4.epidemiology tutorial (realtioonship of epidemiology biostatistics & dph ) sept 25th 2014(edited)

Dr Tin Myo Han

Department of Community Dentistry

Kulliyyah of Dentistry, International Islamic University, Malaysia

Epidemiology Biostatistics Public Health/ Dental Public

Health

25/9/2014

25/9/2014

IIUM

Epidemiology of Dental Caries & Periodontal Disease - Magnitude (prevalence of Dental Caries & PD) - Analysis of Epidemiological Data: *Comparison between clinic’s register and community survey - Applicability of Epidemiological Data analysis

25/9/2014

• Role of Biostatistics in investigation of more Periodontal Cases Findings in Community

• Public Health Activities: -Prevention & Promotion of Oral Health: Action Plan to reduce Periodontal Disease burden

EPIDEMIOLOGY

Bio-stat

• Assignment for Students

DPH

25/9/2014

A public dental Clinic

(KK-Gigi, Kuantan)

In accordance with clinic’s register,

Period : from 1st January 2013 to 31st December 2013

Total dental Patients : 500 patients

-Adult dental caries : 220 cases

-Periodontal diseases : 110 cases

-Pediatric dental caries : 70 cases

-Dentures : 20 cases

- Dental check-up : 30 cases

- Oral surgical cases : 45 cases

- Orthodontics & other : 5 cases

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A Community Oral

Health Survey

- Community dentistry department, KOD, IIUM,

conducted a community survey in Kuantan to

estimate the magnitude of common oral health

problems in 2013

-Total 350 dental caries cases

-250 periodontal cases

-25 newly diagnosed oral ulcer cases and

-15 dental injury cases (old + new)

- were identified from 5000 persons under the study


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• Public Health Activities (Plan): -Prevention & Promotion of Oral Health: Action Plan to reduce burden of Periodontal Disease

EPIDEMIOLOGY

Bio-stat

DPH


25/9/2014

Q 1. How to measure magnitude of Dental Caries & PD (epidemiological measurement)? ( Rate,Ratio, Proportion, Prevalence and Incidence)? Q 2. Which epidemiological measurement will be used to compare these epidemiological data between the public dental clinic and the community survey? Q3. What is your conclusion on the epidemiological data analysis ? Q4. What should you do to get more understanding on the situation ? Why ?

Public Dental Clinic Community Survey

Proportion of dental caries (adult + Child) in 2013 = ( 220 +70)/500 *100 = 58% of patients /year Proportion of PD in 2013 = 110/500 *100 = 22% of patients/year Ratio of Dental Caries

and Periodontal cases = 290:110 = 29:11 ~ 3:1

Prevalence of Dental caries ( 2013)

= 70 cases per 1000 population

Prevalence of PD ( 2013) = 50 cases per 1000 population

25/9/2014

Public Dental Clinic Community Survey

Proportion of dental caries (adult + Child) = ( 220 +70)/500 *100 = 58% of patients Proportion of PD = 110/500 *100= 22% of patients

Prevalence of Dental caries ( 2013)

= 70 cases per 1000 population

Prevalence of PD ( 2013) = 50 cases per 1000

population

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Prevalence Dental Caries = 58% or 580 cases per 1000 patients per year

Prevalence of PD = 220 cases per 1000 patients per year

Ratio of Dental Caries & PD

= 290:110 (or) 58 :22 = 29:11 ~ 3:1

Ratio of Dental Caries & PD

= 350:250 (or) 70:50

= 7:5 =1.4 :1~ 1.5 :1

RATIO

25/9/2014

Q 1. How to measure magnitude of Dental Caries & PD (epidemiological measurement)? ( Proportion, Prevalence and Ratio)? Q 2. Which epidemiological measurement will be used to compare these epidemiological data between the public dental clinic and the community survey ? Q3. What is your conclusion on the epidemiological data analysis ? Q3. What should you do to get more understanding on the situation ? Why ?

