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EPI Review Flashcards

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1
Q

non differential misclassification biases the data toward or away from the null?

A

Non-differential misclassification biases the estimate toward the null; the “true” RR isfurther from the null than the reported RR.

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2
Q

What happens with a basic reproductive rate <1

A

Disease will disappear

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3
Q

What happens with a basic reproductive rate =1

A

Disease becomes endemic

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4
Q

What happens with a basic reproductive rate >1

A

Epidemic

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5
Q

How to calculate the basic reproductive rate (R0)?

A
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6
Q

What are the attributes of a surveillance system?

A

Sensitivity
* Timeliness
* Representativeness
* Positive Predictive Value
* Simplicity
* Acceptability
* Flexibility

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7
Q

What are the types of surveillance?

A

Active Surveillance
* Passive Surveillance
* Syndromic Surveillance
* Sentinel Surveillance
* Population-based Surveys

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8
Q

What is specificity?

A

ability of test to correctly identify all
those without disease

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9
Q

What is sensitivity?

A

ability of test to correctly identify all
those with disease

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10
Q

What is the sensitivity formula?

A

True positives/all diseased

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11
Q

What is the specificity formula?

A

True negatives/all non-diseased

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12
Q

What happens to a test if the cut-off is lowered?

A

More sensitive, less specific

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13
Q

What happens with multiple parallel screenings?

A

– Usually will increase sensitivity.
– Usually will decrease specificity.

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14
Q

What happens with multiple screenings in series?

A

– Some loss in sensitivity.
– Will tend to increase specificity.

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15
Q

Hot to calculate net sensitivity?

A
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16
Q

How to calculate net specificity?

A
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17
Q

What happens to net sensitivity in two stage screening?

A

Loss

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18
Q

What happens to net specificity in two stage screening?

A

Gain

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19
Q

What is PPV?

A

probability
person who tests positive actually has disease

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20
Q

What is NPV

A

probability
person who tests negative does not have disease

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21
Q

What are the measures of association in RCT?

A

Risk ratio, risk difference, rate ratio, numbers needed to treat

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22
Q

What does risk and rate difference measure?

A

Risk or rate difference measures clinical and public
health importance of the causal relationship

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23
Q

What does risk and rate ratios measure?

A

Risk or rate ratio assesses strength of the
association

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24
Q

What is selection bias?

