Chronic Disease Epidemiology HSC 3211 – Flashcards
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What is the latency period of chronic disease?
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the time it takes for the disease to develop once the causes are in place; when signs and symptoms manifest themselves the latency period ends
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What are chronic diseases characterized by?
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latency periods of 10 to 20 or more years; the latency period for lung cancer is 20-25 years
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What are the main causes of chronic diseases?
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behavior, environmental, genetic, and social
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What are many of the diseases of today influenced by?
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lifestyles of modern populations such as: (can also come from stress, career pressure, sedentary lifestyles, high density pop. living, poor diet, crime, drugs, gangs, poverty, pollution, fear, and economic struggles
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What are the most common noninfectious chronic diseases seen in modern times?
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alzheimers disease, arrhythmia, atherosclerosis, cancer, cardiovascular disease, congestive heart failure, coronary artery disease, depression, diabetes, glaucoma, gout, heart attack, osteoarthritis, osteoporosis, parkinsons disease, peripheral vascular disease, rheumatoid arthritis, and stroke (cerebral vascular accident)
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What is chronic disease epidemiology?
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studies are undertaken to demonstrate relationships and associations betwen exposure/condition/agent (genes, envir.) and the frequency in diseases; does NOT determine the cause of a disease in a given individual
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What are some issues to consider when looking at the epidemiology of chronic diseases?
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etiology (cause) of chronic disease is often difficult to determine; many exposures can cause more than one outcome; outcomes may be due to mutliple exposures or continual exposure overtime; and causes may differ by individual
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What are the 8 guidelines on chronic disease etiology?
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suspected chronic disease must be found more freq. in people with disease than without; people with the chronic disease characteristic must develop the disease more freq. than people not possessing the characteristic; if theres an association between risk factor and chronic disease that relationship must be tested; incidence of chronic disease should increase in relation to duration and intensity of risk factor; distribution of risk factor should be related to the level of exposure to the risk factor; reduction of risk factor should reduce disease; people exposed to risk factor in controlled studies should devlop diseases more than people not exposed
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What is association?
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an identifiable relationship between an exposure and disease; implies that exposure MIGHT cause disease; most often we design interventions based upon associations
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What is causation?
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implies that there is a true mechanism that leads from exposure to disease; event or condition that plays a role in producing occurence of disease; exposure and the additional factors such as envir. and genetics that lead to the disease
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How do we establish cause?
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exposure and additional factors lead to disease
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How would you look for consisten findings of chronic diseases?
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look for consistent findings across different populations, in differeing circumstances, and with different study designs
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How does strength of association play a role in determining chronic diseases?
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strong associations are less likely to be caused by chance or bias; a strong association is one in which the relative risk is very high or very low
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What does the biological gradient show?
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the more you are exposed to something the higher the risk for disease; there is evidence of dose-response relationship
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What is the temporal sqeuence of chronic diseases?
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it can take a long time for a person to get the disease; exposure must precede disease; in disease with latency periods, exposures must precede the latent period; and in chronic diseases, often need long-term exposure for disease induction
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What are the realities of causal inferences of a chronic disease?
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no single study is sufficient for causal inference (cant help find out causation); there is no way to prove causal associations for most chronic diseases and conditions; causal inference is not a simple process because it considers the weight of evidence and it requires judgement and interpretation
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What is the prevailing wisdom in epodemiology of chronic diseases?
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most judgements of cause and effect of diseases are open to change with new evidence
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What is a risk factor?
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anything that increases a persons chance of developing a disease (ex: obesity) some risk factors for cancer are radiation, genetics, chemicals found in tobacco smoke or diet, and some viruses/bacteria
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What is one way a risk factor is determined?
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modifying the exposure to the risk factor and observing the results (ex: when exposure to smoking is reduced, rates for lung cancer decrease) greater risk exposure increases the probability of disease occurance
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What are risk factors also referred to?
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at-risk behaviors or predisposing factors
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What is an at-risk behavior?
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an activity performed by persons who are healthy, but are at greater risk of developing a particular disease, condition, disorder because of the behavior; modifying risk factor; is something that you can control (ex: eating healthy)
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What is a predisposing risk factor?
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those existing factors or conditions that produce susceptibility in a host to a disease or condition without actually causing it; they precede the direct cause; nonmodifying risk factor; ex: family history of heart disease or the fact that a school-age child's parents smoke is a predisposing factor that influences the possibility of the child also smoking
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What are the top eight leading causes of death according to specific risk factors?
