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Basic Epidemiology

Types of study

Experimental study Observational study

Randomized Non Randomized Analytical Descriptive


controlled study study study study

Cohort Case control Longitudinal Cross-sectional


study study study study
Experimental designs
• Two or more than 2 groups
• One group – Standard treatment/ Placebo
• Other group(s)- New treatment
• Decision of treatment type depend on the
investigators
Randomized controlled trial
• Controlled- since control groups and
biases are controlled
• Randomized- process to reduce selection
bias and ensure comparability between
group
• Randomization by
– Coin tossing, dice
– Random tables
– Random number generators
Randomized controlled trial
Cohort design
• Cohort- group with same characters
• One or more group followed over time
• Incidence of outcome in the group(s) are
noted and compared
• Relative risk is calculated
Cohort design
Case control design
• Start from effect to cause
• Group of people with outcome and group
of people without outcome are compared.
• Exposure factor in each group is analyzed
and compared.
• Calculate the odds ratio
Case control design
Advantage and disadvantage of
case control studies
Advantage Disadvantage
• Easy to carry out • Bias more chance
• Rapid and inexpensive • Selection of control difficult
• Less no of subjects • Cannot measure incidence,
• Rare disease Relative risk
• No risk to subjects • Doesn’t recognize association
• Study multiple risk factors from causation
• No attrition • Representativeness of case and
control to population
• Ethical problem less
Descriptive epidemiology
• Study of the occurrence and distribution of
disease
• In Terms of Time Place Person
Descriptive epidemiology
• Study of the occurrence and distribution of
disease
• In Terms of Time Place Person
Time trends
• Secular Long term trends over 10-100 yrs
• Periodic over 2-5 years
• Seasonal Over every season
• Epidemic
Tetanus – by year, United States, 1955-2000
During 2000, a total of 35 cases of tetanus were reported. The percentage of cases among persons aged 25-59 years
Has increased in the last decade. Note: A tetanus vaccine was first available in 1933.

900

800

700
Reported Cases

600

500

400

300

200

100

1955 1960 1965 1970 1975 1980 1985 1990 1995 2000
Year
Malaria – by year, United States 1966-2001
2.0

Returning Vietnam Veterans


Reported Cases per 100,000 Population

1.5
Foreign immigration from
Malaria- endemic countries

1.0

0.5

0.0
1966 1971 1976 1981 1986 1991 1996 2001
Year

Imported malaria cases have increased over the last 15 years, most likely as a result of increasing international travel and
immigration and growing antimalarial drug resistance.
Whooping Cough - Four-monthly
admissions, 1954-1973
Pneumonia-Influenza Deaths – By year,
1934-1980
Meningococcal Infection – By year,
United States, 1935-1992
Place distribution
Deaths from Cholera per 10,000 houses
by source of water supply, London 1854
Number of Deaths from Deaths in
Houses Cholera each
Water Supply 10,000 homes

Southwark & Vauxhall 40,046 1,263 315


Company

Lamberth Company 26,107 98 37

Rest of London 256,423 1,422 59


Person
Age Hobbies
Sex Pets
Occupation Travel
Immunization status Personal Habits
Underlying disease Stress
Medication Family unit
Nutritional status School
Socioeconomic factors Genetics
Crowding Religion
Cross-Sectional
• The measurements of cause and effect
are made at the same time which allows
direct measurement of the variables.
• Limited to studies of causes that are
reasonably permanent characteristics of
the individual so that cause and effect are
present at the same time.
• Describes prevalence relationships – not
incidence
Prevalence
• the number of cases of a disease
occurring in a specified population at a
designated time.

• Point prevalence – at a specific point in


time
• Period prevalence – over a specific
period of time
Incidence

• the number of of new cases of a disease


occurring in a specified population in a
specified time period
July 1 August 1
Uses of Epidemiology
• 1-To study historically the rise and fall of
disease in the population
• 2-Community diagnosis
• 3-Planning and evaluation
• 4-Evaluation of individual risk and chances
• 5-Syndrome identification
• 6-Completing natural history of disease
• 7-Searching for causes and risk factors
Association and causation
• Direct association
– One to one causal relationship
• Necessary and sufficient cause
– Multifactorial causation
• Indirect association
• Spurious association
Criteria's for causality
• Experimental evidence
• Temporal association
• Strength of association
• Specificity of association
• Consistency of association
• Biological plausibility
• Coherence of association