk Factor Surveillance System

Copyright © 2011 Pearson Education, Inc.

Risky/Hazardous drinking Severity

• Anyone age 65 or over: no more than 7

• In addition, through his analysis of several

You might also like