Epidemiology

EPIDEMIOLOGY

EPIDEMIOLOGY
The study of the distribution and determinants of disease in human populations.
Features:
1. Quantitative science
2. Applied science 3. Uses mostly observational methods

4. Systematic and orderly 5. Focused on populations

scientific

Occurrence - Patterns
EPIDEMIOLOGY

EPIDEMIOLOGY
Epidemiology is the study of the

distribution and determinants of health related states or events in specified populations and the application of this study to the control of health problems.

(Last, 1988)
EPIDEMIOLOGY

2 BROAD CATEGORIES OF EPIDEMIOLOGY

Descriptive Epidemiology - study of the amount and distribution of disease within a population by person, place and time Analytic Epidemiology

- study of the determinants of disease or reasons for relatively high or low frequency in specific groups
EPIDEMIOLOGY

Description of disease patterns / occurence

Descriptive Epidemiology
Amount and distribution WHO, WHERE AND WHEN Amount: Rates and Ratios Standardization of rates Data gathering and accuracy of measurements Natural History of Disease
EPIDEMIOLOGY

Description of disease patterns / occurence

Analytic Epidemiology
Etiology, cause, risk factor determination Observational analytic study types TESTING DETERMINANTS OF DISEASE

EPIDEMIOLOGY

IMPORTANT EPIDEMIOLOGICAL VARIABLES

EPIDEMIOLOGY

I. CHARACTERISTICS OF PERSONS (host determinants)

- age - sex - ethnic group/ race - marital status - occupation - Socio- economic status - Family variables: Size maternal age parental deprivation birth order interval between births
EPIDEMIOLOGY

II. CHARACTERISTICS OF PLACE

- Environmental Factors

- International Comparisons
- Urban Rural Differences

EPIDEMIOLOGY

III. TIME - Secular Trends

- Periodic or Cyclic Fluctuations

- Short Term Fluctuations (Epidemic)
EPIDEMIOLOGY

Methods Utilized in the Study of Disease Occurrence / Patterns

Example:
PTB

Types of Investigations
Describe its features and distn. By answering: Find out the reasons for the disease occurrence:

EPIDEMIOLOGY

Describe its features distn. By answering:

and

WHO is affected (host factors) - age - sex - occupation - ethnic group - marital status WHERE (place factors) - Geographical distn.

WHEN (time factors) - months - seasonal var. WHAT - signs and symptoms - consequences

EPIDEMIOLOGY

Find out the reasons for the disease occurrence:

WHY - Reasons HOW - interplay between different factors of causation e.g. - susceptibility - source of infection - vectors
EPIDEMIOLOGY

HOST DETERMINANTS

EPIDEMIOLOGY

AGE

Most important determinant among the personal variables In general, chronic conditions tend to increase with age Young children: readily acquire acute respiratory infections Maternal antibodies transmitted during fetal life protect the infant for approximately the first half year after birth (thereafter, protection wanes and #URTI s)
EPIDEMIOLOGY

AGE

Measles, chickenpox, mumps occurred mainly in young children; + immunization patterns of immunity in the population changed Not only related to frequency of infectious disease but also severity e.g. Pnuemococcus and salmonella coliform org./Staph. aureus. - changing biological influences - varying behavior - different experiences
EPIDEMIOLOGY

SEX:
Death Rates: Male > Female

Morbidity Rates:

Male

<

Female

EPIDEMIOLOGY

SEX:
Reasons: sex linked inheritance differences in hormonal balance Environment or habit patterns e.g. > DR in MALE e.g. > MR in FEMALE Depression Attempted suicide homicide COPD Suicide Accidents Liver Disease
EPIDEMIOLOGY

heart disease

Reasons for morbidity rate and mortality rate

1. Women seek medical care more freely and perhaps at an earlier stage of disease
2. That the same disease will tend to have a less lethal course in women than in men.

- women have more episodes of illness and more physician contacts than men have
Different habit patterns

Physiological differences
Environmental exposures Sex linked inheritance
EPIDEMIOLOGY

ETHNIC GROUP OR RACE

Many diseases, differ markedly in frequency, severity, or both in different racial groups Many of the observed differences are related to differences in socioeconomic status
EPIDEMIOLOGY

ETHNIC GROUP OR RACE

e.g. Blacks have DR:

- Hypertensive Heart Disease

- CVA

Whites have

DR:

- Suicide - Leukemia - Atherosclerotic Heart Disease - CA of Breast

EPIDEMIOLOGY

- TB
- Syphilis - Homicide - CA of Cervix

OTHER REASONS:
Varying environmental exposures, Lifestyles, Extent and quality of
Medical Care Cultural Differences Genetic e.g. - virtual restriction of sickle cell anemia to blacks (genetics)

- CA of stomach

- Japan (native)
- Japanese Desc. in U.S.

- Alcoholism among Jews

EPIDEMIOLOGY

OTHER REASONS:
e.g.

1. CA of Cervix

- more common in single with multiple

partners than married women in a monogamy * Infection with HPV

* Early sexual experience * Multiple partners 2. CA of Breast

- more common among single than married women

* Hormonal balance Risk for breast CA: - decreased with early age at first pregnancy - artificial menopause before the age of 40 y/o
EPIDEMIOLOGY

Death rates for the SINGLE are higher than those for the MARRIED
1. Persons in poor health tend to remain single.
2. Persons exposed to disease producing agents and situations tend to remain single.

