Notes for Public Health GI Geography migration and disease burden Disease burden concept, measurement, pattern, Use

e and prob of routine health data Geographical variation of disease Assess health impact of disease on pop. Level monitor risk (health), compare health loss due to diff risk and disease, guide policies and strategies (in health and other sector), support decision on priority actions, estimate changes in disease burden and avoidable diseas burden, analyze cost-effectiveness of intervention. Assess measure health event Fatal = mortality, non fatal event = hosp. care, primary care; fatal + non-fatal = QALY (quality adjusted life yrs) and DALY (disability adjusted life yrs) Mortality rate= no. of death in a pop. Scaled to size of pop per unit time. (deaths per 1000 ppl per year) Crude death rate = total no. of deaths per year per 1000 pop at risk of dying in the middle of the year (early / later = more variable pop size), not consider death cause, Specific mortality rate age specific, sex specific (rate of death occurring subgroup of the pop, crude rate inadequate to describe conditions which are heavily loaded at the extremes of life. Cause / disease specific death rate of individual causes of death. Standardized rates? Measures of Morbidity Healthcare utilization data (hospital based data, primary care data), surveillance data, registration of disease (eg CA registry), pop. Based health info (health surveys) Measuring disease occurence Incidence rate new events occur in pop. Measure rate of occurrence of new cases. Incidence count Incidence risk = proportion: [new cases in specified time period / pop. size under consideration (initially disease free)] Incidence rate - rate (no. of cases per 100000 person yr Prevalence = incidence x average duration = no. of existing cases/ population at risk (looks at all current cases) = proportion of individual in a pop who have disease at a specified time . OTHER health indicators: On mortality/ morbidity - life expectancy, health and disease rating scales. Life expectancy = average yrs a person of given age is expected to live (if apply current mortality rates) Life expectancy at birth = average yrs a newborn baby expected to live (if apply current mortality trends) Life expectancy at given age = average no. of ADDITIONAL yrs a person of age N will live (base on age-specific death rates for a given yr + apply current mortality trends) Combining data on mortality and non-fatal health outcomes into a single no. -DALY QALY DALE HeaLY

QALY (quality adjusted life yr) [ used in research due to - practical difficulty, fairness of assessment] QOL (quality of life) pain/mood/self care/ social/ paid employment/household activity [changes in QOL measured by QALY) QOL weight : 1.00 = full health, 0.625 = reduced health (weights of QOL) QALY = QOL x years lived (suvival) Uses of QALY = compare diff intervention, aim to QOL/ survival DALY (disability -adjusted life yrs) NOT life gain, but life lost Premature mortality and disability Calculating DALY: important = time being chosen as the unit of measurement DALY = YLL (yrs of life lost due to premature mortality) + YLD (years lived with disability) YLL = no. of deaths x standard life expectancy at age of death (in yrs) YLD = no. of incident cases x disability weight x average duration of disability (yrs) [disability weight : 0= perfect health, 1 = dead] Health state weighings: QALY weight 0 = state comparable to death, 1 = state of ideal health Disability weight (DALY) 0 = perfect health, 1 = death Disability weight -> quantify societal prefer for diff health states in relation to the societal ideal of good health; not represent the lived exp of any disability or health state. Not imply any societal value for person in a disability or health state. Age weight = social prefer on value of yr lived a young adult Time discounting = ppl's preference on a health yr of life immediately rather than in the future if given the choice.

Disease burden non communicable disease such as CA and heart disease = dominant cause nowadays, more young and middle age adults suffer. Less child illness/ malnutrition Double disease burden in developing countries. Using routine health data Advantage = cover large pop (countries), available (readily), cheap Disadvantage = not set up to ans any particular research question, type / quality varies.

Factors affecting observed prevalence new case In migration of case In migration of susceptible Out migration of healthy people Less stringent dx criteria improved dx facilites Longer duration of disease Life prolonging tx without cure

new case Out migration of case Out migration of susceptible In migration of healthy people Stringent dx criteria High case fatality rate Short duration of disease Improved cure rate of cases

Variations in data [CART] Completeness, accuracy, relevance(representativeness), timeliness