A
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25
What is information bias?
Systematic difference in the way exposure or outcome is measured between comparison groups
26
in what type of study is selection bias more common?
case control
27
what is the direction of selection bias
can be toward or away from the null
28
What are sources of information bias?
Surrogate interviews * Non-response of particular questions that leads to incorrect classification (vs not being completely excluded) * Invalid instruments (do not measure what you want to measure) * Incomplete or erroneous data sources that leads you to classify incorrectly
29
What are the types of differential misclassification?
If distribution of errors for one variable depend on the other (e.g. detection bias, recall bias) – Can occur both in measurement and in analysis (e.g., when collapsing continuous variables)
30
What is non differential misclassification?
If distribution of errors for one variable do NOT depend on the other
31
What is the bias direction in Misclassification of exposure that is DEPENDENT on outcome?
bias either direction
32
What is the direction of bias in non differential misclassification of exposure?
Misclassification of exposure that is INDEPENDENT of outcome (i.e. same for D+ and D-), generally biases toward the null
33
What is the direction of Differential misclassification of outcome
bias either direction
34
Non-differential misclassification of outcome - direction of bias?
generally biases toward the null
35
What happens with Confounders that OVERESTIMATE
shift the observed measure of association AWAY from the null
36
What happens with Confounders that UNDERESTIMATE
shift measure of association TOWARDS the null
37
What are the confounder criteria?
Cause of outcome – Cause of exposure – Not on E-D causal pathway (i.e. not a mediator)
38
how to control for confounding in study design?
Randomize the exposure * Match exposed and unexposed on variable of interest * Restriction
39
how to control for confounding in the analysis stage?
Stratified analysis * Standardization * Use multivariable adjustment techniques (e.g., regression) * Advanced methods
40
What are the steps to evaluate confounding?
STEP 1: Calculate crude measure of association * STEP 2: Calculate strata specific measures of association * STEP 3: Compare crude vs stratum specific estimates
41
How much of a difference between crude and adjusted beta is enough to conclude that there is evidence of confounding in the data?
10-20%
42
When to use a case cross-over design?
Exposure is dynamic 2. Exposure has a very short induction time example: car crash, MI There must be within person variation in the exposure of interest in order to test the association in a case cross- over design
43
What is the measure of association for case cross over design?
Compare exposure distributions for the case and control periods * Use a matched pair case control analysis * Instead of concordant and discordant pairs of subjects, each patient contributed a pair of intervals, i.e., a hazard and a control period, which were either concordant or discordant for exposure
44
What is incidence density sampling?
Collect information on each case * Collect control at the same time each case is observed; collect control from the underlying source population giving rise to the cases * Controls can become cases!
45
What are the measures of association in nested case control studies?
Odds ratio from nested case-control study approximates the rate ratio
46
Do you need rare disease assumption for nested case control studies?
No
47
When is case based sampling used?
Case cohort studies
48
What is case based sampling?
All controls are selected at the beginning of the study period * Selected so that the ratio of exposed controls to the number of exposed cohort members equals the ratio of unexposed controls to the number of unexposed cohort members (random selection) * Used to study multiple disease outcomes with the same control group
49
What are measures of association for case cohort studies?
Odds ratio from case-cohort study approximates the risk ratio Do not need rare disease assumption
50
What measures of association can be used for cross sectional studies?
can estimate prevalence risk ratios, risk differences, and odds ratios
51
What measures of association can be used in prospective cohort studies?
can estimate risk ratios, risk differences, rate ratios, and odds ratios
52
Wha measures of association can be used in RCTs?
risk ratios, risk differences, rate ratios, and odds ratios
53
What are the measures of association for case control studies?
odds ratios
54
What are the measures of association for ecologic studies?
. Prevalence risk ratios, risk differences, and odds ratios (at the unit of analysis
55
What are the measures of association for retrospective cohort studies?
Risk ratios, risk differences, rate ratios, odds ratios
56
What measures of association in Nested case-control with incident density sampling
odds ratio that approximates the rate ratio
57
What is an example of EMM synergism?
moking combined with asbestos exposure increases risk of lung cancer (synergy) ▪ Effect of exposure and modifier create more risk of outcome than expected based on joint effect of both
58
What is an example of EMM antagonism?
NSAID (ibuprofen) used with anti-diuretic reduces the effectiveness of the anti-diuretic (antagonism)
59
What is the difference between EMM and confounding?
Confounding = Correlated causes acting through independent causal pathways Effect measure modification = several causes acting on same causal pathway
60
What are the steps to assess EMM?
1. Examine crude relationship 2. Stratify based on third variable 3. Compare stratum specific effect measures If there are differences in the measures of effect across strata, there is effect measure modification
61
What can you hope to find when there is EMM?
If there is effect measure modification: stratum specific measures are different from the crude and different from each other. – We should report the stratum specific measure (RR, RD, IRR, OR)
62
What can you hope to find if there is confounding?
stratum specific measures are similar to each other but different from crude (can use 10-20%) – Report Adjusted measure (RR, RD, IRR, OR)
63
What is the difference between crude and strata specific measures for EMM and confounders?
EMM - stratum specific measures are different from the crude and different from each other. Confounding - stratum specific measures are similar to each other but different from crude (can use 10-20%
64
How to assess multiplicative EMM?
Multiplicative Effect Modification: Evaluates differences in relative risk or rate
65
How do you assess additive EMM?
Additive Effect Modification: Evaluates differences in absolute risk or rate.
66
you have a logistic model: logit(p(Y=1)) = α + β1X1 + β1X2 + β3X1*X2, you have evidence ofadditive interaction if:
eβ1 + β2 + β3 ≠ eβ1 + e β2 - 1
67

EPI (3 decks)

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