Social Epidemiology Midterm 1 – Flashcards
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epidemiology (literally)
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the study of what is upon the people
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traditional medical perspective
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biological and physical risk factors in individuals; risk factors for specific disease in individuals
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traditional epidemiological perspective
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determinants of health and disease in populations; spread of disease in populations
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cholera
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an acute diarrheal illness caused by infection of the small intestine with the bacterium vibrio cholerae
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number of infected persons
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one in 20 has profuse watery diarrhea, vomiting, and leg cramps
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rapid loss of body fluids leads to
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dehydration and electrolyte imbalance
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without treatment, death can occur within
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hours
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altitude hypothesis
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Farr (1852)
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John Snow
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"Father of Epidemiology"
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cause of cholera
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Snow suspected that cholera was carried by water; challenge was to test the hypothesis; Broad Street Documentary
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On the Mode of Communication of Choler (1855)
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reported analysis of earlier outbreaks over London districts
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Compared water suppliers to different homes in the same districts
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Southwark and Vauxhall vs. Lambeth
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In 1853, after Lambeth moved its water intake up the Thames,
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its customers had lower cholera levels
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attack rate
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the cumulative incidence of an infection in a group observed over a period during an epidemic
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attack rate determined by
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identifying cases and population at risk for disease
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epidemiology
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study of distribution and determinants of disease across populations
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social epidemiology
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branch of epidemiology that studies the social distribution and social determinants of health
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social determinants of health
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circumstances in which people are born, grow, live, work, and age, in cluding the health system
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social determinants circumstances are shaped by
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political, social, and economic forces
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Why study social determinants of health? "The social determinants of health are mostly responsible for...
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health inequalities or the unfair and avoidable differences in health status seen within and between countries."
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social environmental factors
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-SES -Childhood SES and adult health -income inequality -discrimination and stigma -social capital and support -work environments -neighborhoods
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social determinants
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-lifespan -born -social experiences -circumstances in which people live -work -age -healthcare systems
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John Snow
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father of modern epidemiology; did systematic investigation of cholera epidemic; first PH intervention; lays groundwork of epidemiology; took handle off broad street; emphasis primarily on population-levels
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cholera eliminated worldwide?
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no; prevalent in non-sanitary water areas
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cholera
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disease passed by not washing hands; can cause dehydration; easy to cure
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health
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a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
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what is health?
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"the extent to which an individual or a group is able to realize aspirations and satisfy needs, and to change or cope with the environment"
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measuring health in clinical practice
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specificity and detail; individual's biological status
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measuring health in social surveys
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plain, comparable, concise, general, common
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measring health
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1. subjective health 2. physical impairment 3. vitality and mental well-being 4. awareness of disease and risk to life 5. the absence of disease
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1. Self-Report
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no medical diagnosis, single item that measures it or "perceived" health; correlates with physician diagnoses; predicts mortality
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2. physical impairment
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acute chronic conditions, fatal and nonfatal disease, functional ability or impairment, general well-being
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physical impairment, how much difficulty in
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climbing stairs, kneeling or stooping, lifting/ carrying objects, hearing, seeing, shopping, household work
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vitality
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felt physically fit, had lots of energy, enjoyed life, was happy, was hopeful about the future
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3. mental well-being (depression or anxiety)
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CESD (centers for epidemiologic studies dpression scale);
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DSMIV
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diagnostic and statistical manual of the american psychiatric association, 4th revision--current standard for "caseness"
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clinical diagnosis into categories based on
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intensity and number of symptoms
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4. Measuring Health
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awareness of disease and risk to lif
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5. Presence of disease as a measure of poor health
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morbidity and mortality weekly report (MMWR)
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Measuring Health
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1. Subjective 2. Physical Impairment 3. Mental well-being 4. Awareness of Disease/Risk to Life 5. Absence of Disease (or conversely presence of disease)
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general pattern of subjective health by poverty status
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lower income individuals report bad health
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general pattern of subjective health by ethnicity
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same for all races (black are more likely 2nd is hispanic)
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Why is the WHO definition of Health sometimes criticized?
