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Epidemiologic Studies
Part (I)
UNIVERSITY OF TABUK, FACULTY OF MEDICINE
COMMUNITY MEDICINE MODULE
(MED 402)
November, 2016
 Learning Outcomes
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At the end of this lecture, students should be able to:

1.Describe the importance and types of epidemiological

studies.
2.Differentiate among the target and study populations and
subjects.
3.Identify the different types of scientific samples.
4.Determine the various methods and techniques of data
collection and management.
 Epidemiological Studies
(Definition)
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Definition of epidemiological studies:

Studies on human populations, which attempt to link human

health effects (e.g. cancer) to a cause (e.g. exposure to a
specific chemical).

Epidemiologic studies types of studies that compares two

(2) groups of people who are alike except for one factor,
such as exposure to a chemical or the presence of a health
effect; the investigators try to determine if any factor is
associated with the health effect.
 Epidemiological Studies
(Importance)
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Importance of epidemiological studies:

Used to:

Assess prevalence & incidence.

Assess association & relationship between two or more

factors.

Assess risk factors & causal effect between exposure &

outcome.
 Target Population & Generalizability
(Definition)
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Target population:
The target population is the total group
of individuals from which the sample
might be drawn.

Generalizability:
Refers to the extent to which we can
apply the findings of our research to the
target population we are interested in.
 Study Population & Subjects
(Definition)
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Study population:
The group of individuals in a study.
In a clinical trial, the participants make up the study
population.
Example: all children under 2 years of age in a community.

Subjects:
It can either be a person, a place, a thing, or an idea.
A human subject is defined as a living individual about whom
an investigator conducting research obtains.
Human subject is an individual who participates in research,
either as a recipient of the test article or as a control, and is
either a healthy human or a patient.
 Other Definitions
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Census:
Sampling of the entire population.

Population sampling:
Is the process of taking a subset of subjects that is
representative of the entire population.

Sampling frame:
Is the list of people forming a population from which a sample
is taken.

Sample:
Is a set of data collected and/or selected from a statistical
population by a defined procedure.
It is a subset of population.
 Epidemiological Studies
(Types)
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Interventional studies:

The studied factors related to the relationship are controlled

by the investigator.

They include:

Lab experiments

Animal studies

Clinical trials (RCT)

Community interventions
 Epidemiological Studies
(Types)
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Non-interventional studies:

They are observational studies in which the investigator

doesnt have any control on the factors under study, he just
observes and collect data, this category includes the
following designs:

Descriptive study
Ecologic study
Cross sectional study
Case control study
Cohort study
 Epidemiological Studies
(Types)

Observational Interventional

Descriptive
Lab experiment
Ecologic

analytic
Clinical trials
analytic

Cross-sectional

Community
Case-control interventions

Cohort
 Sampling
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Why sampling:

Since investigating the entire population by census is costly,

sampling is a more cost-effective and convenient alternative
for collecting information.
 Sampling Design
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Sample design is made up of two elements:

Sampling method/technique:
Sampling method refers to the rules and procedures by which some
elements of the population are included in the sample.

The "best" sample design depends on the study objectives and

resources:
For example, a researcher might select the most economical
design that provides a desired level of precision. or,
If the budget is limited, a researcher might choose the design that
provides the greatest precision without going over budget.

Estimator:
The estimation process for calculating sample statistics is called the
estimator.
 Sampling
(Definition)
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The term sampling technique and sampling method are

used interchangeably.

Sampling technique:
It is the name or identification of the specific process by
which the entities of the sample have been selected.

Sampling method:
It is a procedure for selecting sample members from a
population.
 Sampling
(Types)
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Sampling methods produce either of the following:

o Probability samples:
Allow the sampling error to be calculated and hence
allow inferences to be made regarding the population.
Sampling error is the difference between population
parameter & sample statistics.

o Non-probability samples:
Do not permit such inferences.
 Probability Sampling
(Types)
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Introduction:

Probability sampling is also called random sampling.

It is the sampling technique wherein the samples are

gathered in a process that gives all the individuals in the
population equal chances of being selected.

Sampling frame is requested for all studies that aim to

make an inference about the population.

Sampling frame is the complete list of the population

from which the sample is to be drawn.
 Probability Sampling
(Types)
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Types of probability/random sampling:

1. Simple random sampling.

2. Systematic random sampling.

3. Stratified random sampling.

4. Cluster random sampling.

5. Complex/Mixed multi-stage random sampling.

 Probability Sampling
(Simple Random Sampling)
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Description:
Start with a sampling frame.
Sampling frames include:
Postcode address files.
The electoral register.
GP practice list.
Etc.,
Draw a random sample from the sampling frame.
Methods:
Lottery.
Pick number from a hat.
Computer programs.
Advantages:
Purest form of probability sampling.
Allows the sampling error to be calculated.
Disadvantages:
Relatively inconvenient in practice.
Inefficient for rare outcomes.
A sample frame is not always available.
 Probability Sampling
(Systematic Random Sampling)
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Description:
Starting number & constant interval.
Sampling frame.
Calculate the sampling interval (n):
= no. of population / no. of sample
Draw every nth person from the sampling frame.
Advantages:
More convenient than simple random sampling.
Allows the sampling error to be calculated.
Disadvantages:
Potential for bias if there are underlying patterns in the sampling
frame.
Modified systematic random sampling:
Total population/Sample size = Sampling fraction = Constant
=Interval
 Probability Sampling
(Stratified Random Sampling)
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Description:
Assign members of the population into relatively homogeneous subgroups
strata before sampling:
The most common strata used in stratified random sampling are age, gender,
socioeconomic status, religion, nationality and educational attainment.
Draw a random sample of subjects from each stratum.
Types:
Proportionate stratified random sampling: same fraction ,
Disproportionate stratified random sampling: different fraction ,
Advantages:
Improves the accuracy of estimation.
Efficient.
Allows the sampling error to be calculated.
Disadvantages:
Requires accurate information about the population.
Choice of relevant stratification variables can be difficult.
Not useful if there are no homogeneous subgroups.
 Probability Sampling
(Cluster Random Sampling)
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Description:
Used when there are natural clusters in the population (e.g. GP practices
within a borough)
A random sampling technique is used to choose which clusters to include in
the study.
Single/One-stage cluster sample:
pure cluster sampling (all the elements from each of the selected clusters are used
i.e. all patients in selected practices).
Two-stage cluster sample:
simple cluster sampling (elements from each of the selected clusters are selected
at random i.e. a sample of patients from within the selected practices)
Advantages:
Convenient for fieldwork.
Cost-efficient.
Allows calculation of the sampling error.
Disadvantages:
Increased sampling error.
 Probability Sampling
(Complex, Mixed, Multi-stage)
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Description:

