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Population Health > Quiz 1 Epidemiology > Flashcards

Quiz 1 Epidemiology Flashcards

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1
Q

Top 5 leading causes of death in 2010

A
  1. heart disease
  2. cancer
  3. COPD
  4. cerebrovascular disease
  5. unintentional injuries
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2
Q

Top 5 leading causes of death in 1900

A
  1. pneumonia
  2. tuberculosis
  3. diarrhea, enteritis
  4. heart disease
  5. liver disease
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3
Q

Major population/community-based strategies to prevent disease and improve health

A 
sanitation
immunization
legislation
education
litigation
early identification (screening)
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4
Q

4 main goals of Healthy People 2020

A
  1. increase quality + years of life
  2. eliminate health disparities (healthy equity)
  3. create environments that promote health
  4. promote healthy behavior across life stages
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5
Q

Major social determinants of health

A 
socio-economic status
occupation
physical environment
transportation
housing
social environment
discrimination
access to care and services
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6
Q

what percentage of health care is paid for by private insurance?

A

35%

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7
Q

what percentage of U.S. population is uninsured?

A

13%
46-51 million uninsured
25 million underinsured

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8
Q

how much does private sector contribute to total expenditure of health care?

A

more than half

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9
Q

what are methods of payment for U.S. healthcare?

A

out-of-pocket payment, individual private insurance, employee-based private insurance, and government financing

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10
Q

Medicare?

A
  • federal insurance program (govt. contracts for HCPs for range of health benefits)
  • social program - individual has contributed to his/her coverage
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11
Q

4 parts of Medicare?

A

Part A - hospital insurance
Part B - professional services (outpatient)
Part C - Medicare Advantage plans
Part D - prescription drug coverage

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12
Q

Medicaid?

A

joint federal-state insurance program to provide basic medical care to economically indigent populations

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13
Q

Medicaid percentage covered?

A

16% of population (2009)

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14
Q

Medicaid eligibility?

A
  • pregnant women and children under age 6 with family incomes below 133% FPL
  • children under 19 with family income up to 100% FPL
  • disabled children and adults covered under SSI program
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15
Q

New Medicaid expansion?

A

all non-Medicare eligible individuals under age 65 with incomes up to 133% FPL

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16
Q

Major cost drivers in U.S.?

A
  • demographic changes
  • technology and intensity of healthcare
  • increased insurance coverage
  • obesity rate
  • income of population medical care price increase
  • medical malpractice premiums
  • rise/fall of HMOs
  • reduced market competition as a result of consolidation in hospital sector and managed care insurer mergers
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17
Q

barriers to healthcare access?

A
  • rural areas lack full access to providers/institutions

- some providers do not accept Medicaid and sometimes Medicare

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18
Q

percentage of U.S. health insurance coverage that is employer-sponsored?

A

53%

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19
Q

measures of morbidity?

A

incidence, prevalence

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20
Q

measures of mortality?

A

mortality
case fatality
years of potential life lost (YPLL)
life expectancy

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21
Q

types of measurements?

A
  • crude
  • adjusted
  • quality-adjusted life years (QALYs)
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22
Q

3 rate types used in epidemiology?

A
  • crude (biased but real and easy to calculate, difficult to interpret)
  • specific (for subgroup)
  • adjusted/standardized (unbiased, using standard population, fictional)
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23
Q

Absolute risk?

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A

= calculated from incidence! (exposed risk - unexposed risk)

-determined from cohort studies (esp. prospective) comparing exposed and non-exposed people

24
Q

Relative risk?

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A

= by how many times exposure to certain risk factor increases risk of contracting disease
= (incidence of exposed)/(incidence of unexposed)

25
Relative risk reduction?
= 1 - relative risk
26
Risk ratio/odds ratio interpretation?
= 1, no association | > 1, positive association
27
Number needed to treat (NNT)?
= 100/(absolute risk reduction)
28
Absolute risk reduction?
= (unexposed risk - exposed risk) | = -(absolute risk)
29
Odds ratio?
= p/(1-p) | = (probability of event)/(probability of NOT event)
30
hierarchy of evidence?
meta-analysis > systematic reviews > *randomized control trials > cohort studies > case control studies > case reports/series
31
as you move up pyramid of hierarchy of evidence?
- stronger methodology - less bias - controls for comparison - fewer studies
32
primary studies?
factual, firsthand accounts of study written by person who was part of study -collection of primary data collected by researcher
33
descriptive/observational primary studies?
- case reports/series - prevalence surveys - correlational/ecological studies
34
analytic primary studies?
- case control studies | - cohort studies (prospective/retrospective)
35
secondary studies?
analysis and interpretation of primary research | -summary, collation, and/or synthesis of existing research
36
gold standard of evidence for cause-and-effect relationships?
randomized controlled clinical trial (RCT)
37
disadvantages of randomized clinical trials?
- very expensive and time-consuming - may pose ethical problems - impractical if cause-and-effect relationship takes a long time to appear
38
Phase I of clinical trial?
up to several months STUDIES SAFETY OF TREATMENT 20-80 participants 70% success rate
39
Phase II of clinical trial?
up to 2 years STUDIES EFFICACY OF TREATMENT 100-300 participants 33% success rate
40
Phase III of clinical trial?
1-4 years STUDIES SAFETY, EFFICACY, AND DOSING 1000-3000 participants 25-30% success rate
41
Phase IV of clinical trial?
1+ year STUDIES LONG-TERM EFFECTIVENESS, COST-EFFECTIVENESS thousands of participants 70-90% success rate
42
Crossover design clinical trial?
half the patients receive active treatment for a period followed by placebo, while other half receives placebo first followed by experimental treatment = within-subject design
43
Non-inferiority trials?
seeks to show only that a new treatment is not inferior to an existing one -null hypothesis = old treatment is more effective than new one being tested -alternative hypothesis = new treatment is AT LEAST as effective as old one = one-tailed statistical testing!
44
2 categories of non-experimental studies?
descriptive + analytic - descriptive = indicate occurrence/distribution of disease - analytic = testing hypotheses or explanations about disease
45
Cohort studies?
cohort does not have disease of interest, observed for outcome -prospective = unbiased!
46
Advantages of cohort studies?
- best form of investigation when true experiment not feasible - only method that can establish absolute risk - assesses whether exposure is risk factor
47
Disadvantages of cohort studies?
- time-consuming, laborious, expensive | - may be impractical for rare diseases
48
Case control studies?
compares people who do have disease (cases) to similar people who do not have disease (controls), assesses their relative exposures -retrospective!
49
Advantages of case control studies?
- quick and cheap to perform, even for rare diseases that take a long time to appear - require comparatively few subjects - allow multiple potential causes of disease to be investigated
50
Disadvantages of case control studies?
- recall bias because retrospective - misses undiagnosed/asymptomatic cases - selection bias - cannot determine rate/risk of disease in exposed and non-exposed people - cannot prove cause-and-effect relationship
51
Case series?
simply describes presentation of a disease in a number of patients (commonly used to present new info for rare disease) -no following of patients or control/comparison group -no cause-and-effect relationships established
52
Case report?
special form of case series with only one patient described
53
Ecological studies?
study in which data is collected about a whole population (large group or community) and is analyzed at that level - no data analyzed about individuals - done quickly and inexpensively using existing bodies of data
54
2 types of secondary studies?
- systematic reviews | - meta-analyses
55
Systematic review?
-objective, goal of enabling clinical decisions to be made on basis of all the good-quality studies that have been done
56
Meta-analysis?
- quantitative analysis of the results of a systematic review - validity depends on quality of review and underlying studies

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