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heart disease, cancer, stroke, accidents, diabetes, cirrhosis, suicide, and homocide
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What are some behaviorally related risk factors?
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smoking, alcohol abuse, nutrition, lack of exercise, high blood pressure, cholesterol levels, obesity, stress, drug use/abuse, and lack of seatbelt use
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What are some environmentally related risk factors?
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worksite risks/exposures, environmental hazards, car hazards, household hazards, medical care risks, radiation exposures, infectious pathogens, and engineering/design hazards
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What are some biological/genetic related risk factors?
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chromosome/genetic defects, congenital anomalies, and developmental defects
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What are some socially relates risk factors?
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poverty, low educational level, lack of work skills, and disrupted families
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Chronic disease develop from multiple exposures to what?
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a single source and a single agent (ex: cancer of the lip, gums, mouth, and throat from chewing tobacco; chewing tobacco is the single agent and the single source to which the user has multiple exposures
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What does the web of causation demonstrate?
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the interconnectedness of possible causes
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What factors would the web of causation for cancer of the mouth with smokeless tobacco include?
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free samples given to teens from tobacco companies in hopes of hooking the youth,social inifluences, sex, age, place, aprental influences, physiological factors, addiction factors, etc.
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What do webs of causation have and what do we use with them to help the epidemiologst get closer to discovering the cause?
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have limitations in that they may not directly lead the epidemiologist right to the cause; we would use the decision tree to help find the cause; when making a web of causation a separate decision tree would be developed for each aspect, factor, and causation element
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What do decision trees do?
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can ask leading questions that are answered wither yes or no, thus eliminating possibilites of causation while leading the investigator down the correct path toward discovery, assuming the questions are answered correctly; helps us determine the disease; answer yes/no
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How do the web of causation and decision tree work together?
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web of causation is a flow chart that identifies every risk factor leading eventually to the diagnosed disease and the decision tree is established and worked through in order to assure the correct decision is being made leading to causation of the disease
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What are the steps in constructiong a web of causation and decision tree?
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identify the problem and obtain an accurate diagnosis of the disease; place the diagnosis at the center or bottom of the web; brainstorm and list all of the possible sources for the disease; organize and arrange lists of sources and risk factors from general to more distant from disease, in steps, being more specific; and develop and work through causation decision trees for each element and consideration on the way toward the diagnosed disease
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In a decision tree what do the diamond and rectangular shaped boxes represent?
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rectangular boxes are activities and diamond boxes are decision points (ex: diamond box says active tuberculosis? if yes then rectangular box says further evaluation with smear culture)
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Why are fish bone diagrams developed?
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also called cause-effect diagrams; developed to provide a visual presentation of all possible factors that could contribute to disease, disability, or death; assist the epidemiologist in defining, determining, uncovering, or eliminating possible causes; statements are answered yes/no or true/not true
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What is highest for smokers?
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relationship between failing and dropping out of high school is highest
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What percent of people in the US smoke?
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47.2 million/ 24% adults (24.8 million/ 26.4% were male and 22.4 million/ 22.4% were femalie
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What percent of students first smoke before the age of 11?
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8.2%
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What percent of people who have hip fractures are dead within one year?
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20% which costs the health care system about 5.4 billion each year and many of the survivors never regain an acceptable level of function; women have them more than men
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What are suggested causes of hip fractures?
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diet, cigarette smoking, an increasingly sedentary lifestyle, alcohol, and falls (1-2%)
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What is largely genetically determined?
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bone mass
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What are risk factors for hip fractures?
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low bone mineral density, history of falls, direction of fall, neuromuscular impairment, decrease in weight, poor health status, older age, physical inactivity, family history of hip fracture, osetoarthritis, white race, and female
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What does epidemiology also involve?
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prevent and control health problems
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What is the ultimate aim in prevention and control?
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to prevent and control diseases in the population
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What is the health belief model?
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a widely used conceptual framework for understanding health behavior
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Behavior change requires a rational decision making process that considers what?
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perceived susceptibility to illness, perceived consequences or seriousness of the illness, belief that recommended action is appropriate to reduce risk, and belief that the benefits of action outweigh the costs
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What are the 6 concepts the health belief model involves?
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perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy
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What can be powerful motivational forces in changing behavior?
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fear and pain, however, to avoid chronic diseases one must embrace healthy behaviors and lifestyles long before pain or fear occurs
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What is the primary purpose for the existence of epidemiology?
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prevention and control of diseases, disorders, injuries, disabilities, and death in populations
