Epidemiology Class Notes 2012-09-18

News of the Day

• Health insurance for children of illegal immigrants
• Medicare restructuring > The restructuring would affect some of the most vulnerable Americans: the elderly, nearly half of whom live on less than $22,000 a year, and who already spend 16 to 22 percent of their income on health care. Many have dementia and other complex medical problems.

I had dinner last night with a person who works at DeLoitte on human resources consulting. He said that the number for health care is $8000 per person. The “Affordable Care Act” taxes employers $2000 who fail to provide health insurance. The remainder, for much of the population, will need to get picked up by the government.

• Morbidity and Mortality Weekly Reports. See also the summary of reportable diseases
• World Health Organization and the Horn of Africa report

Using Spreadsheet Software

• Evolving Document on How to do Calculations in Spreadsheets
• The spreadsheet assignment

Age Adjustment Calculation

In-class Activity on Standardization and Age Adjustment

Life Expectancy

Is medicine improving? How has life expectancy changed in the last 100 years?

Explanation of calculation.

Central Question: How is it possible to say what the expected life span is of a child born today?

Age specific death rates and the projection of this through a hypothetical population.

Activity on Life Expectancy
Spreadsheet implementing the calculation

Interpretation of Life Expectancy

Deaths at an early age have a strong impact. A spreadsheet for investigating Add in extra deaths at different ages to see the effect on life expectancy.

• Article about crime statistics How much of the difference between blacks and whites for life expectancy at birth is due to homocide?

• Child mortality measures from EE Table 2.7. \url{{EE5.pdf}}
  

QALY, DALY, Healthy life expectancy, years of potential life lost:

Essential Epidemiology Chap 3

• What is a case report? What is a case series? Examples:
  • rubella and congenital cataracts (what's “congenital”)?
    
  • Oral contraceptives and pulmonary embolism?
  • ''Pneumocystis carinii'' pneumonia in young, previously healthy homosexual men.
• What's a prevalence survey?
• What's a disease registry?
• Sources of data: Table 3.2
• Death certificate US Standard Certificate
  • Describe what happened in the two cases given as examples in the instructions.
  • Note the “common problems in death certification”
• Birth certificate Barack Obama, II note how little health data is recorded.
• What's an ecological study? What is the disadvantage of them?
  
  • Example: employment is higher in cities with lots of immigration.
    
  • Example: inverse relationship between SAT scores and expenditures.

Group task: What are the analogous sources of data in one of these system? What do you think would be a good source of data?

• education
• the legal system
• the economy