25/9/2014

“We have more dental caries cases than PD! (3:1)” ……” Prevalence of dental caries in the clinic higher than that of PD” ! (Clinic attendance rate)

“In our community survey also more dental caries cases than PD! (1.4:1)” …”Prevalence of dental caries is also higher than that of PD in community”…

..” However, PD cases were found more in the community survey than clinics “ ……………

(3:1) vs (1.4:1)

25/9/2014

Q 1. How to measure magnitude of Dental Caries & PD (epidemiological measurement)? ( Proportion, Prevalence and Ratio)? Q 2. Which epidemiological measurement will be used to compare these epidemiological data between the public dental clinic and the community survey ? Q3. What is your conclusion on the epidemiological data analysis ? Q4. What should you do to get more understanding on the situation ? Why ?

25/9/2014

..” However, PD cases were found more in the community survey than clinics “ ……………

(3:1) vs (1.4:1)

..” We want to know why PD cases were found more in the community survey than in the clinic “

“ Which factors are influencing on it?

“Epidemiological question (or) starting point for Epidemiological study “

1. Trend study 2. Community diagnosis 3. Health services evaluation 4. To know the individual risks and chances 5. Syndrome identification 6. Completing the clinical picture 7. Searching for causes / risk factors for

establishing causal relationship (New diseases or existing diseases)

15

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Why PD cases were found more in the community survey than in the clinic“ “ Which factors are influencing on it?

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TIME

PLACE PERSON

Agent

Host Environment

Causation Triads Distribution Triads

MOT

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TIME

PLACE PERSON

Agent

Host Environment

Causation Triad Distribution Triad


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• Public Health Activities (Plan): -Prevention & Promotion of Oral Health: Action Plan to Combat Periodontal Disease

EPIDEMIOLOGY

Bio-stat

DPH


“Role of Biostatistics in Epidemiological Investigation “

25/9/2014

25/9/2014

Community Survey: December 1st -31st,2013

Clinic: Klinik Kasiharan Balok

“Distribution of disease (Distribution Triad)”

Clinic register:1st January to December 31st,2013

Community: Sungi Lembing

Survey: 250 PD cases

/5000 person

Clinic: 110 PD cases/500

Patients

TIME PERSON

PLACE

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“Distribution Triad: TIME

Balok Clinic register: 1st January to December 31st,2013

Distribution: endemic pattern Distribution: epidemic/outbreak pattern

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“Distribution Triad: PLACE

Residence:

Out of 110,

-108 patients

(Balok community)

-2 patients (Beserah)

•* *

* * •* *

* *

*

KK Balok Dental Clinic Community Survey: December 1st -31st,2013

Residence:

Out of 250,

-108 cases

(Sungai Lembing )

-142 patients

(Flood Relief Center

Sungai Lembing)

•* *

* *

•* *

* *

•* *

* *

Epidemiological Mapping

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“Distribution of disease (Distribution Triad)”

TIME

3rd to 7th December 2013

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“Distribution Triad: PERSON (Age,Gender,Race,Edu & Occupation)

Age Groups

Periodontal Cases

Significant test & “p” Value

Community Survey Sungai Lembing

(n=250) n(%)

Public Dental Clinic (Balok) (n=110)

n(%)

< 20 years 10 (4) 6 (6)

X2 test “p” >0.05

21-40 years 63(25) 28 (25)

41-60 years 127(51) 61 (55)

>60 years 50(20) 15(14)

Total 250 110

Summary descriptive statistics

Minimum = 18 Maximum = 67 Mean(±SD )= 43(± 5.1)

Minimum =17 Maximum = 65 Mean(±SD )= 44(± 4.9)

“ t” Test “p” >0.05

Based on distribution triad analysis,

- unexpected increase in number of PD cases was found 2 weeks after Flood (time) - 56.8%(146/250) of them were from Flood relief

centers (place) - 51% ( 127/250) were 41-60 years old ( Person) - Thus, more PD cases in Community survey may be more occurrence of PD among Persons from flood relief centers

