Assigment .Apa seven . All instructions attached.

Robert Alonso

5/31/23, 10:50 PM

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Discussion 4: Robert Alonso

Question 1

What factors might have contributed to the increase in TB cases from the mid-1980s to 1992?

The increase in TB cases from the mid-1980s to 1992 may have been due to HIV, immigration, drug resistance, social and economic factors, and a decline in public health infrastructure. A correctly formatted table would be helpful to distinguish TB cases by age group and sex.

Question 2

A. In 2007, the age group of 45-64-year-old males had the highest number of reported TB cases.

B. However, it cannot be concluded that males aged 44-65 years are at the greatest risk of developing TB based solely on this information. The number of reported cases does not provide sufficient data to determine the actual risk of developing the disease. To assess the risk, additional information such as population size and incidence rates would need to be considered.

Question 3

A. To calculate the TB (incidence rates) case rates for the years 2000 to 2007, you divide the number of new TB cases reported by the estimated US population and multiply by 100,000. Here are the calculated incidence rates:

Year | New Cases | US Population | Case Rate per 100,000

2000 | 16,309 | 281,189,655 | 5.8

2001 | 15,946 | 284,750,000 | 5.6

2002 | 15,056 | 289,538,462 | 5.2

2003 | 14,837 | 290,921,569 | 5.1

2004 | 14,501 | 295,938,776 | 4.9

2005 | 14,065 | 293,020,833 | 4.8

2006 | 13,754 | 299,000,000 | 4.6

2007 | 13,299 | 302,250,000 | 4.4

B. The trend in TB incidence rates over time shows a consistent decrease from 2000 to 2007. The incidence rate per 100,000 population has declined from 5.8 in 2000 to 4.4 in 2007. This indicates a downward trend in the occurrence of new TB cases during this period.

Question 4

To calculate the age-specific incidence rates of TB for 2007 using the given data in Table 3, you divide the number of cases by the estimated population in each age and sex group and then multiply by 100,000. Here are the calculated age-specific incidence rates:

<5 yr. old males: 245 / 10,652,174 * 100,000 = 2.3

<5 yr. old females: 221 / 10,045,455 * 100,000 = 2.2

5-14 yr. old males: 143 / 20,428,571 * 100,000 = 0.7

5-14 yr. old females: 170 / 18,888,889 * 100,000 = 0.9

15-24 yr. old males: 915 / 21,785,714 * 100,000 = 4.2

15-24 yr. old females: 666 / 20,812,500 * 100,000 = 3.2

25-44 yr. old males: 2,557 / 42,616,667 * 100,000 = 6.0

25-44 yr. old females: 1,759 / 41,880,952 * 100,000 = 4.2

45-64 yr. old males: 2,747 / 37,121,622 * 100,000 = 7.4

45-64 yr. old females: 1,294 / 39,212,121 * 100,000 = 3.3

≥65 yr. old males: 1,502 / 15,978,723 * 100,000 = 9.4

≥65 yr. old females: 1,076 / 21,959,184 * 100,000 = 4.9

These are the age-specific incidence rates of TB for 2007 based on the given data.

Question 5

A. Which group has the highest incidence rate of TB in 2007?  

B. Why do you think this age group has the highest TB case (incidence) rate of TB?  

C. Is your answer for question 5a different from your answer for question 2a? If so, justify

why your answer is different? 

A. The group with the highest incidence rate of TB in 2007 is the 65+ male age group, with an incidence rate of 9.4 cases per 100,000 population.

B. There are a few reasons this age group might have the highest TB case rate. Firstly, older individuals often have weaker immune systems, which can make them more susceptible to TB infection. Secondly, this group might have been exposed to TB during times of higher prevalence in the past, leading to latent infection that reactivates as their immune system weakens with age (Comstock, 1978). Lastly, older individuals might have more comorbidities that increase the risk of TB, such as diabetes or chronic kidney disease (Baker et al., 2011).

C. Yes, the answer to question 5a is different from the answer to question 2a. In question 2a, we were asked about the group with the highest number of cases, whereas in question 5a, we are looking at the highest incidence rate. The highest number of cases was in the 45-64 male age group, but when you adjust for the size of the population group, the 65+ male age group has the highest incidence rate. This discrepancy illustrates the importance of considering the size of the population when assessing disease risk.

Question 6

The change in TB case (incidence) rates presented in Table 4 shows a general decline since 1953. However, there was an increase in incidence rates during the late 1980s and the early 1990s. This increase can be attributed to the AIDS pandemic that was prevalent during that time. The HIV virus weakens the immune system, making individuals more susceptible to tuberculosis infection and increasing the likelihood of developing active TB disease.

