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102 Cards in this Set
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Population health
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the ANALYZING, understanding of determinants of health and demographic research
Ex policy formation, research, resource allocation decision |
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Public Health
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the DOING, developing and administration of programs to promote health
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Epidemiology
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study of the distribution and discriminants of health-related states or events in specified populations and the application of this study to control health probs
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3 types of epidemiology
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descriptive
analytical experimental |
dae
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descriptive epidemiology
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Describes distribution of diseases and health conditions
Uses data to examine how rates vary accroding to demographic variables are rates uniform across person, time, place |
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Analytical epidemiology
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Determines causes (determinants, factors) of disease by STATISTICAL ANALYSES to test hypotheses of suspect risk factors
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Experimental epidemiology
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Addresses prevention and control of health problems using experiments and clinical trials
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Endemic
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Constantly present in an area or population and noted as a baseline rate
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Epidemic
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disease which exceeds endemic levels
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Pandemic
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An epidemic that affects large areas of land and multitdues of people
ex plague, spanish flu, obesity |
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3 eras leading up to modern epidemiology
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Sanitary statistics
Infection disease Chronic disease epidemiology Eco-epidemiology (now) |
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Epidemiology vs pop health
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Epidem - concerned with causation of disease, too proximal, clinical
Pop health - look at underlying social determinants |
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Sanitary statistics:
paradigm, analytic approach, preventative approach |
Miasma - disease caused by foul emanations from soil, air and water
Demonstrate morbidity and mortality clustering Sanitation, drainage, sewage |
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Edwin Chadwick
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Proponent of sanitation
Layered maps of dirty/poor areas and dots of cholera to show cholera resulted from unsanitary conditions |
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Era of Infection DIsease Epi
paradigm, analytic approach, preventative approach |
Germ theory - organisms cause disease, vector epidemiology
Laboratory isolation and culture from disease sites; experiemntal transmission; reproduction of lesions interrupt transmission (vaccination, quarantine, antibiotics) |
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John Snow
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father of epidemiology
first to suspect cholera was water borne illness mapped cholera incidence on broad street test hypothetsis of cholera incidence by remove pump handle |
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Epidemiologic Triangle
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Host, environment, agent
points are at where epidemiologists intervene |
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Era of Chronic Disease Epidemiology
paradigm, analytic strategy, preventive approach |
Black box - exposure related to outcome without necessity for interveneing factors or pathogenesis
Risk ration of exposure to outcome at individual level in populations control risk factors by modifying life style or environment |
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Epidemiologic transition
(1900 to 2000 CoD) |
1900 - leading cause of death was infectious disease
(pneumonia, tuberculosis) 2000 - chronic conditions assoc with health behaviors of individuals leading cause of death (heart disease, stroke, cancer) |
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Health Indicators
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Physical activity
Overweight/Obesity Tobacco Substance Abuse Sexual Behavior Injury and Violence Immunization Access to Health care Mental Health Environmental Quality |
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Eco-Epidemiology
paradigm, analytic approach, preventative approach |
Chinese boxes - complex layers of det of health
Analysis of multiple determinants of health within and across contexts Use multi-level, multi-contextual information to develop effacious prevention programs |
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The Health Gradient
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inverse assoc b/w SES and morbidity/mortality consistently observed
US spends greatest per capita on health care but only ranked 25th/30 in life expectancy |
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Health disparities
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population specific differences in the presence of disease, health outcomes or access to health care; health inequalities
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Social causation theory
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low SES affects health
lower access, greater stress |
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Selection hypothesis
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childhood health affects SES later; unable to rise out SES
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Health disparities
population characteristics |
race and ethnicity
gender ses disability sexual orientation age geography |
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Health disparities
Health status |
screening
incidence mortality survivorship coverage access quality |
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Health disparity examples
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black infants of black women 2x higher infant mortality rate
white life expectancy about 5 yrs greater than black new mammogram guidelines - women should begin screening at 50 not 40 but younger black women more likely to get agressive forms of cancer |
blacks more likely to go to ER for asthma, whites more likely to just have an inhaler
black men have highest incidence and death from cancer gays have greater prob of heart disease |
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Explanation of greater income = greater risk of breast cancer
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Live longer, don't get other lethal diseases, must die of some other cause
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Why is the prevalence of diabetes II expected to increase
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inc obesity
colored people increase in population aging population |
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Health disparities (contd)
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High risk blacks less likely to recieve newer drugs for heart disease, more likely to have worse surgeon
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Nonmedical sources of disparities in health care
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mistrust and refusal
overuse of services among whites language and cultural barriers financing and delivery |
molf
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Incidence
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rate at which NEW events occur in a population in a specified time period; CHANGE in number of existing cases
= # new events/ population at risk (often midyear pop) usu expressed per 100,000 people |
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Cumulative incidence
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incidence expressed as a proportion or precent
AKA attack rate |
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Prevalence
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Proportion of people who possess a certain health condition at a certain point in time or period
= # of people w/health condition/ population at risk of that event in specified time period expressed as percentage |
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point prevalence
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prevalence of current cases of disease on a given date (census date)
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period prevalence
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proportion of people who have ever had the disease during a specified time period (ex asthma this past year?)
