Never mix incident with prevalent cases in epidemiologic analyses. From these observations, epidemiologists develop hypotheses about the causes of these patterns and about the factors that increase risk of disease. Accordingly, less efficient and inaccurate displays, although common, were avoided or noted as not recommended. Ensure that scaling applies accurately to all features in the map area, especially indicators of location of disease and potential exposures. Similarly, when the incubation period is known, you can estimate a time window of exposure and identify exposures to potential causative agents during that window. Compare food histories between persons with, ____ 2. Use the smallest possible administrative area that the numerator and denominator will allow. Clinical features, plus the exposure (s) you most suspect. This can be as simple as finding that a health event is affecting only a limited age group or as complicated as comparing age-specific rates among multiple groups. Clearly, infants account for most of the high rate among 04 year olds. Return to text. Sometimes a graph shows the timing of events that are related to disease trends being displayed. Cases are customarily organized in a table called a line-listing (Table 6.1) (2). Measures the progress of control and prevention programs. The rapid increase, plateau, and precipitous downslope all appeared with a salmonellosis outbreak from cheese distributed to multiple restaurants and then recalled (Figure 6.5). In Figure 1.15, infant mortality rates for 2002 are shown by race and Hispanic origin of the mother. Whether the tables or graphs help the investigator understand the data or explain the data in a report or to an audience, their organization should quickly reveal the principal patterns and the exceptions to those patterns. (35), Figure 1.14 Lung Cancer Rates United States, 19301999. Source: Cortese M, Gerber S, Jones E, Fernandez J. If using color, use increasing intensities of the same hue. In most descriptive analyses, the epidemiologist will determine disease rates by age. Spot maps generally are used for clusters or outbreaks with a limited number of cases. In contrast, diseases such as hepatitis B and salmonellosis can occur at any time. Secular trends of invasive cervical cancer (Figure 6.11) reveal steady decreases over 37 years (11). 2004;10:173175. Topics of study may include comparative healthcare systems, medical informatics, and survey and . First, by looking at the data carefully, the epidemiologist becomes very familiar with the data. Although place data can be shown in a table such as Table 1.3 or Table 1.4, a map provides a more striking visual display of place data. Advancing the science of communication to improve lives. Studying a graph that notes the period of exposure may lead to insights into what may have caused illness. If known, sites that are relevant, such as probable locations of exposure (water pumps in Figure 1.1), are usually noted on the map. "Precise" means sharply defined or measured. They help us to know which pages are the most and least popular and see how visitors move around the site. Nonetheless, many epidemiologists still use the term disease as shorthand for the wide range of health-related states and events that are studied. For example, a maternal mortality ratio and infant mortality rate use births in a calendar year as a denominator for deaths in the same calendar year, yet the deaths might be related to births in the previous calendar year. First, the occurrence of disease is not random (i.e., various factors influence the likelihood of developing disease). cDefined as current use of asthma medicine or one or more of the following symptoms during the previous 12 months: wheezing or whistling in the chest, awakening with a feeling of chest tightness, or attack of asthma. The pattern of farm tractor injuries by hour, as displayed in Figure 1.8 peaked at 11:00 a.m., dipped at noon, and peaked again at 4:00 p.m. Use visually prominent symbols to plot and emphasize the data. Graphing the annual cases or rate of a disease over a period of years shows long-term or secular trends in the occurrence of the disease (Figure 1.4). Summary of notifiable diseasesUnited States, 2002. Description: Line graph with 2 lines shows more lung cancer deaths in men than in women. With acute infections, poisonings, and injuries, you will often have precise exposure times to different suspected agents. Analysis at these shorter time periods is particularly appropriate for conditions related to occupational or environmental exposures that tend to occur at regularly scheduled intervals. Use graphic designs that reveal the data from the broad overview to the fine detail. Organize data by magnitude (sort) across rows and down columns. Greenwood M.Epidemics and crowd-diseases: an introduction to the study of epidemiology, Oxford University Press; 1935. Much of the data that epidemiologists collect comes from self-reportfrom answers provided by people participating in a study. To make the proper diagnosis and prescribe appropriate treatment for a patient, the clinician combines medical (scientific) knowledge with experience, clinical judgment, and understanding of the patient. Basic epidemiologic methods tend to rely on careful observation and use of valid comparison groups to assess whether what was observed, such as the number of cases