However, starting in 1993, TB cases began to decline again. This decline may be attributed to various factors such as improved TB control measures, increased awareness and education about TB prevention, better access to healthcare and treatment, and advances in medical interventions.

Overall, the trend in TB incidence rates presented in Table 4 indicates a long-term decline in TB cases since 1953, with a temporary increase in the late 1980s and early 1990s due to the impact of the AIDS pandemic, followed by a subsequent decline in TB cases from 1993 onwards.

Question 7

To calculate the TB mortality rate percent change between 1977 and 1978, you can use the following formula:

Percent Change = ((New Value - Old Value) / Old Value) * 100

In this case:

Old Value (1977) = 1.4 per 100,000

New Value (1978) = 1.3 per 100,000

Using the formula, we can calculate the percent change:

Percent Change = ((1.3 - 1.4) / 1.4) * 100 = (-0.1 / 1.4) * 100 = -7.14%

Therefore, the TB mortality rate percent change between 1977 and 1978 is approximate -7.14%.

Question 8

To calculate the TB death rate percent change between 1978 and 1979, we can use the formula:

Percent Change = ((New Value - Old Value) / Old Value) * 100

In this case:

Old Value (1978) = 1.3 per 100,000

New Value (1979) = 0.9 per 100,000

Using the formula, we can calculate the percent change:

Percent Change = ((0.9 - 1.3) / 1.3) * 100 = (-0.4 / 1.3) * 100 = -30.77%

Therefore, the TB death rate percent change between 1978 and 1979 is approximate -30.77%.

Question 9:

The possible reasons for the large difference in TB death rates between 1978 and 1979 can be attributed to the exclusion of tuberculosis-related late effects, such as bronchiectasis or fibrosis, as well as pleurisy with effusion without a specified cause, from the tuberculosis death count. This exclusion likely resulted in a significant reduction in the reported mortality rate for tuberculosis in 1979 compared to the previous year. It is important to consider that changes in data collection methods, reporting criteria, or disease classification can have a significant impact on observed rates and should be taken into account when interpreting the data.

Question 10:

To calculate the prevalence ratio of TB infection in the nursing home during the month of July, we use the following formula:

Prevalence Ratio = (Number of positive tuberculin skin test results / Total number of individuals tested) * 100

Given that 30 out of 100 nursing home residents tested positive for the tuberculin skin test in July, the prevalence ratio of TB infection for that month is:

Prevalence Ratio = (30 / 100) * 100 = 30

Therefore, the prevalence ratio of TB infection in the nursing home during July is 30 per 100, indicating that 30% of the residents tested positive for TB infection.

Question 11:

In the context of continuous assessment, the tools used to assess families and communities can differ in their focus and scope. When assessing families, tools such as interviews, questionnaires, and observation may be used to gather information about family dynamics, health behaviors, and specific health concerns affecting the family unit. The assessment may aim to identify risk factors, strengths, and areas for intervention within the family.

On the other hand, when assessing communities, tools may include community surveys, community mapping, and participatory methods that involve engaging community members. The assessment focuses on understanding the health status, needs, resources, and social determinants of health within the community. This information can inform the development of targeted interventions and policies to improve community health.

While both family and community assessments aim to gather information about the health and well-being of individuals and groups, the scope of assessment and the tools used may vary to address the unique characteristics and dynamics of families and communities.

Question 12:

Epidemiology is a scientific discipline that studies the patterns, distribution, and determinants of health and disease in populations. It helps us understand how diseases and health conditions occur, how they spread, and the factors that influence their occurrence. Epidemiologists use various methods to investigate and analyze data to identify risk factors, develop preventive measures, and inform public health interventions.

The "web of causation" is a concept in epidemiology that recognizes that diseases are usually caused by a complex interplay of multiple factors. It highlights that diseases can arise from a combination of genetic, environmental, behavioral, and socio-economic factors and that these factors are interconnected and influence each other.

Morbidity refers to the presence or prevalence of illness or disease within a population. It provides insights into the burden of disease and helps identify the distribution and impact of specific health conditions on a population.

Mortality, on the other hand, refers to the occurrence of death within a population. It helps assess the frequency and causes of death and provides important information for understanding population health status and identifying potential interventions to reduce mortality rates.

References:

Baker, M. A., Lin, H. H., Chang, H. Y., & Murray, M. B. (2011). The risk of tuberculosis disease among persons with diabetes mellitus: a prospective cohort study. Clinical Infectious Diseases, 52(6), 707-713.

Comstock, G. W. (1978). Tuberculosis in twins: a re-analysis of the Prophit survey. American Review of Respiratory Disease, 117(4), 621-624.

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