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UKURAN DAMPAK DALAM EPIDEMIOLOGI Nurul Wandasari Singgih Prodi Kesehatan Masyarakat Univ Esa Unggul 2012/2013.

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Presentasi berjudul: "UKURAN DAMPAK DALAM EPIDEMIOLOGI Nurul Wandasari Singgih Prodi Kesehatan Masyarakat Univ Esa Unggul 2012/2013."— Transcript presentasi:

1 UKURAN DAMPAK DALAM EPIDEMIOLOGI Nurul Wandasari Singgih Prodi Kesehatan Masyarakat Univ Esa Unggul 2012/2013

2 Measures of Public Health Impact Attributable Risk (AR)Number Attributable Risk Percent (AR%)Percentage Population Attributable Risk (PAR)Number Population Attributable Risk Percent (PAR%)Percentage

3 Measures of Public Health Impact IMPORTANT! They all assume (require) that a cause-effect relationship exists between the exposure and the outcome.

4 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).

5 Relative Risk vs. Attributable Risk Relative Risk: Etiology Attributable Risk: Policy decisions Funding decisions (e.g. prevention programs)

6 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)

7 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)

8 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.

9 Attributable Risk (AR) AR = I exposed – I nonexposed = “Risk Difference” Smoke YesNo Yes No Develop CHD I SM = 84 / 3000 = = 28.0 / 1000 I NS = 87 / 5000 = = 17.4 / 1000 (background risk) AR = (28.0 – 17.4) / 1000 = 10.6 / 1000

10 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.

11 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 Kumulatif

12 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]

13 Ukuran-ukuran dampak Ukuran perbedaan efek – Perbedaan prevalens (PD = Prevalence Differrence) PD = [Prevalens dalam kelompok terpajan] - [Prevalens dalam kelompok tidak terpajan]

14 Attributable Risk I exposed - I unexposed

15 Ukuran-ukuran dampak/efek Ukuran perbedaan efek – Attributable Risk (AR) Percent = AR%

16 Attributable Risk Percent (AR%) AR% = (I exposed – I nonexposed ) / I exposed = “Etiologic fraction” Smoke YesNo Yes No Develop CHD AR% = (28.0 – 17.4) / 28.0=37.9% I SM = 84 / 3000 = = 28.0 / 1000 I NS = 87 / 5000 = = 17.4 / 1000 (background risk)

17 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.

18 Attributable Risk Percent I exposed – I unexposed RR = x 100% I exposed RR

19 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 PAR

20 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%

21 Population Attributable Risk Percent PAR% = (I total – I nonexposed ) / I total Weight YesNo Obese Slim Diabetes PAR% = (110 – 45.5) / 110=58.6% I T = 1100 / = 0.11 = 110 / 1000 I NE = 250 / 5500 = = 45.5 / 1000 (background risk)

22 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.

23 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 exposure

24 PF: Vaccine efficacy

25 Ringkasan ukuran Tipe Kuantitas Matematis Tanpa denominator Enumerasi Hitung, angka mutlak Dengan denominator RasioProporsiRate

26 Ringkasan ukuran Tipe Kuantitas Matematis EnumerasiRasio RR OR IDR Proporsi % AR% PAR% Rate Crude Spesific Adjusted

27 Ringkasan ukuran Ukuran dalam epidemiologi Ukuran Frekuensi Penyakit Ukuran asosiasi Ukuran efek /dampak

28 Ukuran frekuensi penyakit Ukuran frekuensi Penyakit Insidens Kumulatif Incidence Density Prevalens titik Prevalens periode Mortalitas

29 Ukuran frekuensi penyakit Ukuran Rasio Risk Ratio Odds Rasio Insidence Density Ratio Prevalence Ratio

30 Ukuran frekuensi penyakit Ukuran Efek /dampak Perbedaan efek RD AR ER PAR Fraksi Efek AR%PAR%PF RD = Risk Difference AR = Attributable Risk ER = Excess Risk PAR = Population Attributable Risk PF = Prevented Fraction


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