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Teaching EpidemiologyA guide for teachers in epidemiology, public health and clinical medicine$
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Jørn Olsen, Naomi Greene, Rodolfo Saracci, and Dimitrios Trichopoulos

Print publication date: 2015

Print ISBN-13: 9780199685004

Published to Oxford Scholarship Online: June 2015

DOI: 10.1093/acprof:oso/9780199685004.001.0001

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Study of clustering and outbreaks

Study of clustering and outbreaks

(p.463) Chapter 25 Study of clustering and outbreaks
Teaching Epidemiology

Paul Elliott

Anna Hansell

Oxford University Press

This chapter concerns investigation of outbreaks of chronic disease, particularly those potentially related to chronic exposures to environmental pollutants. Key concepts covered are context, definitions, the role of random variability, principles of initial investigation (including statistical tests, adjustment for confounding (e.g. by socioeconomic status), and assessment of potential bias), and consideration of when further investigation of a possible cluster is appropriate. References are given to commonly used protocols for cluster investigation. The chapter has four case studies/worked examples based on real-life scenarios. The first concerns initial identification of a cluster and cluster definition. The second demonstrates calculation of (1) the standardised morbidity ratio and (2) the probability that the number of observed cases is larger than expected. The third concerns denominator and confounder adjustments. The fourth covers a national case-control study that arose as a consequence of initial cluster reports.

Keywords:   outbreak, cluster investigation, chronic disease, statistical tests, environment

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