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Hypothesis of Distribution

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AGENT

ENVIRONMENT

HOST

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AGENT

Ref: Basic Epidemiology assignment answered by dental students (2014-2015)

29

?P

D K

no

wle

dg

e

Diet/Sweet

?S

tres

s

AGENT

Most likely causes of PD in Community Survey in Kuantan 2013

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Risk factors

Periodontal Cases Significant

test & “p” Value

Community Survey Sungai Lembing

(n=250) n(%)

Public Dental Clinic (Balok) (n=110)

n(%)

Yes No Yes No

X2 test “p”

Poor Oral Hygiene 67% 33% 42% 58%

Stress (+) 70% 30% 30% 70%

DM (+) 47% 53% 27% 73%

-Significant Association between “(Poor oral hygiene & PD)”

(Stress & PD ) were found in community survey

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HOST

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HOST

More severe PD cases were seen among:

- more than 41 years old (60%),

- female (67%) and

- DM patients ( 76%)

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ENVIRONMENT

Macro environment : -weather (flood) -Social status ( flood relief centre) - OH materials and supply -Other factors

Micro environment : -Oral flora changes because of Oral hygiene practices , Stress, Underlying Medical disease (DM)

Based on causal triad analysis, Causes of more PD cases

were :

- Poor OH practices , Stress, and underlying medical

disease (DM) (Agent)

- Severe PD were above 41 years old, female, DM (Host)

- flood in Kuantan and changing oral flora (environment)

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Causal Hypothesis

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EPIDEMIOLOGY

Descriptive Hypothesis

Descriptive

Statistics

Age , sex,

occupation,

( Minimal ,

Maximum age,

Frequency ( %)

Causal Hypothesis

Inferential

Statistics

Significant Association

b/t age, sex , risk factors & occurrence of disease

( X2, ANOVA)


25/9/2014


• Public Health Activities (Plan): -Prevention & Promotion of Oral Health: Action Plan to reduce burden of Periodontal Disease

EPIDEMIOLOGY

Bio-stat

DPH


Prevention & Promotion of Oral Health: Action Plan to reduce burden of

Periodontal

25/9/2014

Primary prevention : -Screening PD among community & risk populations

(self-reported questionnaires & professional screening (BPE)

Secondary prevention : - Early diagnosis and prompt treatment to reduce loss

of teeth ( avoidable ) Tertiary prevention (Rehabilitation) : Quality of life of PD patients!

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Oral health care in unusual situation ( eg. flood) :

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More

PD cases in Community survey

Public Dental Clinic vs Community

Survey

(Case findings of caries and PD)

( 270 vs 350 in dental caries) &

(110 vs 250 in PD)

Dental Caries vs Periodontal Disease

( 3:1 in Public Clinics & 1.4 :1 in Community survey

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In the scenario, Ratio of Dental Caries &

PD, Dental caries ceases are higher than PD in both private dental clinics data and community survey.

Q-1 : Give reasons for attending less PD at

public dental clinics and finding less PD in community survey comparing with dental caries?

Dental Caries vs Periodontal Disease?

Answers 1:

Nature of diseases (Overt caries vs hidden PD

cases)

Knowledge of patients on PD

Awareness of patients on PD & Dental services

Oral health seeking behavior ( peer )

Other unknown factors (!!! Research)

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In the scenario, more Dental caries and PD cases were found in community survey than public dental clinic

Q-2 : Give reasons for finding more Dental

caries and PD cases in community survey?

Community survey data vs Public dental clinic data?

Answers 2:

Active case finding (community survey) vs passive case

finding ( public dental clinic)

Iceberg phenomenon

Socio-economic and cultural factors

( communication, financial support, value and norm on

oral health)

Knowledge of patients on OH care & services

Other factors (unknown )!! Research

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25/9/2014 47

“ Oral Health Manpower & Trends of common oral health problems in

“MALAYSIA ” comparing with Japan, & Singapore )

4th Year Dental Students ( 2014-2015)

Healthcare

4.epidemiology tutorial (realtioonship of epidemiology biostatistics & dph ) sept 25th 2014(edited)