Required reading is from: Clinical Epidemiology – The Essentials, by Grant S. Fletcher (6e)
Risk: Exposure to Disease, Ch. 6 (p92-110)
Studies of Risk
When experiments are not possible or ethical
Cohorts
Cohort studies
Prospective and historical cohort studies
Prospective cohort studies
Historical cohort studies using medical databases
Case-cohort studies
Advantages and disadvantages of cohort studies
Ways to express and compare risk
Absolute risk
Attributable risk
Relative risk
Interpreting attributable and relative risk
Population risk
Taking other variables into account
Extraneous variables
Simple descriptions of risk
Confounding
Working definition
Potential confounders
Confirming confounding
Control of Confounding
Randomization
Restriction
Matching
Stratification
Standardization
Multivariable adjustment
Overall strategy for control of confounding
Observational studies and cause
Effect modification
Mendelian randomization
Risk: From Disease to Exposure, Ch. 7 (p111-125)
Case-control studies
Design of case-control studies
The source population
Selecting cases
Selecting controls
The population approach
The cohort approach
Hospital and community controls
Multiple control groups
Multiple controls per case
Matching
Measuring exposure
Multiple exposures
The odds ratio: an estimate of relative risk
Odds ratio calculation
Odds ratio as an indirect estimate of relative risk
Odds ratio as a direct estimate of relative risk
Controlling for extraneous variables
Investigation of a disease outbreak
Societal factors that influence health: A framework for hospitals
Designed to guide hospital strategies to identify patient social needs, the social drivers of health in their communities and the systemic causes that lead to health inequities so all stakeholders can take action around these critical issues (AHA).
American Hospital Association (AHA) framework
Who: Individuals who present for health care services.
Setting: Patient encounter at a point of care.
Examples:
- Lack of stable housing.
- Homelessness.
- Limited access to healthy food.
- Insufficient transportation options.
- Loneliness.
- Human trafficking.
- An unsafe home environment.
Strategies: Patient-level interventions can mitigate non-medical social and economic challenges.
Hospitals can:
- Screen and document social needs.
- Gather race, ethnicity, and language data.
- Utilize relevant ICD-10-CM Z codes.
- Create interdisciplinary care teams that include social workers, case managers, and community health workers.
- Establish hospital-based food pharmacies.
- Connect to temporary supportive housing.
- Partner with ride shares to provide transportation to medical appointments.
- Provide referrals to social service organizations.
- Provide assistance in signing up for medical and social benefits.
Who: The community served by the hospital.
Setting: In the community—where people live, learn, work, play, and pray.
Examples:
- Food deserts.
- Lack of affordable housing.
- Community violence.
- Inadequate public transportation.
Strategies: Hospitals can lead, convene, collaborate, invest in or support activities that improve the community environment with multi-sector stakeholders.
Hospitals can:
- Support local food banks and meal delivery services.
- Partner with economic development organizations and contribute to the local investment environment.
- Build grocery stores in food deserts.
- Invest in affordable housing.
- Foster employment and career advancement opportunities.
- Advocate for the public transportation ecosystem.
Who: Anchor organizations, such as hospitals and health systems, community leaders, legislators or policymakers.
Setting: Community, state or national.
Examples: Systemic inequities such as:
- Racism.
- Sexism.
- Generational poverty.
- Redlining by financial institutions.
- Environmental injustice.
- Educational systems.
Strategies: In partnership with other stakeholders, hospitals can support and affect policy, system, environmental and cultural changes to achieve widespread impact on societal issues.
Hospitals can:
- Incentivize investments in poor communities.
- Develop health career partnerships with local school districts.
- Advocate for the removal of barriers to cross-sector and inter-agency coordination.
- Invest in early childhood education.
AHA