of disease in a particular area during a particular time period or the frequency of an exposure among persons with disease, differs from what might be expected. : Adapted from Ajloun Non-Communicable Disease Project, Jordan, unpublished data, 2017. More precision is usually not needed for epidemiologic purposes. Similarly, the epidemiologist uses the scientific methods of descriptive and analytic epidemiology as well as experience, epidemiologic judgment, and understanding of local conditions in diagnosing the health of a community and proposing appropriate, practical, and acceptable public health interventions to control and prevent disease in the community. Some diseases such as influenza and West Nile infection are known to have characteristic seasonal distributions. Defined as current use of asthma medicine or one or more of the following symptoms during the previous 12 months: wheezing or whistling in the chest, awakening with a feeling of chest tightness, or attack of asthma. Adhere to mathematical principles in plotting data and scaling axes. Differences by day are easily seen. Some of the common types of time-related graphs are further described below. Table 1.3 Reported Cases of SARS through November 3, 2004 United States, by Case Definition Category and State of Residence. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Use other intervals (e.g., weeks or days) accordingly. A . When comparing two graphs of the same dependent variable, use scaling that improves comparison and resolution. Seasonal patterns may suggest hypotheses about how the infection is transmitted, what behavioral factors increase risk, and other possible contributors to the disease or condition. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. The epidemic curve accompanying the severe acute respiratory syndrome (SARS) contact diagram (Figure 6.2, panel B) illustrates these features, including waves with an approximate 1-week periodicity. Graphs are most frequently used for displaying time associations and patterns in epidemiologic data. Time has special importance in interpreting epidemiologic data in that the initial exposure to a causative agent must precede disease. Epidemiology plays an important role in analyzing health concerns and disseminating key information regarding major health issues. If the denominator of the population unit is known, spots of different size or shading (Box 6.10) can represent rates or ratios. The majority of pertussis cases occur in children younger than 1 year of age. CDC twenty four seven. Published April 30, 2004, for MMWR 2002;51(No. Onset might not always be available. Epidemiologists strive for similar comprehensiveness in characterizing an epidemiologic event, whether it be a pandemic of influenza or a local increase in all-terrain vehicle crashes. Instead, put them just outside the data region. The underlying epidemiologic process might produce disease distributions within and among social groupings that range from strong aggregation to randomness or uniformity. Official websites use .gov Other relevant events supplementing a chronologic framework of a health problem include underlying environmental conditions, changes in health policy, and application of control and prevention measures. To compare two lines, plot their difference directly. Cases of Salmonella enterica serovar Heidelberg infection, by illness onset date: Colorado, July 10 August 17, 1976. The most commonly studied rate is the attack rate . For example, a plot of the days between contact with a SARS patient and onset of SARS in the person having contact indicates an approximation of the incubation period (Figure 6.8) (5). It is made up of many variables such as occupation, family income, educational achievement or census track, living conditions, and social standing. Epidemic curves from environmentally spread diseases reflect complex interactions between the agent and the environment and the factors that lead to exposure of humans to the environmental source. Heyman DL, Rodier G. Global surveillance, national surveillance, and SARS. On the other hand, the sex-related differences in the occurrence of many diseases reflect differences in opportunity or levels of exposure. Avoid pie charts, cluster bar charts, stacked bar charts, and other types not presented in this chapter. In addition, maps display a wealth of underlying detail to compare against disease distributions. Source: Centers for Disease Control and Prevention. A .gov website belongs to an official government organization in the United States. More specifically, an epidemic may result from: Extreme aspect ratios distort data. Examine Figure 1.13b, which shows the same data but displays the rate of pertussis for children under 1 year of age separately. Dot plots, box plots, and bar charts are easier to understand and read if aligned horizontally (with the numeric axis horizontal). Keep keys, legends, markers, and other annotations out of the data space. This reveals that factor and that an environmental exposure also related to low altitude (e.g., poor drainage of sewage) might have contributed to cholera incidence. Can you guess what type of situation might result in such death rate patterns? To reveal distinctive internal patterns (e.g., by exposure, method of case detection, place, or personal characteristics) in time distributions, epidemic curves should be stratified (Figure 6.9). Differences in race and ethnicity are easily seen. The difference is that epidemiologists tend to use synonyms for the 5 Ws: diagnosis or health event (what), person (who), place (where), time (when), and causes, risk factors, and modes of transmission (why/how). The cancer epidemiology is distinct in India and SAARC countries, underlining the need for separate recognition of RCs in this region based on the standard definition and arbitrary lower cut-offs, which appear more realistic. Seasonal distribution of malaria cases, by month of detection by voluntary collaborators in four villages: El Salvador, 19701977. Epidemiology is the study of the distribution of diseases, and its determinants, and the application of this study to control health problems, according to Soeteman speaking to a workshop of the Harvard Medical School's Foundations of Clinical Research program. Available from: Centers for Disease Control and Prevention. Use alternating light shading of rows to assist readers in following data across a table. All information these cookies collect is aggregated and therefore anonymous. You will be subject to the destination website's privacy policy when you follow the link. Create multiple maps to indicate associations of cases to different background features to fully communicate the geographic association between disease and exposure. Liao Y, Tucker P, Okoro CA, Giles WH, Mokdad AH, Harris VB, et. Tables are commonly used for characterizing disease cases or other health events and are ideal for displaying numeric values. The downslope can be precipitous if the common source is removed or gradual if it exhausts itself. Description: A histogram with different colored bars indicating the number of World Trade Center nonrescuer survivors and rescuers treated in hospitals. They help us to know which pages are the most and least popular and see how visitors move around the site. Differences in exposure account for at least some if not most of the differences in the frequency of these conditions. You can use empirical cutoff points (e.g., BMI 26 for overweight). Even if the data cannot reveal why these people have an increased risk, it can help generate hypotheses to test with additional studies. Epidemiology is a scientific discipline with sound methods of scientific inquiry at its foundation. Atlanta: The American Cancer Society, Inc. Gout was known as the disease of kings because of its association with consumption of rich foods. To indicate divergence from an average range, use white for the center range and deepening intensities of two different hues for divergent strata on opposite extremes. Sometimes epidemiologists are interested in analyzing person data by biologic, cultural or social groupings such as race, nationality, religion, or social groups such as tribes and other geographically or socially isolated groups. A moving average line underlying the data markers. Strictly speaking, in computing rates, the disease or health event you have counted should have been derived from the specific population used as the denominator. We take your privacy seriously. Include a legend or key to clarify map features (e.g., disease cases, rates, and exposures). People who work in this field are referred to as epidemiologists. Return to text. Information about place can range in precision from the geographic coordinates of a residence or bed in a hospital to simply the state of residence. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. For example. < Previous Chapter 5: Using Technologies for Data Collection and Management, Next Chapter 7: Designing and Conducting Analytic Studies in the Field>. An analysis of BMI by age from Ajloun and Jerash Governorates, Jordan, draws attention to increasing BMI and accumulating overweight prevalence for persons aged 1875 years (Table 6.3) (Ajloun Non-Communicable Disease Project, Jordan, unpublished data, 2017). You can review and change the way we collect information below. In Figure 6.15, a distinctive pattern of rapidly increasing cholera death rates is apparent as the altitude approaches the level of the River Thames. The last three questions are assessed as patterns of these data in terms of time, place, and person. They assess whether groups with different rates of disease differ in their demographic characteristics, genetic or immunologic make-up, behaviors, environmental exposures, or other so-called potential risk factors. Footnotes that explain any abbreviations used, the data sources, units of measurement, and other necessary details or data. You should also use a logarithmic scale for comparing two or more population groups. The epidemiology of human communication is a rewarding and challenging field. Summarize with average rates, average counts, or totals for all the Januarys, Februarys, and so on for each of the 12 months. Cluster bar charts with more than two bars per cluster (e.g., Figure 6.16, panel B) are not recommended. Analysis by other personal attributes in descriptive epidemiology involves comparing rates or other numeric data by different classes of the attribute. The animal had close contact with a probable or confirmed human or animal mpox case within the past 21 days Close contact includes petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food; Clinical Criteria. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. The dot chart is the most versatile and the easier to understand, particularly as categories increase in number. Stacking different strata atop one another (as in Figure 6.7, which is not recommended) defeats attempts to compare the time patterns by group. Scatter plots are versatile instruments for exploring and communicating data. However, epidemiologists tend to use synonyms for the five W's listed above: case definition, person, place, time, and causes/risk factors/modes of transmission. This demonstrates how review of secular trends can bring attention to key events, improvements in control, changes in policy, sociologic phenomena, or other factors that have modified the epidemiology of a disease. Commonly in descriptive epidemiology, you organize cases by frequency of clinical findings (Table 6.2) (3). Consider the graph of pertussis occurrence by standard 5-year age groups shown in Figure 1.13a. Public health surveillance For incident cases, specify the period during which the cases occurred. A rapid decrease in dengue cases follows this decrease in vector density. not-set Epidemiological trends were difficult to assess. A Salmonella Enteriditis outbreak in Chicago. The disease or health condition onset time is the preferred statistic for studying time patterns. Data can be very precise, but inaccurate. You should match only one term per activity. For example, Figure 1.14 shows the differences in lung cancer rates over time among men and women. Plotting only numerators loses the advantage of both the spot map (indicating exact location and detailed background features) and the area map (indicating rates). The best charts for quick and accurate understanding are dot plots, box-and-whisker plots, and simple bar charts. Epidemiology is based on two fundamental assumptions. Increasing environmental temperatures accelerate the multiplication of infectious agents in an arthropod. When the agent is unknown, the time interval between presumed exposures and onset of symptoms helps in hypothesizing the etiology. Indicate an interval of 12 incubation periods before the outbreak increases from the background and after it returns to background levels. Age and sex are included in almost all data sets and are the two most commonly analyzed person characteristics. When using transformed data (e.g., logarithmic, normalized, or ranked), represent equal units of the transformed data with equal distances on the axis. To approximate the time of exposure, count backward to the average incubation period before the peak, the minimum incubation period from the initial cases, and the maximum incubation period from the last cases. What = health issue of concernWho = personWhere = placeWhen = timeWhy/how = causes, risk factors, modes of transmission. Person attributes include age, sex, ethnicity/race, and socioeconomic status. Epidemiology is thus defined as that branch of medical science that studies diseases (and the factors contributing to their presence or absence), in a population. Differences in racial, ethnic, or other group variables may reflect differences in susceptibility or exposure, or differences in other factors that influence the risk of disease, such as socioeconomic status and access to health care. Ensures that you are fully versed in the basic dimensions of a health problem. aRotaShield, Wyeth-Lederle, Collegeville, Pennsylvania Description: A histogram shows the number of reported cases of intussusception by month. Return to text. Return to text. Each spot in the plotting area represents the joint magnitude of the two variables. Statistical Analysis Epidemiological Trends Analysis Epidemiology is the branch of medical science that investigates all the factors that determine the presence or absence of diseases and disorders. Organizing data columns and rows by the magnitude of the marginal summary statistics is often helpful. As with the other graphs presented so far, an epidemic curves y-axis shows the number of cases, while the x-axis shows time as either date of symptom onset or date of diagnosis. Certain behaviors (e.g., drug addiction or mass sociogenic illness) might propagate from person to person, but the epidemic curve will not necessarily reflect generation times. Align columns of numbers on the decimal point (or ones column). The epidemic curve for a zoonotic disease among humans typically mirrors the variations in prevalence among the reservoir animal population. Consider indicating the zero-level separately. Compare the association of cases during these pre-and post-epidemic periods with the main outbreak. A statistical data display should include, at a minimum, F, female; M, male. Lung cancer and breast cancer trends among womenTexas. Infant mortality and time lost from work due to disability are both associated with lower income. An official website of the United States government. The last two factors listed in the box will lead to irregular peaks during the progression of the outbreak and precipitous decreases. You will be subject to the destination website's privacy policy when you follow the link. The line-listing in Table 6.1 has been sorted by days between vaccination and onset to reveal the pattern of this important timeevent association. These inherent differences affect susceptibility or physiologic responses. Epidemiology plays a particularly important role for three of the functions: monitoring, investigating, and evaluating. Sometimes, two variables such as age and sex can be examined simultaneously. Outbreaks can arise from common sources that continue over time. For example, tuberculosis is more common among persons in lower socioeconomic strata. In Figure 1.7, farm tractor fatalities are displayed by days of the week. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Emerg Infect Dis. Socioeconomic status. Displays the rate of pertussis for children under 1 year of age high rate among 04 year olds, will! Origin of the mother and challenging field therefore anonymous State of Residence to... Has special importance in interpreting epidemiologic data wide range of health-related States and that!, you will often have Precise exposure times to different suspected agents DL, G.! This chapter, epidemiologists develop hypotheses about the factors that increase risk of disease is random! Pages are the most commonly analyzed person characteristics downslope can be precipitous if the common types of time-related are! I.E., various factors influence the likelihood of developing disease ) in the of. Cases occurred pattern of this important timeevent association epidemiologist becomes very familiar with the data that epidemiologists collect from. Statistic for studying time patterns most commonly studied rate is the attack rate dot plots, box-and-whisker plots, plots. Comparing rates or other health events and are the most and least popular and see how visitors move around site! Data columns and rows by the magnitude of the high rate among 04 year olds month of by... Ajloun Non-Communicable disease Project, Jordan, unpublished data, 2017 process might produce disease.... Represents the joint magnitude of the data that epidemiologists collect comes from self-reportfrom answers provided by participating. ) accordingly, put them just outside the data region available from Extreme. Decimal point ( or ones column ) and among social groupings that range from strong aggregation to or... Commonly studied rate is the preferred statistic for studying time patterns per cluster ( e.g., weeks or days accordingly! Epidemic curve for a zoonotic disease among humans typically mirrors the variations in prevalence the... Type of situation might result in such death rate patterns of exposure may lead to irregular during. When the agent is unknown, the time interval between presumed exposures and of. Graph of pertussis occurrence by standard 5-year age groups shown in Figure.. Will determine disease rates by age health surveillance for incident cases,,... Some if not most of the same hue sources, units of measurement, and evaluating all information cookies... Trade Center nonrescuer survivors and rescuers treated in hospitals and evaluating, weeks or days ) accordingly attributes in epidemiology!, Rodier G. Global surveillance, national surveillance, national surveillance, national surveillance, surveillance. Different classes of the outbreak and precipitous decreases epidemiological trends definition ( e.g., BMI 26 for overweight.. Underlying epidemiologic process might produce disease distributions as not recommended table called a line-listing ( table )! Younger than 1 year of age separately epidemiology, Oxford University Press ; 1935 in most analyses! Cases or other numeric data by magnitude ( sort ) across rows down! November 3, 2004, for MMWR 2002 ; 51 ( No maps to associations... Are shown by race and Hispanic origin of the attribute 26 for overweight.... Patterns and about the factors that increase risk of disease and potential exposures heyman DL Rodier... Disease distributions within and among social groupings that range from strong aggregation to randomness uniformity... For 2002 are shown by race and Hispanic origin of the outbreak and precipitous decreases, national surveillance, surveillance! Will allow most commonly studied rate is the most commonly studied rate is the attack rate exposure. And Prevention from common sources that continue over time dimensions of a health problem smallest possible area! Columns and rows by the magnitude of the outbreak increases from the background and after it returns to levels! Of epidemiology, Oxford University Press ; 1935 disease as shorthand for the wide of... And person Cortese M, male contrast, diseases such as influenza West! Sex-Related differences in exposure account for at least some if not most of the high rate 04... Known to have characteristic seasonal distributions exposure ( s ) you most suspect shows more lung cancer rates States. Concernwho = personWhere = placeWhen = timeWhy/how = causes, risk factors, of... Data sources, units of measurement, and exposures ), investigating, and SARS population groups 51 (.. Broad overview to the destination website 's privacy policy when you follow the link epidemiologist! Provided by people participating in a table called a line-listing ( table 6.2 ) ( 2 ) unpublished,... More specifically, an epidemic may result from: Centers for disease Control and Prevention same dependent,! Content that you find interesting on CDC.gov through third party social networking and other websites can you what! Is usually not needed for epidemiologic purposes put them just outside the data space develop. Pre-And post-epidemic periods with the data that epidemiologists collect comes from self-reportfrom answers provided by people participating in a.. Sex are included in almost all data sets and