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Assignment Prompt & Instructions

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**Case Study: “The Greenwood Asthma Spike—Understanding Measures of Disease and Epidemiologic Methods”**

**Aligned to Chapters 6 & 7**

**Scenario**

The community of **Greenwood County** (population 142,000) has seen a reported rise in asthma-related emergency department (ED) visits over the last 18 months. Two healthcare systems— **St. Helena Medical Center** and **Greenwood Regional Hospital**—serve the area and have contributed encounter data to the county public health department.

You are part of a joint analytic team assigned to determine whether the apparent increase represents:

– A true rise in asthma incidence
– A reporting artifact
– A change in healthcare-seeking behavior
– A result of environmental shifts
– Or a combination of these factors

**Available Data**

**Past Year:**

– 2,842 asthma-related ED visits
– Of these visits, **1,118 are repeat visits** within the same year
– **County population:** 142,000
– **Estimated number of individuals with physician-diagnosed asthma:** 15,400
– **Number of newly diagnosed asthma cases recorded this year:** 410

**Environmental data:**

– Air quality index (AQI) exceeded 100 on 37 days (previous year: 14 days)
– Two schools report increased mold concerns following water damage
– New industrial activity began in the east corridor 20 months ago

**Healthcare data:**

– Improved EHR documentation implemented at both hospitals
– Two urgent care centers closed, shifting non-urgent cases to EDs
– School nurse reports indicate rising inhaler use among middle school students

**Student Tasks (4–5 pages)**

**1. Calculate Key Measures of Disease (Ch. 6)**

Using the provided data:

– Calculate **incidence** of asthma in Greenwood County.
– Calculate **prevalence** of asthma.
– Explain the difference in interpretation of incidence vs. prevalence in this scenario.
– Determine whether ED visit counts reflect disease burden accurately.

**2. Evaluate Potential Biases and Errors (Ch. 7)**

Discuss how the following may influence observed trends:

– Improved EHR documentation
– Closure of urgent care centers
– Repeat visits inflating counts
– Potential misclassification

Explain how each could bias either incidence or prevalence.

**3. Interpret Environmental and Demographic Clues**

Analyze whether environmental patterns (AQI, mold exposure, industrial activity) could represent:

– A true increase in incidence
– A non-causal correlation
– A confounder
– An effect modifier

**4. Develop an Analytic Epidemiology Plan**

Propose a study design (cohort, case-control, cross-sectional) to test the hypothesis that air quality changes are contributing to the increase in asthma cases.

Explain:

– Why you chose that study design
– What data you would collect
– How you would measure exposure
– How you would reduce confounding

**5. Identify the Next Steps for Public Health Action**

Recommend three immediate actions the county health department should take based on your findings and interpretation.