Introduction to Epidemiology – Exercises & Activities
Gaetano Marrone – 25.09.2019
Exercise 1
For each of the following scenarios, determine whether it is more closely related to
incidence or to prevalence.
1. Number of campers who developed gastroenteritis within a few days after eating potato
salad at the dining hall?
2. Number of persons who reported having diabetes as part of the National Health Interview
Survey?
3. Occurrence of acute myocardial infarction (heart attack) among participants during the first
10 years of follow-up of the Framingham Study?
4. Number of children who have immunity to measles, either because they had the disease or
because they received the vaccine?
Suppose a surveillance system was able to accurately and completely capture all new
occurrences of disease in a community. Suppose also that a survey was conducted on July 1st
asking every member of that community whether they currently had that disease. For each of
the following conditions, determine whether incidence (per 1,000 persons per year) or
prevalence (per 1,000 persons on July 1st) is likely to be higher.
5. Rabies (occurs rarely and has a short duration, e.g., death within one week)?
6. Multiple sclerosis (rare occurrence, long duration [many years])?
7. Influenza (common but winter-seasonal occurrence, short duration)?
8. Poison ivy dermatitis (common spring/summer/fall occurrence, 2-week duration)?
9. High blood pressure (not uncommon occurrence, lifelong duration)?
Exercise 2
1. Explain the difference between incidence and prevalence regarding the numerator.
2. Two surveys were done of the same community 12 months apart. Of 5,000 people surveyed
the first time, 25 had antibodies to histoplasmosis. Twelve months later, 35 had antibodies,
including the original 25. Calculate the prevalence at the second survey, and compare the
prevalence with the 1-year incidence.
Exercise 3
Suppose an investigator is conducting a study of the incidence of death due to second myocardial
infarction (MI). He follows 5 subjects from baseline (first MI) for up to 10 weeks.
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Introduction to Epidemiology – Exercises & Activities
Gaetano Marrone – 25.09.2019
1. Calculate the time contributed by each subject;
2. Calculate the total person-time (person-days);
3. Calculate the total number of deaths;
4. Calculate the incidence rate.
Exercise 4
Investigators enrolled 2,100 men in a study and followed them over 4 years to determine the rate of
heart disease. The follow-up data are provided below. We will calculate the incidence rate of
disease. We assume that persons diagnosed with disease and those lost to follow-up were disease-
free for half of the year, and thus contribute 1/2 year to the denominator.
Initial enrollment: 2,100 men free of disease
After 1 year: 2,000 disease-free, 0 with disease, 100 lost to follow-up
After 2 years: 1,900 disease-free, 1 with disease, 99 lost to follow-up
After 3 years: 1,100 disease-free, 7 with disease, 793 lost to follow-up
After 4 years: 700 disease-free, 8 with disease, 392 lost to follow-up
1. Identify the number of cases diagnosed;
2. Calculate the total person-years;
3. Calculate the incidence rate.
Exercise 5
1. What is the meaning of the following statement? The 10-year risk that a 45-year-old male
will develop prostate cancer is 5%? (State your answer in probability terms and be as
specific as you can in terms of the assumptions required).
2. Will the 5-year risk for the same person described in the previous question be larger or
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Introduction to Epidemiology – Exercises & Activities
Gaetano Marrone – 25.09.2019
smaller than the 10-year risk? Explain briefly.
Exercise 6
Using data from one of the classic studies of pellagra by Goldberger3,
1. calculate the cumulative incidence rate ratio of pellagra for females versus males;
2. In the same study, the risk of pellagra among mill workers was 0.9%. The risk among those
who did not work in the mill was 4.4%. Calculate the cumulative incidence ratio of pellagra
for mill workers versus nonmill workers. Give an interpretation of the results.
Exercise 7
The follow table provides death rates from lung cancer taken from the classic study on smoking and
cancer by Doll and Hill4.
1. Using these data calculate the incidence rate ratio of smokers of 1-14 cigarettes per day to
nonsmokers. The “exposed group” is the smokers of 1-14 cigarettes per day. The
“unexposed group” is the smokers of 0 cigarettes per day.
2. Calculate the following incidence rate ratios:
a. Smokers of 15-24 cigarettes per day compared with nonsmokers;
b. Smokers of 25+ cigarettes per day compared with nonsmokers.
3. Discuss what the various rate ratios show about the risk for lung cancer among cigarette
smokers.
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Introduction to Epidemiology – Exercises & Activities
Gaetano Marrone – 25.09.2019
Exercise 8
The table shows data from a cross sectional study showing the prevalence of hay fever and eczema
in 11 year-old children5.
1. Calculate the odds ratio.
References
1. Centers for Disease C. Summary of notifiable diseases, United States. 1990. MMWR Morb
Mortal Wkly Rep. 1991; 39(53): 1-61.
2. Control CfD. Current trends: Heterosexual behaviors and factors that
influence condom use among patients attending a sexually transmitted disease clinic - San
Francisco. . MMWR 1990; 39: 685-9.
3. Goldberger J, Wheeler GA, Sydenstricker E, King WI, Bean WS, Dyer RE, et al. A study of
endemic pellagra in some cotton-mill villages of South Carolina. Washington,: U.S. Govt. Print.
Off.; 1929.
4. Doll R, Hill AB. Smoking and carcinoma of the lung; preliminary report. Br Med J. 1950;
2(4682): 739-48.
5. Strachan DP, Butland BK, Anderson HR. Incidence and prognosis of asthma and wheezing
illness from early childhood to age 33 in a national British cohort. BMJ. 1996; 312(7040): 1195-9.