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Relation between P and I
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prevalence = incidence x duration
prevalence is not a measure of risk because it ignores duration of disease or death |
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Adjusted rate
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take into account differences in population structure to allow comparisons to be made across pops and time
standardized |
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2 types of direct standardization
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external
internal |
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external standardization
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populations drawn from outside sources used to adjust two or more study pops
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internal standardization
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a) standardize one's population rates to other's pop structure
or b) standardize both study populations/ rates to an average of the 2 populations' structures being compared |
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population
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number of people in a given area at a given time
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3 main types of rates
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crude rates
adjusted rates specific rates - rates disaggregated by some demographic characteristic |
cas
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2 ways to ENTER a population
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birth, immigration
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2 ways to EXIT a pop
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death, emigration
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Demographic accounting equation
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P = B - D + net migration
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Epidemiologic transition
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shift from infectious and deficiency diseases to chronic noncommunicable diseases
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Orman's 3 stages
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age of pestilance and famines
Age of receding pandemics Age of degernative and manmade diseaes |
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Consequences of the transition between health eras infectious and chronic conditions
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population growth
pop aging inc life expectancy inc morbidity |
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sex ratio
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# of males/100 females
declines with age |
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dependency ratio
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# of dependents/# of working age individuals in a population x 100
working age = 20-64 |
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Youth dependency ratio
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number of youth per 100 working age adults
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Aged or retirement dependency ratio
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number aged (usu 65+) / # working age individuals x 100
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Crude birth rate
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number of births in a given year divided by total midyear pop
= B/P x 1000 "crude" because fails to take into account age structure of population |
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General fertility rate
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# births in given year/ # of women of childbearing age (15-44)
x1000 doesn't take age structure into account |
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Age specific fertility rate
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# of children born to women of a given age range/ # of women in that age
x1000 |
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Teen fertility rate
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# of children born to women age 15-19 / # of women that age
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Total fertility rate
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Measures expected number of children a woman now at beginning of childbearing would have if she experienced current age specific fertility rates for whole of reproductive life
sum of all ASFR x 5 for women age 15-49 can compare across pop with diff age structures overall, worldwide TFRs are declining |
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Crude death rate
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# died/total population
x 1000 |
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Age specific mortality rates
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# deaths in an age group/ population in an age group
x 1000 j shaped mortality curve |
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Infant mortality rate
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# of infant deaths (under 1 year of age) / 1000 live births in the same period
D(<1 year)/B x 1000 |
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Neonatal mortality rate
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D(<28 days)/Births x 1000
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Post-neonatal mortality rate
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D(28 days - 1 year)/Bx1000
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Perinatal mortality rate
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# of fetal (still births) + infant deaths (less than 7 days old) / 1000 live births
x 1000 |
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Cause-specific mortality rate
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# of deaths from a given cause or group of causes
= Dc/P x 100,000 p not specific to cause |
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Maternal mortality ratio
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# of maternal deaths / 1000,000 births
Dm/B x 100,000 black much higher than white |
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Proportionate mortality
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Dc/D x 100
Of all deaths in given period, what proportion was caused by c disease |
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Case fatality ratio
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proportion of people diagnosed with a specific disease who die within a certain time after diagnosis
Dc/Pc x 100 Measure of severity of a disease |
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How to standardize rates
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Use US standard million
apply age specific rates to populations given by standard million (external) Use age specific rate on another's population (internal) comparison of rates with same pop structure |
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Issues with standardization
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inapproriate if events in cell are <25
new 2000 versus 1940 standard million cannot compare ADRs of pops that were adjusted using diff standards |
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Life table
