EPIDEMIOLOGY

DEFINITION

 "The study of the distribution and determinants of health related

states or events in specified population and the application of
this study to the control of health problems.”
COMPONENTS:-

 1. Disease frequency
 2. Distribution of disease
 3. Determinants of disease
AIMS IN EPIDEMIOLOGY:-

 to describe the distribution and magnitude of health and disease problems in human
populations

 to identify aetiological factors (risk factors} in the pathogenesis of disease;

 to provide the data essential to the planning, implementation and evaluation of

services for the prevention, control and treatment of disease and to the setting up of
priorities among those services.
EPIDEMIOLOGICAL STUDIES

 Descriptive studies,
 Analytical studies,
 Experimental or intervention studies.
ULTIMATE AIM:-

 to eliminate or reduce the health problem or its consequences;

 to promote the health and well-being of society as a whole.
Measurements in Epidemiology

 a. Measurement of mortality
 b. Measurement of morbidity
 c. Measurement of disability
 d. Measurement of natality
 e. Measurement of the presence, absence or distribution of the
characteristic or attributes of the disease
Measurements in Epidemiology

 f. Measurement of medical needs, health care facilities,

utilization of health services and other health-related events.
 g. Measurement of the presence, absence or distribution of the
environmental and other factors suspected of causing the
disease
 h. Measurement of demographic variables.
Tools of measurement

 1. Rates
 2. Ratios, and
 3. Proportions
RATE:-
   rate measures the occurrence of some particular event (development of
A
disease or the occurrence of death) in a population during a given time
period. An example of a typical rate is the death rate.

A rate comprises the following elements - numerator, denominator, time

specification and multiplier.
RATIO:-
  It expresses a relation in size between two random quantities. The numerator
is not a component of the denominator. It is expressed in the form of:
x: y or x/ y
EXAMPLE 1:-
The ratio of white blood cells relative to red cells is 1 : 600 or 1/600,
meaning that for each white cell, there are 600 red cells.

EXAMPLE 2:-
PROPORTION

   proportion is a ratio which indicates the relation in magnitude of a part of the whole.
A
The numerator is always included in the denominator. A proportion is usually
expressed as a percentage.

Example:-
Crude death rate:-

   is defined as "the number of deaths (from all causes) per 1000 estimated
It
mid-year population in one year, in a given place". It measures the rate at
which deaths are occurring from various causes in a given population, during
a specified period. The crude death rate is calculated from the formula:

 
Specific death rates:-

(a)  Cause
 or disease specific - e.g., tuberculosis, cancer, accident;
Example:-

(b) Related to specific groups e.g., age specific, sex-specific, age and sex
specific, etc.
Example:
Case fatality rate

  
Case fatality rate represents the killing power of a disease. It is simply the
proportion of deaths to cases. The time interval is not specified. Case fatality
rate is typically used in acute infectious diseases (e.g., food poisoning,
cholera, and measles).

Example:-
Proportional mortality rate:-
   is sometimes useful to know what proportion of total deaths are due to a
It
particular cause (e.g., cancer) or what proportion of deaths are occurring in a
particular age group (e.g., above the age of 50 years).
Example: - (a) Proportional mortality from a specific disease

(b) Under-5 proportionate mortality rate

Survival rate:-

   is the proportion of survivors in a group, (e.g., of patients) studied and

It
followed over a period (e.g., a 5-year period). It is a method of describing
prognosis in certain disease conditions. Survival experience can be used as a
yardstick for the assessment of standards of therapy.
Adjusted or standardized rates

 Direct standardization
 Indirect standarization
Direct standardization:-
Calculation of age-specific death rates for City ''X''

AGE MID YEAR DEATHS IN THE AGE SPECIFIC DEATH

POPULATION YEAR RATES
0 4000 60 15
1-4 4500 20 4.4
5-14 4000 12 3
15-19 5000 15 3
20-24 4000 16 4
25-34 8000 25 3.1
35-44 9000 48 5.3
45-54 8000 100 12.5
55-64 7000 150 21.4
  Total= 53500 Total= 446  
Crude death rate per 1000 = 8.3
Calculation of the standardized death rate for City "X"

AGE STANDARD AGE SPECIFIC DEATH RATES PER EXPECTED

POPULATION 1000 DEATHS
0 2400 15 36
1-4 9600 4.4 42.24
5-14 19000 3 57
15-19 9000 3 27
20-24 8000 4 32
25-34 14000 3.1 43.4
35-44 12000 5.3 63.6
45-54 11000 12.5 137.5
55-64 8000 21.4 171.2
  Total 93000   Total = 609.94

Standardized death rate per 1000 =

 
Standardized mortality ratio (SMR):-
  
Standard mortality ratio is a ratio (usually expressed as a percentage) of the
total number of deaths that occur in the study group to the number of deaths
that would have been expected to occur if that study group had experienced
the death rates of a standard population (or other reference population).

If the ratio had value greater than 100, then the occupation would appear to
carry a greater mortality risk than that of the whole population. If the ratio had
value less than 100, then the occupation risks of mortality would seem to be
proportionately less than that for the whole population
Limitations of mortality data

 Incomplete reporting of deaths.

 Lack of accuracy
 Lack of uniformity
 Choosing a single cause of death
 Changing
 Diseases with low fatality
MEASUREMENT OF MORBIDITY

 persons who were ill;

 the illnesses (periods or spells of illness) that these persons experienced
 the duration (days, weeks, etc.) of these illnesses.
value of morbidity data

 they describe the extent and nature of the disease load in the community,
and thus assist in the establishment of priorities.
 they usually provide more comprehensive and more accurate and clinically
relevant information on patient characteristics, than can be obtained from
mortality data, and are therefore essential for basic research.
 they serve as starting point for aetiological studies, and thus play a crucial
role in disease prevention.
 they are needed for monitoring and evaluation of disease control activities.
INCIDENCE

   Incidence rate is defined as "the number of NEW cases occurring in a defined

population during a specified period of time".

For example, if there had been 500 new cases of an illness in a population of
30,000 in a year,
the incidence rate would be: 500/30,000 x 1000 = 16. 7 per 1000 per year
USES OF INCIDENCE RATE

 The incidence rate, as a health status indicator, is useful for taking action
(a) To control disease, and
(b) For research into aetiology and pathogenesis, distribution of diseases,
(c) To know efficacy of preventive and therapeutic measures
PREVALENCE

 "the total number of all individuals who have an attribute or disease at a

particular time (or during a particular period) divided by the population at
risk of having the attribute or disease at this point in time or midway through
the period".

 Although referred to as a rate, prevalence rate is really a ratio.

Types of prevalence

 (a) Point prevalence

 (b) Period prevalence
Point prevalence

  
Point prevalence of a disease is defined as the number of all current cases
(old and new) of a disease at one point of time, in relation to a defined
population.

Point prevalence is given by the formula:

Period prevalence

  
 It measures the frequency of all current cases (old and new) existing during a
defined period of time (e.g., annual prevalence) expressed in relation to a
defined population.
Uses of prevalence

 Prevalence helps to estimate the magnitude of health/ disease problems in

the community, and identify potential high-risk populations
 Prevalence rates are especially useful for administrative and planning
purposes, e.g., hospital beds, manpower needs, rehabilitation facilities, etc.