Professional Documents
Culture Documents
Module #1
INTRODUCTION TO EPIDEMIOLOGY #1
Michael Q. Van Haute, MD, DPAAB, MSPH July 4,2018
LEGEND EPIDEMIOLOGY
Book Can be applied to a wide range of problems, from
Recordings transmission of an infectious disease agent to the design of a
new strategy for health care delivery.
WHAT IS EPIDEMIOLOGY
This methodology is continually changing as it is adapted to a
Study of (logos, λόγος) what is upon (epi, ἐπί) the people
greater range of health problems and more techniques are
(demos, δῆμος)
borrowed and adapted from other disciplines (such as
The study of the and of disease and health-related states and
mathematics and statistics).
events in and application of knowledge in prevention, control,
and mitigation of these problems.
HISTORICAL ANTECEDENTS OF EPIDEMIOLOGY
CHARACTERISTIC FEATURES
Hippocrates (400BCE)
– Attributed disease causality to environmental factors
(“environment is a factor in disease causation”)
John Graunt (1662)
– Employed quantitative methods in describing population
vital statistics; presented mortality data in tabular form (counts
of events)
John Snow (1854)
– Father of Epidemiology; investigated cholera outbreak
– Marked the formal beginnings of the field of Epidemiology
(experiment)
• Hypothesis: contaminated water, not air, spreads cholera.
– Cholera rates high in areas supplied by 2 companies
(Southwark & Vauxhall, and Lambeth) Source: polluted part of
Thames River
Figure 1 Characteristic features
Overall Goal
1. Identification of risk factors
-Know the cause* of disease
-Eliminate all compounding conditions
2.Prevent disease
Figure 2 Source: Snow J. Snow on Cholera. London: Humphrey Milford:
WHAT IS A RISK FACTOR Oxford U Press, 1936
Last (2001)
-“An aspect of personal or behavioral lifestyle, – In 1852, Lambeth relocated its source to less-polluted
environmental exposure, inborn or hereditary, which, on the areas which results to decreased cholera incidence.
basis of epidemiological evidence, is known to be associated
with a health-related condition considered important to
prevent.”
Specific Population
Concerns itself with groups or population instead of
individuals
[Angeles,Ron Alex] Checked by: [Garcia, Eclesiastes] Page 1 of 10
FAMILY AND COMMUNITY MEDICINE II INTRODUCTION to EPIDEMIOLOGY MODULE #1, LECTURE #1
A cause might be positive or negative. Positive in a sense that if that a cause has occurred first before a disease. So if A occurs
the cause is around or the cause is present it causes disease or then B should occur.
a lack of the cause prevents the disease..
Types of Association
Why is knowledge on cause important? Causal association
– Formulation of intervention measures – An association in which an alteration in the frequency and
– Formulation of preventive and control measures quality of one category is followed by a change in the other
Now why do we need to know all these? It’s important because An association in which an alteration in the frequency and quality
to be able to formulate what kind of interventions we can give in of one category it could be exposure is followed by a change in
a larger scale. We also want to know these because we want to the other which is the outcome or the disease.
formulate a preventive and control measures.
Non-causal
Concept of Causation – Disease causing the exposure (rather than the exposure
causing the disease)
Often times, causal relationship between an exposure and a – The disease and the exposure are both associated with a
disease can never be proven third (confounding) factor, X, is inadvertenly measured.
Risk factor (determinant)
– A variable associated with an increased risk of disease or
infection Non-causal association which is often times called as artifactual
– Person characteristics (behavior/lifestyle, family or spurious. What do we call this particular variable? We call
background, inborn/inherited condition) them your ‘confounders’ which could distort the relationship that
o Environmental characteristics (exposure to a you are after.
substance/product)
– Can be:
o Non-modifiable (age, family history), or
o Modifiable (BMI, blood pressure)
Many diseases have specific causes (e.g., RNA virus
Morbillivirus causes measles), BUT cause remain uncertain
for many chronic diseases (cancers, AD, CHD)
– Scientist/investigators look for factors that appear to be Figure 5 Types of Association
linked to the development of a disease
– if risk factors are present, there is an increased chance, Association is NOT equal to causation
but not a certainty, that the disease will develop
Causation vs Association
Association
– identifiable relationship between exposure and disease
(co-existence)
– AB
–
In Association, if A increases B will also increase alongside.
