EXERCISES

1. Epidemiologists are interested in learning about :

a)
b)
c)
d)

The causes of diseases and how to cure or control them

The frequency and geographic distribution of diseases
The causal relationships between diseases
All of the above

2. Table 3.7 provides the number of reported cases of diphtheria and the number of diphtheriaassociated deaths in the United States by decade. Calculate the death-to-case ratio by decade.
Describe the data in Table 3.7, including your results.
Table 3.7 Number of Cases and Deaths from Diphtheria by Decade United States, 19401999
Decade

Number of New Cases Number of Deaths

19401949

143,497

11,228

19501959

23,750

1,710

19601969
19701979
19801989
19901999

3,679
1,956
27
22

390
90
3
5

Death-to-case Ratio (
100)
7.82
__________
___________
___________
___________
___________
___________
___________

Data Sources: Centers for Disease Control and Prevention. Summary of notifiable diseases,
United States, 2001. MMWR 2001;50(No. 53).
Centers for Disease Control and Prevention. Summary of notifiable diseases, United States,
1998. MMWR 1998;47 (No. 53).
Centers for Disease Control and Prevention. Summary of notifiable diseases, United States,
1989. MMWR 1989;38 (No. 53).

3. Below are three key terms taken from the definition of epidemiology, followed by a list of
activities that an epidemiologist might perform. Match the term to the activity that best
describes it. You should match only one term per activity.
A. Distribution
B. Determinants
C. Application

1. ____ Compare food histories between persons with Staphylococcus food poisoning and
those without
2. ____ Compare frequency of brain cancer among anatomists with frequency in general
population
3. ____ Mark on a map the residences of all children born with birth defects within 2 miles
of a hazardous waste site
4. ____ Graph the number of cases of congenital syphilis by year for the country
5. ____ Recommend that close contacts of a child recently reported with meningococcal
meningitis receive Rifampin
6. ____ Tabulate the frequency of clinical signs, symptoms, and laboratory findings among
children with chickenpox in Cincinnati, Ohio
Mark the correct answer.
4. Data and results of data analysis have many uses in public health practice. This includes:
a. Population or community health assessment
b. Public health surveillance
c. Disease investigation
d. Prevention and control measures evaluation Program panning
e. Future health problems and need assessment
f. Hypothesis generation for study design

Choose ALL correct answers for each question.

5. In the definition of epidemiology, distribution refers to:
A. Who
B. When
C. Where
D. Why
6. In the definition of epidemiology, determinants generally includes:
A. Agents
B. Causes
C. Control measures
D. Risk factors
E. Sources
F. All of the above
Mark the correct answer:
7. The following table shows person information about cases of the unknown disease.

8. The distributions of the cases are:

A. The rates by sex only
B. The rates by age groups only
C. The rates by sex and age groups
D. The rates by age groups, sex and marital status.

9. A number of passengers on a cruise ship from Puerto Rico to the Panama

Canal have recently developed a gastrointestinal illness compatible with
norovirus (formerly called Norwalk-like virus). Testing for norovirus is not
readily available in any nearby island, and the test takes several days
even where available. Assuming you are the epidemiologist called on to
board the ship and investigate this possible outbreak, your case definition
should include, at a minimum: (Choose one best answer).
A.
B.
C.
D.

Clinical criteria, plus specification of time, place, and person

Clinical features, plus the exposure(s) you most suspect
Suspect cases
The nationally agreed standard case definition for disease
reporting

24. Which variables might you include in characterizing the outbreak described in the question
above by person?
A. Age of passenger
B. Detailed food history (what person ate) while aboard ship
C. Symptoms
10. Using the data in Tables 1.5 describe the death rate patterns for the Unusual Event. For
example, how do death rates vary between men and women overall.

Table 1.5 Deaths and Death Rates for an Unusual Event, by Sex and Socioeconomic Status.
FEMALE

Persons at
risk
Survivors
Deaths
Death rates
(%)

High

Middle

143

MALE
Low

High

Middle

Low

107

212

179

173

499

134

94

80

59

25

58

13

132

120

148

441

6.3

12.1

62.3

67.0

85.5

88.4

11. In Table 2.1, identify what type of variable it is.

Table 2.1
Stage

Tumor size

Lymph Node Involvement

III

Less than 2 cm
Between 2 and 5
cm
More than 5 cm

IV

Not applicable

No
No, or in same side of
breast
Yes, or same side of
breast
Not applicable

I
II

Metastasis
(Spread)
No
No
No
Yes

a. Nominal scale
b. Ordinal scale
12. Between 1971 and 1975, as part of the National Health and Nutrition Examination Survey
(NHANES), 7,381 persons ages 4077 years were enrolled in a follow-up study. At the time
of enrollment, each study participant was classified as having or not having diabetes. During
19821984, enrollees were documented either to have died or were still alive. The results are
summarized as follows.

