Monitoring Diabetes and other NCDs in the Americas

1
Counting Whales Counting a Disease
2
Rates are the hallmark for epidemiology for they
form the basis of comparisons between population
groups

• Rose and Barker,1986

3
The Price of Health, like that of liberty, is
Eternal Vigilance
4
An improvement in the treatment of disease, and
any addition to medical science, will tend
ultimately to the diminution of human suffering
but the registration of the causes of death is
calculated to exercise a still more direct
influence upon public health. Diseases are more
easily prevented than cured, and the first step
to their prevention is the discovery of their
exciting causes by numerical facts and measure
the intensity of their influence. William
Farr, 1839
5
Norway, 1856 Leprosy Registry
Exclusively Rural Areas Doctors sent to rural
areas Leper census, 1836 (5), 1845 (8), 1845
(11) Leprosy viewed as inheritable--sexual
isolation, hospitals, prohibiting marriage No
experience in setting up the registration Local
Health officer Royal Decree
6
Problems
Problems with local registration (definition,
deadlines, incomplete) Circular letters Chief
Medical Officer travelling to each area Over
diagnosis initially (acne, scabies) Low
prevalence areas, disease overlooked Undercount,
Undercount, Undercount Isolation Areas where
isolation practiced, most rapid decline in disease
7
Definitions
Prevention

• Reducing the incidence of disease (primary
  prevention)
• Reducing the prevalence of disease (second.
  prevent.)

Control

• Ongoing operations or programs aimed at reducing
  the incidence and/or prevalence of disease

Last, Dictionary of Epidemiology
8
General Motors sold 2,542,455 Automobiles World
Wide
9
99 Billion Sold
10
NCDs

• What is the incidence of Diabetes?
• What is the incidence of CHD?
• What is the incidence of Cancer?

Nobody Knows
11
Surveillance
Health Dept.
12
Surveillance
Continuous analysis, interpretation, and feedback
of systematically collected data, generalized
using methods distinguished by their
practicality, uniformity, and rapidity, rather
than by accuracy or completeness. Last,
Dictionary of Epidemiology
13
(No Transcript)
14
Registry
Academia
15
Registry
the term register is applied to the file of data
concerning all cases of a particular disease or
health -relevant condition in a defined
population such that the cases can be related to
a population base. Last, Dictionary of
Epidemiology
16
Disease Monitoring Systems
17
Allegheny County Type I Diabetes Registry
Criteria for Registration
1. Diagnosed between 1/1/65 and 12/31/99 2. Age
at onset lt20 3. Diagnosis of Diabetes 4. On
Insulin at time of Hospital Discharge 5.
Resident of Allegheny County at Diagnosis
18
Allegheny County Type I Diabetes Registry
Undercount
19
Chronic Disease Epidemiology Incidence Prevalence
Registry
20

WHO DiaMond Project
21
Epidemiologists Cant Count
22
Epidemiologists Counting Disease
23
Prairie Chicken
24
Endangered Species in Africa
25
Biostatistics
26
(No Transcript)
27
(No Transcript)
28
How Many Fish are there in Lake Geneva?
1 2 3 4 5 6 7 8 9
29
Capture
30
Mark
31
(No Transcript)
32
RECAPTURE
33
Capture-Recapture
Sample 2
Sample 1
M
m
n
2
In Common
34
Capture-Recapture Methods

• Long history of use in Demography
• i.e. US Census
• The standard for estimating the abundance or
  shortage of wildlife populations

35
(No Transcript)
36
Lower Extremity Amputation Study
Adolescent Injuries Sports injuries Dog Bites
37
Optimal Lists to identify cases

• Independent
• Reasonable ascertainment
• Inexpensive

38
Pilot Test Pilot Test Pilot Test
Comparison of lists to gold standard CR to
Registry
39
Good monitoring does not necessarily ensure the
making of right decisions, but it reduces the
risk of wrong ones. Languimer, 1963
40
Public Health
41
Cancer Incidence in Middle East
42
Good monitoring does not necessarily ensure the
making of right decisions, but it reduces the
risk of wrong ones. Languimer, 1963
43
Porpoises can teach Epidemiologists how to count
Lecture Available at www.pitt.edu/super1/