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set of tabulations that describe probability of dying, death rate, numbers of survivors for each age group
GIVES LIFE EXPECTANCY AT BIRTH |
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Life expectancy
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Average number of years of life remaiing for persons who have attained a given age x (ex)
e0 = life expectancy at birth |
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Life span
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oldest age to which an organism or species may live under optimal conditions
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Cohort life table
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presents the mortality experience of a birth cohort
based on age specific death rates observed over time rarely have this data |
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Period life table
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presents the mortality experience of a hypothetical cohort of 100,000 indiciduals if it experienced the mortality conditions of a particular point in time
estimates mortality and life expectancy |
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Complete vs abridged life tables
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complete - data for every single year of age
abridged - uses 5 or 10 yr intervals |
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Age interval on a life table (subscript)
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x to x+n
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Probability of dying on a life table
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nQx
probability of dying from age x to x+n |
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Number surviving on a life table
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Lx
L0 is the synthetic cohort (radix) |
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Person years lived on a life table
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nLx
need to know: number of people who survive age interval, number of people who die during interval ex 5L5 = number of ppl alive at age 10 x 5 yrs + 2.5yrs x people who died between age 5 and 10 |
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Formula for calculating nLx
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n x Lsubscript(x+n) + .5n x nDx
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Formula for calculating person years lived during first year of life
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L0 = aL0 + (1-a) x L1
a is average time to death for those dying within first year of life (about .3) |
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Total person years lived
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Tx
Person years lived at and abpve indicated age interval sum of all rows in nLx values at and above age interval x to x+n |
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Life expectancy
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average number of years of life remaining to be lived
nTx / Lx |
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Assumption made in life expectancy calculations
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person experiences today's age specific mortality rates as they live out their lives
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Rectangularization of mortality
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flatter and more horizontal at lower ages (in response to lower mortality) and more vertical at higher ages
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Survival rates
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numerator - # of people alive at age y
denominator - # people alive at age x if specific age, use Lx If age intervals, use nLx values |
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Health indicator
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indicators that measure levels of and changes in health characteristics
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Purpose of health indicators and indices
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describe health of a population
measure scope of problem identify needs evaluate impact of effectiveness of intervention |
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Social determinants of health
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Income/social status
Biology and genetics Social support and coping Education Culture Social environment Physical environment Working conditions Healthy child development Employment Gender Personal health practices |
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Health Index
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composite measure o fhealth constructed from multiple social and health indicators
produces single number to measure health of pop |
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Index of social heatlh
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fluctuates in relation to economic stability
social health way of measuring health |
south ranked very low in social health compared to north
on bible belt/ poverty belt/ stroke belt |
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UN Human development index
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rank countries based on:
life expectancy at birth literacy rate gross school enrollment ratio per capita GDP |
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Quality of health indicators depends on
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Validity
Reliability Sensitivity Acceptability Feasibility Universality |
FAVURS
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Morbidity
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presence of illness or disease
state of being diseased degree or severity of a disease |
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Types of summary measures of population health (SMPH)
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health expectancies - similar to life expectancy but adjusts life years according to time spent in different health states
Health gaps - quantifies diff b/w actual health of pop and ideal health |
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Summary Measures of Population Health
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Explicitly integrates the mortality and morbidity experiences of the population
uses life table |
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Uses for SMPHs
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Examine wehter factors responsible for reducing mortality have a similar effect on morbidity
Measure health disparities Tool for health planning and policy decisions |
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Compression of morbidity
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Chronic conditions being pushed to the last few years of life
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Measuring morbidity (nπx)
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Age specific prevalence data
Health surveys |
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Period health expectancy
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Proportion of population healthy = (1-nπx)
Proportion of these years lived in a healthy state = nL'x = (1 - nπx) nLx Healthy life expectancy = T'x / Lx |
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