## 04 Mar Epidemiological Tools There are a variety of tools that an epidemiologist might have at his or her disposal. The most common tools that are used in the field are SAS, SPSS

**Epidemiological Tools**

There are a variety of tools that an epidemiologist might have at his or her disposal. The most common tools that are used in the field are SAS, SPSS, EpiInfo, R, and many others. These require significant time and diligence to become proficient at each of these statistical tools. However, almost every office has Microsoft Excel, Numbers (the Mac equivalent), or Google's Excel-like product.

Often times, epidemiological calculations can seem/appear intimidating. However, if you let the excel document do the work for you then you do not have to worry about making errors in simple math. Please download the attached Microsoft Excel spreadsheet. You will be doing the following:

**Calculating:**

- Crude Mortality Rate
- Age-Specific Mortality Rate
- Age-Adjustment (using the direct method)
- Prevalence
- Incidence Density

**Graphing:**

- Incidence and Prevalence

You will need to go to the Census Bureau, then click on Advanced Search then click on Geography. In the area marked state, county, or place, type your community or a community near you and select enter. You are going to want information from a table that contains Age and Sex in the title.

Please see attached file

## Morbidity Measures

Example: Open Cohort (City, State, Zip Code etc) | |||||||||

Year | Number Sick | Total Pop | Incidence | Prevalence | |||||

2001 | 900 | 890,750 | 101.04 | 101.0384507438 | |||||

2002 | 400 | 908,830 | 44.01 | 143.0410527821 | |||||

2003 | 200 | 920,623 | 21.72 | 162.9331441861 | |||||

2004 | 400 | 930,517 | 42.99 | 204.1875645474 | |||||

2005 | 100 | 939,605 | 10.64 | 212.855402004 | |||||

2006 | 300 | 948,844 | 31.62 | 242.4002259592 | |||||

2007 | 600 | 956,749 | 62.71 | 303.1098020484 | |||||

2008 | 200 | 963,160 | 20.76 | 321.8572199842 | |||||

2009 | 100 | 975,122 | 10.26 | 328.1640656246 | |||||

Problem !: Open Cohort | This is the space where you should place your chart! | ||||||||

Year | Number Sick | Total Pop | Incidence | Prevalence | |||||

2012 | 900 | ||||||||

2013 | 400 | ||||||||

2014 | 200 | ||||||||

2015 | 400 | ||||||||

Formulas in Excel can be useful. Most epidemiological measures of incidence and prevalence are simple formulas that you can program in excel. Please visit this Microsoft Overview: https://support.office.com/en-us/article/overview-of-formulas-in-excel-ecfdc708-9162-49e8-b993-c311f47ca173 Once you have finished the material, you will be ready for our first step. Incidence and Prevalence. The generic formula for both incidence and prevalence is sick/total population x some population multiplier, which can range from 100, 1,000, 10,000, 100,000, or even 1,000,000.

Figure 1: Incidence and Prevealence of Herpes 2001 – 2009

Incidence 2001.0 2002.0 2003.0 2004.0 2005.0 2006.0 2007.0 2008.0 2009.0 101.0384507437553 44.01263162527646 21.72441922480755 42.98685569420011 10.64277010020168 31.61742077728267 62.712372837599 20.76498193446572 10.25512705076903 Prevalence 2001.0 2002.0 2003.0 2004 .0 2005.0 2006.0 2007.0 2008.0 2009.0 101.0384507437553 143.0410527821485 162.9331441860566 204.1875645474505 212.8554020040336 242.4002259591672 303.1098020483951 321.8572199842186 328.164065624609

Years

Rate Pper 100,000 Population

In this example, let's assume that once you are infected with this disease you have it for life. Also, a fundamental assumption of this table will be that no one dies in this 9 year time window. Click on each incidence and prevalence window to see where I inserted the formula. Incidence = (Number Sick Cell/TotalPopulation Cell)*100,000 Prevalence is a little more different. Because people do not die from this disease and for this example, no one is dieing we have to add the previous years numbers for total diseased. If we were trying to calculate the prevalence for 2002, we would have to enter the number from 2001 + 2002. Please click on the cell to see how I wrote the formula.