Involves combination of two or more probability/random

sampling techniques.
 Non-probability Sampling
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This Should Be Covered By

Assignment
 Data Collection
(Introduction)
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Introduction:

Data collection starts after writing the questionnaire.

Data is collected using tools.

Tool in research is an instrument used to collect data from

respondents, subjects, animal, lab, etc.,
 Data Collection
(Tools)
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Types of tools:

For quantitative study:

Observation
Questions
Questionnaire
Measurements (instruments)

For qualitative study:

Observation
In-depth interview (IDI)
Focus Group Discussion (FGD)
 Data Management
(Screening, Entry & Storage)
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After data collection:

Check the data gathered:

For errors, mistakes,

Data entry:
To computer software (excel, SPSS, WORD, ETC.,)

Storing of data:
Backup, backup & backup some more and more!
 Data Management
(Categorization)
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Categorize data into specific types of variables:

Categorical variables:
Dichotomous
Polynomial
Ordinal

Numerical variables:
Continuous
Discrete
 Data Management
(Coding & Labeling)
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For categorical variables:

Gender:
Male =1
Female =2

Race:
Malay =1
Chinese =2
Indian =3
Others =4

Level of education:
Primary =1
Secondary =2
Tertiary =3
 Data Management
(Verification/validation & Screening)
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Verification/validation & screening for errors and mistakes:

Screening for errors & mistakes.

Checking with the relevant questionnaire.

Cleaning of errors & mistakes.

 Data Management
(Analysis)
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Descriptive analysis:

Tables, graphs, charts, lines, etc.,

Categorical variables:
Counts/frequency.
Percentages.
Pie chart & bar chart.

Numerical variables:
Minimum & maximum.
Mean, median & mode.
Range, standard deviation & Inter-quartile range.
Histogram, plots, line.
 Data Management
(Analysis)
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Bivariate analysis:

Assessment of the relationship between two variables.

Use of appropriate statistical test.
Whether there is association or not?
The association is significant or not?
Presented with the value of the test, degree of freedom,
effect size, confident interval & P value.
 Data Management
(Analysis)
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Multivariable analysis:

Assess the relationship between one variable & two or

more variables.

E.g.:
Smoking cigarette (as outcome) & age, gender, race,
income & level of education (as associated factors).
 Data Management
(Analysis)
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Multivariate analysis:

Assess the relationship between two or more variables &

two or more other variables.

E.g.:
Smoking cigarette & alcohol consumption (as outcomes)
& age, gender, race, income & level of education (as
associated factors)
 Data Management
(Interpretation)
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Interpret your result by:

Explaining what do the figures, number, charts, graphs, &

tables mean?

Converting the result into simple understandable text.

 Data Management
(Discussion)
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Compare your findings with other available data:

Similar

Different why?
 Data Management
(Conclusion)
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Summary of your findings

The most important findings

 Data Management
(Dissemination & Communication )
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Research presentation:
Conference
Forum
Journal clubs
Colleagues
Health authorities
Your respondents

Research publication:
Abstract
Full article
High impact journal

End
 Question
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Briefly answer the following question:

What are the differences between intervention and non-

intervention epidemiological studies?
 References
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Textbooks:
1. K. Park's (2015): Textbook of Preventive and Social Medicine. Banarsidas Bhanot-Jabalpur. 23rd edition.
2. Text Book of Public Health and Community Medicine. RajVir Bhalwar, Department of Community
Medicine, Armed Forces Medical College, Pune, in collaboration with WHO, India Office, New Delhi
(2009).
3. Lucas, A. and Gilles, H. (2003): Short Textbook of Public Health Medicine for the tropic, 4th edition, Oxford
University Press Inc., New York, USA.
4. Portney, L. G. and Watkins, M. P. (2008): Foundation of Clinical Research. Applications to Practice. 3rd
edition.
5. Kumar, R.(1996): Research methodology. A step by step guide for beginners. 3rd edition.
6. Miller, D. C. (1991): Handbook of Research Design and Social Measurement. 5th edition.
7. Altman, D. G. (1991):Practical statistics for medical research. Boca Ratn, Chapman & Hall/ CRC;

Websites:
1. World Health Organization (WHO): http://www.who.ch
2. Centers for Disease Control and Prevention (CDC), USA: http://www.cdc.gov
3. The Johns Hopkins Bloomberg School of Public Health, OPENCOURSEWARE (OCW) project:
http://ocw.jhsph.edu
4. The WWW Virtual Library (Medicine and Health): Epidemiology
(http://www.epibiostat.ucsf.edu/epidem/epidem.html).
 THANK YOU
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