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it stresses presence of well-being and social function; can't measure or quantify it; amended it to any good measure of health should have
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mental disorders are diagnosed using
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DSMIV
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rate =
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# of events in specific time/ pop. at risk in specific time
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if event is a disease
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morbidity rate
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if event is a death
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mortality rate
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proportion
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a specific type of ratio; numerator is included in denominator
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rate
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expresses probability or risk of disease in a defined population over a specified period of time
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incidence rate
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measures risk that healthy people will develop a disease during a specified time period
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prevalence
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measures probability of people having a disease at given point in time, aka "point prevalence"
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incidence rate =
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# new cases of disease in specific time / pop. at risk of disease in specific time
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prevalence rate =
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# existing cases of disease at point in time / total pop. at point in time
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measuring incidence requires
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follow-up of population orprosepctive study
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measuring prevalence
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no prospective follow-up, but rather can be estimated from cross-sectional study
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incidence requires knowledge of
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population; disease/non-disease confirmed by physician report screening, health records, self-report
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incidence requires time of
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onset of disease; straight forward for colds, flu, not for others (e.g., cancer)
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incidence requires numerator
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# of persons vs. # of conditions if counting # of conditions, not "true" incidence rate
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incidence requires denominator
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over time; only at risk for developing the disease
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use midpoint
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when population changes over time
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person-time denominator
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used when study subjects are observed for different periods of time; weighs each person's contribution interms of time observed in the denominator of the incidence rate
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person years calculation
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number of events / sum of years of follow-up
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incidence rates
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direct indicators for burden of diseases in populations
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assumptions necessary to use person-years denominator
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1. risk of disease (or death) constant throughout entire period of study 2. rate of disease in group lost to follow-up is same as group followed
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prevalence depends on 2 factors
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number of people who are sick with disease and duration of illness
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prevalence =
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prevalence x duration
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prevalence is useful for
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planning of facilities and manpower for treatment of chronic disease; tracking changes in disease patterns over time
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crude birth rate =
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# live births during year / average (mid year) population
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age-specific death rate
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# of deaths among persons of given age group in a year / average (mid year) pop in specified age group
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cause-specific death rate
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number of deaths from stated cause a year / average mid year population
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rate
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the most commonly used statistic to quantify or measure disease in populations
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what is incidence?
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number of disease free people who develop disease over time
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what is prevalence?
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number of existing disease over total population
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prospective cohort study
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begins with group free from disease but can be classified according to "exposure". followed to see development of disease. ex. exposure is smoking, disease is lung cancer; risk factor measured 1st
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retrospective study
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people diagnosed with disease (case) are compared with persons without disease (controls) in terms of past "exposure" experience; outcome is measured first then backwards; ex: lung cancer and smoking
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cohort design
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prospective
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case control design
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retrospective
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cross-sectional
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sample survey
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longitudal surveys
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prospective
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trend vs. panel surveys
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prospective
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trend
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over time with different samples; ex: current pop. survey;
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panel
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track changes in same people
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internal validity
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degree to which variation in outcome variable can be attributed to presumed causal variable and not some other source
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research designs with high internal validity allow
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high confidence in the causal inference
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causal inference
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1. strength of association 2. presence of dose relationship 3. consistency of association 4. temporal correctness 5. biological plausibility 6. confounding
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confounding
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rule out plausible rival explanations for observed association
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causal direction between
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social indicator and health
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nature of association
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the lower an individual's socioeconomic position, the worse their health
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most widely accepted causal direction of social indicator and health
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social causes health
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what are the mediators between low SES and poor health?
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social disadvantage and multiple risk exposure
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moderated relationship
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relationship between SES ad health different for whites than blacks
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mediator between SES and health
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race/ethnicity
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telomeres
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cap the ends of chromosomes and shorten with age; the shorter its length, the more cardiovascular disease and mortality
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race "moderates" the ______ between SES and Cellular ageing
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telomere length
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among white males, those with low SES had
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shorter telomeres and change in length over 5 yrs
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among black males,
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SES was not related to telomere length
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4 types of relationships between social indicators and health
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1. association 2. direct causal 3. mediated 4. moderated
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mediated
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indirect causatio
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moderated
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interaction is present
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individual-level
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social indicators of a person are used to predict health of the person
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aggregate or ecological-level
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social indicators of an area (eg, census tract) are used to predict health of the eighborhood
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Robinson Study 1950
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at ecological level, high liear correlation, but idividual level no correlation
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Robinson's conclusion
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ecological correlations does not equal individual correlations (ecological fallacy)
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compositional
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areas include different types of individuals, and individuals between individuals account for the observed differences between areas
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contextual
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there are features of social or physical environment that influence the health of those exposed (i.e., those who live in the area)
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Area Features Affecting Health
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1. physical features of the environment shared by residents 2. availability of healthy environment at home 3. services provided, publicly or privately, to support people in their daily lives 4. sociocultural features of a neighborhood 5. reputation of the area
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Child care subsidies and child development [PDF] from chrisherbst.net UC-eLinksCM Herbst... - Economics of Education Review, 2010 - Elsevier
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Research is mixed, Some studies find significant effects Others do not
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Cross-level relationship
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social indicators of the neighborhood are combined with individual-level characteristics to predict health of the individual
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mediation for multi-level relationships
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social indicators cause poor health
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Moderated for multi-level relationships
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low SES and health but is it the same for everybody?
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Example of Cross-Level Interaction:
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Poor individuals living in poor neighborhoods experience worse health than poor individuals who live in wealthy neighborhoods.
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The relationship between poverty and health depends on
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the type of neighborhood one lives in
