DAMPAK DALAM EPIDEMIOLOGI Nurul Wandasari Singgih Prodi Kesehatan Masyarakat Univ Esa Unggul 20122013 Measures of Public Health Impact Attributable Risk AR ID: 459439
Download Presentation The PPT/PDF document "UKURAN" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
UKURAN DAMPAK DALAM EPIDEMIOLOGI
Nurul
Wandasari
Singgih
Prodi
Kesehatan
Masyarakat
Univ
Esa
Unggul
2012/2013Slide2
Measures of Public Health Impact
•
Attributable Risk (AR)
Number
• Attributable Risk Percent (AR%)
Percentage
• Population Attributable Risk (PAR)
Number
• Population Attributable Risk Percent
(PAR%)
PercentageSlide3
Measures of Public Health Impact
IMPORTANT!
They all assume (require) that a
cause-effect
relationship exists between the exposure and the outcome.Slide4
Relative Risk vs. Attributable Risk
Relative Risk:
Measure of the
strength of association
,
and indicator used to assess the possibility of a causal relationship.
Attributable Risk:
Measure of the potential for
prevention of disease
if the exposure could be eliminated (assuming a causal relationship).Slide5
Relative Risk vs. Attributable Risk
Relative Risk:
• Etiology
Attributable Risk:
• Policy decisions
• Funding decisions (e.g. prevention programs)Slide6
Tipe ukuran yang digunakan dalam epidemiologi
Ukuran efek/dampak
Merefleksikan dampak suatu faktor pada frekuensi atau risiko dari suatu masalah (
outcome
) kesehatan
Merefleksikan kelebihan jumlah kasus karena suatu faktor (
attributable
) atau jumlah kasus yang dapat dicegah oleh eksposur (pemajan)Slide7
Ukuran-ukuran dampak
Ukuran perbedaan dampak/efek
Perbedaan risiko =
Risk Difference (RD) = Attributable Risk (AR) = Excess Risk (ER) = Absolute Risk (AR)
[
Risiko pada kelompok terpajan] – [Risiko pada kelompok tidak terpajan
]
Berguna untuk mengukur besarnya masalah kesehatan masyarakat yang disebabkan oleh suatu pemajan
bermanfaat untuk penilaian prioritas untuk aksi kesehatan masyarakat (
Public Health Action
)Slide8
Attributable Risk (AR)
Among the
EXPOSED:
How much of the disease that occurs can be attributed to a certain exposure?
AR
AR%
This is of primary interest to the practicing clinician.Slide9
Attributable Risk (AR)
AR = I
exposed
– I
nonexposed
= “Risk Difference”
Smoke
Yes
No
Yes
84
2916
3000
No
87
4913
5000
Develop CHD
I
SM
= 84 / 3000 = 0.028 = 28.0 / 1000INS = 87 / 5000 = 0.0174 = 17.4 / 1000 (background risk)
AR = (28.0 – 17.4) / 1000 = 10.6 / 1000Slide10
Attributable Risk (AR)
AR = (28.0 – 17.4) / 1000 = 10.6 / 1000
Among SMOKERS
,
10.6 of the 28/1000 incident cases of CHD are
attributed
to the fact that these people smoke …
Among SMOKERS
,
10.6 of the 28/1000 incident cases of CHD that occur could be
prevented
if smoking were eliminated.Slide11
Ukuran-ukuran dampak
Ukuran perbedaan dampak/efek
Perbedaan insidens kumulatif
=
Cumulative Incidence Difference= CID
[IK pada kelompok terpajan] - [IK pada kelompok tidak terpajan]
IK = Insidens KumulatifSlide12
Ukuran-ukuran dampak
Ukuran
perbedaan
efek
Perbedaan
rate/
perbedaan
densitas
insidens
(IDD =
Insidence
Density Difference)
IDD = [Densitas insidens dalam kelompok terpajan] - [Densitas insidens pada kelompok tidak terpajan] Slide13
Ukuran-ukuran dampak
Ukuran perbedaan efek
Perbedaan prevalens
(PD =
Prevalence Differrence)
PD = [Prevalens dalam kelompok terpajan] - [Prevalens dalam kelompok tidak terpajan] Slide14
Attributable Risk
I
exposed
- I
unexposedSlide15
Ukuran-ukuran dampak/efek
Ukuran perbedaan efek
Attributable Risk (AR) Percent = AR%Slide16
Attributable Risk Percent (AR%)
AR% = (I
exposed
– I
nonexposed
) / I
exposed
=
“Etiologic fraction”
Smoke
Yes
No
Yes
84
2916
3000
No
87
4913
5000Develop CHD
AR% = (28.0 – 17.4) / 28.0 = 37.9%ISM = 84 / 3000 = 0.028 = 28.0 / 1000I
NS
= 87 / 5000
= 0.0174 = 17.4 / 1000
(background risk)Slide17
Attributable Risk Percent (AR%)
AR% = (28.0 – 17.4) / 28.0 = 37.9%
Among SMOKERS
, 38% of the morbidity from CHD may be attributed to smoking…
Among SMOKERS
, 38% of the morbidity from CHD could be prevented if smoking were eliminated.Slide18
Attributable Risk Percent
I
exposed
– I
unexposed
RR - 1
------------------------------- = ------------ x 100%
I
exposed
RRSlide19
Ukuran-ukuran dampak
Population Attributable Risk (PAR)
=
Attributable Fraction (population)
atau
Etiologic Fraction (population) = Population Attributable Risk Proportion = Population Attributable Risk Fraction
Proporsi (atau fraksi)
rate
penyakit pada seluruh populasi yang mewakili
rate
penyakit dalam kelompok terpajan
Rumus PARSlide20
Ukuran-ukuran dampak
Population Attributable Risk Percent (PARP)
attributable fraction (population) atau etiologic fraction (population)
Berarti proporsi kasus baru yang dapat dicegah jika pada semua orang yang tidak terpajan
Rumus PAR%Slide21
Population Attributable Risk Percent
PAR% = (I
total
– I
nonexposed
) / I
total
Weight
Yes
No
Obese
850
3650
4500
Slim
250
5250
5500
Diabetes
PAR% = (110 – 45.5) / 110 = 58.6%
11008900
10000
I
T
= 1100 / 10000
= 0.11 = 110 / 1000
I
NE
= 250 / 5500
= 0.0455 = 45.5 / 1000
(background risk)Slide22
Population Attributable Risk Percent
PAR% = (110 – 45.5) / 110 = 58.6%
In Tampa
,
59% of the cases of diabetes may be attributed to obesity in the population…
In Tampa
,
59% of the cases of diabetes could be prevented if Tampa residents lost sufficient weight.Slide23
Prevented Fraction (PF)
If relative risk <1
Proportion of potential new cases which would have occurred if the exposure had been absent
Proportion of potential cases prevented by the exposureSlide24
PF: Vaccine efficacySlide25
Ringkasan ukuranSlide26
Ringkasan ukuranSlide27
Ringkasan ukuranSlide28
Ukuran frekuensi penyakitSlide29
Ukuran frekuensi penyakitSlide30
Ukuran frekuensi penyakit
RD = Risk Difference
AR = Attributable Risk
ER = Excess Risk
PAR = Population Attributable Risk
PF = Prevented Fraction