In the chart above, please find the population data from your town for the years 2012-2013. Using Excel formula complete the table. Once your table is complete, please visist the following link: https://support.office.com/en-us/article/create-a-chart-from-start-to-finish-0baf399e-dd61-4e18-8a73-b3fd5d5680c2#OfficeVersion=Windows You will need to create a chart based on the data you generated. Please see my example to the right of these instructions.

## Mortality Measures

Example 1: Crude Mortality Rate & Age Specific Rate (ASR) | |||||

Age Group | Deaths | Total Population | ASR | ||

0 – 14 | 4 | 231,158 | 1.73 | ||

15 – 19 | 23 | 73,200 | 31.42 | ||

20 – 34 | 500 | 231,158 | 216.30 | ||

35 – 54 | 250 | 231,158 | 108.15 | ||

55+ | 1000 | 211,895 | 471.93 | ||

Total | 1777 | 978,569 | |||

Crude Mortality Rate | 181.59 | ||||

Example 2: Age-Adjusted Rate (Direct Method) | Expected Deaths are calculated by multiplying the raw ASR X Standard Pop | ||||

Age Group | Deaths | Total Population | ASR* | Standard Population ^ | Expected Deaths |

0 – 14 | 4 | 231,158 | 0.000017304 | 56,100,000.00 | 970.76 |

15 – 19 | 23 | 73,200 | 0.000314208 | 23,100,000.00 | 7258.20 |

20 – 34 | 500 | 231,158 | 0.002163023 | 69,300,000.00 | 149897.47 |

35 – 54 | 250 | 231,158 | 0.001081511 | 85,800,000.00 | 92793.67 |

55+ | 1000 | 211,895 | 0.004719319 | 92,400,000.00 | 436065.03 |

Total | 1777 | 978,569 | 326,700,000.00 | 686985.14 | |

* we leave the ASR in decimal form and do not multiply it by 100,000 for this method | |||||

^ the standard population is usually the standard population for the United States. | |||||

However, it can really be whatever population you want it to be. | |||||

Adjusted Mortality Rate = Expected Deaths / Standard Population x 100,000 | |||||

Adjusted Mortality Rate | 210.28 | ||||

Your job is to use the Example 2 chart except for the standard population. Replace the standard population | |||||

data with data points from the American FactFinder. | Then calculate the adjusted rate. | ||||

Age Group | Deaths | Total Population | ASR* | Your Population | Expected Deaths |

0 – 14 | 4 | 231,158 | 0.000017304 | ||

15 – 19 | 23 | 73,200 | 0.000314208 | ||

20 – 34 | 500 | 231,158 | 0.002163023 | ||

35 – 54 | 250 | 231,158 | 0.001081511 | ||

55+ | 1000 | 211,895 | 0.004719319 | ||

Total | 1777 | 978,569 | |||

Adjusted Mortality Rate |

In this exercise, we will be exploring how to calculate crude mortality, age-specific mortality, and direct age-adjustement. This exercise will require you to have access to demographic data from American FactFinder. Please work on the morbidity assignment prior to tackling this assignment. I am going to assume you already know how to use Excel formulas, as they were used extensively in the morbidity tab. As with the previous tab, I will provide you examples. Remember: Age Specific Mortality (ASR): Total Died in that Age Category/Total in that Age Category x 100,000 Crude Mortality Rate: All deaths/Total Population x 100,000 Age-adjustment is odd, you have to calculate the ASR first and not multiply it by 100,000. Then you multiply it by a standard population, or a population you are attempting to compare it to.

Now if you look at the ASR, you will see that clearly 55+ have the highest age specific rate. However, remember that population covers a lot of people and can be prone to a high rate or mortality already. Calculating an age specific adjustment be useful to see if the crude rate increases or decreases.

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