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UKURAN - PPT Presentation

DAMPAK DALAM EPIDEMIOLOGI Nurul Wandasari Singgih Prodi Kesehatan Masyarakat Univ Esa Unggul 20122013 Measures of Public Health Impact Attributable Risk AR ID: 459439

ukuran risk population attributable risk ukuran attributable population dampak 1000 perbedaan kelompok par percent terpajan pada chd fraction cases

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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