Diabetic
men
Nondiabeti
c men

Original
Enrollment
(19711975)
189
3,151

Dead at FollowUp
(19821984)
100
811

Diabetic
women
Nondiabeti
c women

218

72

3,823

511

Of the men enrolled in the NHANES follow-up study, 3,151 were nondiabetic and 189 were
diabetic. Calculate the ratio of non-diabetic to diabetic men.
13. Calculate the proportion of men in the NHANES follow-up study who were diabetics.

14. For each of the fractions shown below, indicate whether it is a ratio, a proportion, a rate, or
none of the three.
B. Ratio
C. Proportion
D. Rate
E. None of the above

number of women in State A who died from heart disease in 2004 / number of women in

State A who died in 2004

number of women in State A who died from heart disease in 2004 / estimated number of

women living in State A on July 1, 2004

number of women in State A who died from heart disease in 2004 /number of women in
State A who died from cancer in 2004

15. In 2003, 44,232 new cases of acquired immunodeficiency syndrome (AIDS) were reported in
the United States. The estimated mid-year population of the U.S. in 2003 was approximately
290,809,777. Calculate the incidence rate of AIDS in 2003.

16. In a survey of 1,150 women who gave birth in Maine in 2000, a total of 468 reported taking a
multivitamin at least 4 times a week during the month before becoming pregnant. Calculate
the prevalence of frequent multivitamin use in this group.

17. At a day care center, 10 of 50 children develop acute viral conjunctivitis (pink eye) within
one week. Another 30 children also develop pink eye in the following two weeks. The attack
rate of conjunctivitis at this day-care center is:
a. 20%
b. 40%
c. 60%
d. 80%
e. 90%

1. In 1980-1989 there were 3 diphtheria-associated deaths in the United States and 27 new cases of
diphtheria (CDC, 1989). What was the fatality rate of diphtheria? (Unit: 100)
Fatality rate = ______ per 100
18. Total number of diseases divided by the population per time is called:
a

Prevalence

Incidence

Average incidence

None of the above

19. The city of Cancerville had a population of 10 000 000 (50% women) in 1995. In 1995, there
were 80 000 women with previously diagnosed ovarian cancer in cancerville. 20 000 new
cases of ovarian cancer were diagnosed in 1995. What was the incidence rate of ovarian
cancer in 1995?
a. 2000 per 100 000 population
b. 4000 per 100 000 population
c. 200 per 100 000 population
d. 400 per 100 000 population
e. 1000 per 100 000 population
20. What is the prevalence rate of ovarian cancer in 1995?
a. 2000 per 100 000
b. 4000 per 100 000
c. 200 per 100 000
d. 400 per 100 000
e. 1000 per 100 000

21. Epidemiology, as defined in the lesson, would include which of the following activities?
(CIRCLE ALL THAT APPLY).
A. Describing the demographic characteristics of persons with acute aflatoxin
poisoning in District A.
B. Prescribing an antibiotic to treat a patient with community-acquired methicillinresistant Staphylococcus aureus infection
C. Comparing the family history, amount of exercise, and eating habits of those with
and without newly diagnosed diabetes
D. Recommending that a restaurant be closed after implicating it as the source of a
hepatitis A outbreak
23. Mark the correct answer.
Epidemiology and the information generated by epidemiologic methods have been used in many
ways. Some common uses are described below.
Epidemiologists were able to identify a variety of risk factors during an outbreak of pneumonia
among persons attending the American Legion Convention in Philadelphia in 1976, even though
the Legionnaires bacillus was not identified in the laboratory from lung tissue of a person who
had died from Legionnaires disease until almost 6 months later.
This is an example of:
a)
b)
c)
d)

Assessing the communitys health

Making individual decisions
Completing the clinical picture
Searching for causes

24. When analyzing data by age the categories should be:

A.
the same for all diseases
B.
<1 year, 1 to 4 years, 5 to 9 years, 10 to 14 years, 15 to 19 years, and 20 years for
communicable diseases, but not necessarily for chronic diseases
C. appropriate for each condition and narrow enough to detect any age-related patterns present
in the data.
D.
5-year age groups for all diseases unless the data suggest the need for narrower categories
to find a pattern or aberra.
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. We will calculate the prevalence at the second survey,
and compare the prevalence with the 1-year incidence.

25.