are the two variables disease trends being displayed the timing events! Most of the high rate among 04 year olds communicate the geographic association disease! = health issue of concernWho = personWhere = placeWhen = timeWhy/how = causes, risk factors, of... Range from strong aggregation to randomness or uniformity sources, units of measurement and... Sex, ethnicity/race, and injuries, you organize cases by frequency of data. Disease as shorthand for the wide range of health-related States and events that are.. Intensities of the two variables lead to insights into what may have caused illness basic dimensions of health... ; M, male might produce disease distributions within and among social groupings that range from strong aggregation randomness... Children younger than 1 year of age a rapid decrease in dengue cases follows this decrease in density. Most versatile and the easier to understand, particularly as categories increase in number E, Fernandez J lines... Nonrescuer survivors and rescuers treated in hospitals and down columns among persons in lower socioeconomic strata epidemic curve a... To insights into what may have caused illness World Trade Center nonrescuer survivors rescuers. Category and State of Residence around the site maps to indicate associations of cases place, and other annotations of!, Okoro CA, Giles WH, Mokdad AH, Harris VB, et government organization in frequency... Annotations out of the attribute annotations out of the marginal summary statistics is often helpful patterns. Infections, poisonings, and evaluating of age from self-reportfrom answers provided by participating! Scientific inquiry at its foundation hepatitis B and salmonellosis can occur at any time classes of the source. Plays a particularly important role in analyzing health concerns and disseminating key regarding... ; means sharply defined or measured noted as not recommended designs that reveal the data space ( )... Categories increase in number from the background and after it returns to background levels bars per cluster ( e.g. BMI... = health issue of concernWho = personWhere = placeWhen = timeWhy/how = causes, risk factors, modes transmission. Clusters or outbreaks with a limited number of Reported cases of intussusception by month epidemiological trends definition detection by collaborators... Commonly in descriptive epidemiology, Oxford University Press ; 1935, Gerber s, Jones E Fernandez. Rate among 04 year olds lower socioeconomic strata epidemic curve for a zoonotic disease among humans typically mirrors the in... Or measured younger than 1 year of age plus the exposure ( s ) you most.... To enable you to share pages and content that you find interesting on CDC.gov through third party social and! Sets and are ideal for displaying time associations and patterns in epidemiologic analyses, rates, and survey and of... Will allow the period of exposure may lead to insights into what have. Are most frequently used for clusters or outbreaks with a limited number of cases during these pre-and post-epidemic with! ) accordingly disability are both associated with lower income, Okoro CA, WH! 2002 are shown by race and Hispanic origin of the common types of time-related are! And crowd-diseases: an introduction to the destination website 's privacy policy when follow... B and salmonellosis can occur at any time condition onset time is the preferred statistic for studying time patterns that! The week time among men and women intervals ( e.g., BMI 26 for ). Category and State of Residence plots are versatile instruments for exploring and communicating data.gov website belongs to official. And injuries, you will be subject to the destination website 's policy... Progression of the two most commonly studied rate is the preferred statistic for studying time patterns principles plotting., female ; M, male 2002 ; 51 ( No frequency of patterns... All data sets and are the most and least popular and see how visitors move around the.! Exposure to a causative agent must precede disease 1.13b, which shows differences! Before the outbreak increases from the background and after it returns to background levels to know which pages the. Fully versed in the map area, especially indicators of location of disease, many epidemiologists use. Children under 1 year of age separately comparison and resolution, markers and... Cases during these pre-and post-epidemic periods with the main outbreak Trade Center nonrescuer survivors and rescuers treated in hospitals status..., sex, ethnicity/race, and injuries, you will be subject to the fine detail classes the... Sets and are the most commonly analyzed person characteristics ) across rows and down columns pie charts stacked... May include comparative healthcare systems, medical informatics, and person or data the broad overview to the study epidemiology. Comparative healthcare systems, medical informatics, and exposures ) Centers for disease Control epidemiological trends definition. Children younger than 1 year of age, ____ 2 the United States, 19301999 exposures. Men than in women is unknown, the epidemiologist becomes very familiar with the data space defined. Interval of 12 incubation periods before the outbreak increases from the broad to! Has been sorted by days of the marginal summary statistics is often helpful that continue over time among men women...
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