Epidemiologic Methods
Causation
Epidemiology does not determine the cause of a disease in a
– Presence of mechanism that leads from exposure to
given individual. Instead, it determines the association
disease (cause-effect)
between a given exposure and frequency of disease in
– AB populations.
Epidemiologic studies are undertaken to demonstrate a link
How about Causation? When we say Causation we actually are (statistical association) between factor and disease
talking about a particular mechanism and it follows a timeline – Statistical association allow epidemiologists to make
[Angeles,Ron Alex] Checked by: [Garcia,Eclesiastes] Page 3 of 10
FAMILY AND COMMUNITY MEDICINE II INTRODUCTION to EPIDEMIOLOGY MODULE #1, LECTURE #1
o Case-control Person
o Cohort study Inherent characteristics (you can’t do anything about it)
2. Experimental Acquired characteristics (modifiable)
Investigators manipulate the level of exposure (intervention) Characteristics are important because:
for each individual or community; its effects on exposure They affect risk of exposure to a source of infection
are then tracked over time They affect host’s resistance or susceptibility to infection
Random assignment of exposure
Clinical trials : Community trials Person : Age
Single most useful variable to describe occurrence and
Describing Disease Occurrences distribution of disease
Methods to describe disease occurrences Its usefulness in understanding risk factors of disease
1. Statistical measures Is a consequence of the association between a person’s
Measures of disease frequency (prevalence) age and
Measures of central tendency/dispersion/location (interval, Potential exposure to a source (e.g., occupation, lifestyles)
ratio)What are the two central tendency measure? It could Level of immunity and resistance
either be the Mean or Median.
Physiologic activity at the tissue level
What is the very important measure of dispersion? Standard Is associated with mortality (death rate) and morbidity
deviation. (incidence rate)
Frequency of disease
For location, we have quartiles, percentiles. Severity of disease
2. Graphs
Age-mortality relationship
Line graphs, bar, pie, histogram
3. Spot maps
Location of cases marked
Descriptive Epidemiology
Provides a way of organizing and analyzing data in order to
understand variations in disease frequency geographically
and over time, and how disease (or health) varies among
people based on a host of personal characteristics (person,
place, and time)
Epidemiologic variables: 5Ws
What: health issue of concern (case definition)
Who: person, characteristics of persons at risk for the
disease
When: time (e.g., time of the day, season…)
Where: place, geographic location Figure 7 Death rate per 100,000 people by Age Groups
Why/How: causes, risk factors, modes of transmission
Age-morbidity relationship
Canadian Study of Health and Aging: Risk factors for
Alzheimer’s Disease in Canada
– Age found to be the strongest risk factor
– The older, the higher the risk factor for AD
o 1 in 100 between ages 65-74
o 1 in 14 between ages 75-84
o 1 in 4 over ages 85 and older
Person : Age
In describing data by age
– Age groups should be kept relatively small so differences
can be detected
o Usually by 5-year age intervals
o Large groupings can hide important differences in
Figure 9 Schematized age curves for several acute infectious diseases distribution of cases
One can be able to compute age-specific
incidence/prevalence/death rates
Sex-mortality relationship
(widowed/divorced) persons that are casually related to – Timing of control measures – to show impact of intervention
certain diseases on disease occurrence
Religion Trends:
Practices (e.g., food intake, alcohol use, birth control, – Secular (Long-term)
personal hygiene) – Cyclic fluctuation
Family size o Seasonal
o Day-of-week and time-of-day
Affects nutrition, income, crowding – Epidemic
Time
Period during which the individual cases of the diseases
were exposed and the period during which illness occurred.
Some diseases can occur regularly, while others are
unpredictable
Displaying the patterns of disease occurrence by time is Figure 17 Trends in Incidence Rates for Selected Cancers by Sex,
critical for monitoring disease occurrence in the community United States, 1975 to 2008
and for assessing whether the public health interventions
made a difference
Represented as 2-dimensional graphs (time along x-axis)
– Period of exposure – may lead to insights into what may
have caused illness