3. Differences in ways of life of single and married.

GENERALLY, DR for most specific diseases and from all causes combined, have been found to vary from lowest to highest in the following order: Married, Single, Widowed and Divorced.
EPIDEMIOLOGY

SOCIAL CLASS:
Used for ranking or stratifying a total population into subgroups that differ from each other in prestige, wealth and power. - socioeconomic status - nutritional status

- crowding
- personal hygiene
EPIDEMIOLOGY

SOCIAL CLASS:
Poverty affects utilization of medical care services for a variety of reasons:
1. Having limited financial resources

2. Restricted access to medical care

3. Poor tend to under utilize available preventive services

4. Health needs tend to have a relatively low priority (lack of motivation to seek such care)
EPIDEMIOLOGY

OCCUPATION:
Occupationally related experiences - can exert a profound effect on health and contribute to large differences in mortality

e.g.
pulmonary fibrosis - free silica mesothelioma - asbestos workers bladder CA - aniline dyes lung CA - chromate workers
EPIDEMIOLOGY

OCCUPATION:
Occupational Selection State of Health may determine entry into a specific occupation - undemanding jobs vs demanding jobs Degree of Stress of the Job

EPIDEMIOLOGY

PLACE DISEASE
Disease occurrence is associated with characteristics peculiar to the place of occurrence.

EPIDEMIOLOGY

PLACE DISEASE
CRITERIA:
1. High rates observed in all ethnic groups inhabiting the place.

2. High rates are not observed among ethnic groups living in another locality.
3. Migrants develop similar rates as the inhabitants.

4. Reversal of rates if inhabitants leave place.

5. Same manifestations maybe exhibited by other species.
EPIDEMIOLOGY

TYPES OF COMPARISONS
1. International 2. Urban Rural 3. With Countries

4. Local distribution
EPIDEMIOLOGY

INTERPRETATION
1. Characteristics of inhabitants 2. Characteristics peculiar to place

- Biological environment
- Chemical and Physical environment - Social environment

e.g. social conditions determining preferences, availability and distribution of food malnutrition
EPIDEMIOLOGY

CHARACTERISTICS OF PLACE
PLACE DETERMINANTS

Physical Environment

Chemical Environment Biologic Environment Socio cultural Environment

EPIDEMIOLOGY

MIGRANT STUDIES Used in delineating the influence of genetic inheritance and factors in the environment
EPIDEMIOLOGY

MALARIA
250 200 150 100 50 0

YEAR
EPIDEMIOLOGY

TYPES OF VARIATION IN DISEASE FREQUENCY OVER

TIME
EPIDEMIOLOGY

I. SECULAR CHANGE
-Changes in disease frequency encompassing long periods of time EXPLANATIONS:

1. Abrupt changes maybe due to variation in diagnosis, reporting, coding cause of death
2. Altered killing power of disease 3. Change in the characteristics of the population
EPIDEMIOLOGY

Forecast of Cancer Deaths

600 500 510 443 382 268 211 41 65 85 118 158 311

Thousands of Deaths

400 300 200 100 0

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 Years

EPIDEMIOLOGY

Cancer Death Rates by SITE

EPIDEMIOLOGY

EPIDEMIOLOGY

Possible Reasons for Changes in Trends

Real

Changes in age distribution of the population Changes in survivorship Changes in incidence of disease resulting from

Genetic factors Environmental factors

EPIDEMIOLOGY

Possible Reasons for Changes in Trends

Artifactual
Errors in numerator due to
Changes in the recognition of disease Changes in the rules and procedures for classification of causes of death Changes in the classification code of causes of death Changes in accuracy of reporting age at death Errors in the denominator due to error in the enumeration of the population
EPIDEMIOLOGY

II. CYCLIC FLUCTUATIONS

-recurrent alterations in disease frequency * Seasonal variation * Every X years cycle - periodic fluctuations on annual or other basis REASONS FOR VARIATIONS: 1. Differences in peoples activities by season 2. Possible role of insect vectors (influenced by temp. and humidity for each season)
EPIDEMIOLOGY

MEASUREMENT OF HEALTH AND DISEASE IS REQUIRED FOR:

Preventing disease Promoting health

Planning health services

THE CENTRAL TOOL OF EPIDEMIOLOGY IS THE COMPARISON OF RATES:

numerator RATE = denominator

EPIDEMIOLOGY

Uses of Epidemiology
1. Causation Genetic Factors Good Health
Environmental Factors (Including lifestyle)
Epidemiology can be used to establish CAUSATION; for example, how genetic and environmental factors can adversely influence people in good health and lead to poor health.
EPIDEMIOLOGY

Ill health

Uses of Epidemiology
2. Natural History
Death Good Health Subclinical Changes Clinical Disease Recovery
Epidemiology can also be used to study the NATURAL HISTORY of a disease. The person in good health experiences increasing severity of change in bodily functions until clinical disease has developed. In the case of a physical injury these changes usually occur very rapidly. Finally, the disease or injury may lead to death, or, alternatively, recovery, due to the bodys natural healing mechanisms or as a result of treatment.
EPIDEMIOLOGY

Uses of Epidemiology
3. Description of health status of populations
Good health

ill health

time
Epidemiology can also be used to DESCRIBE the health status of a population; what proportion is healthy, how health status changes overtime, the occurrence of disease in different geographic areas, etc.
EPIDEMIOLOGY

Uses of Epidemiology
4. Evaluation of intervention
Good Health Health promotion Preventive measures Public health services Treatment Medical care

III health

Finally, epidemiology is increasingly used to EVALUATE the impact of interventions to prevent disease or injury in a population or the impact of treatment on groups of patients. In this case, measurements focus on modifications of the ways in which good health becomes ill health or vice versa.
EPIDEMIOLOGY