MPH 604:

EPIDEMIOLOGY
CHAPTER 5
DESCRIPTIVE EPIDEMIOLOGY:
PERSON, PLACE, TIME
Learning Objectives

State primary objectives of descriptive epidemiology

Provide examples of descriptive studies

List characteristics of person, place, and time

Characterize the differences between descriptive and analytic

epidemiology
Descriptive vs. Analytic Epi Studies

Descriptive Analytic

Used to identify a health problem follow descriptive studies

that may exist

Characterize the amount and

Used to identify the cause of the
distribution of disease.
health problem
Objectives of Descriptive Epi

To evaluate and compare trends in health and disease.

To provide a basis for planning, provision, and evaluation of health

services.

To identify problems for analytic studies (creation of hypotheses).

Three Approaches to Descriptive Epi

Case reports (counts)--simplest category.

Case series--summarize characteristics of patients from major clinical

settings.

Cross-sectional studies--surveys of the population to estimate the

prevalence of a disease or exposure.
Characteristics of Persons

Age Nativity and migration

Sex Religion
Marital Status Socioeconomic status
Race and ethnicity
Trends by Age Subgroup

Childhooddevelopmental problems, e.g., congenital

birth defects, infectious diseases such as
meningococcal disease

Teenage yearsunplanned pregnancy, substance abuse

Adultsaccidental injury, homicide, suicide

Older adultschronic diseases

Sex Differences: Males vs. Females

All-cause age-specific mortality rates higher for men

than for women.
May be due to social factors.
May have biological basis.

Men often develop severe forms of chronic disease.

Generally, death rates for both sexes are declining.

General Comments About Race

U.S. becoming increasingly more diverse.

Race is a continuously evolving concept that overlaps with

other dimensions (economic status, diet, religion)

Scientists propose that race is primarily a social and cultural

(rather than biological) construct.

http://www.pbs.org/race/000_General/000_00-Home.htm

https://www.youtube.com/watch?v=1ReHUMUb9gY
Life expectancy at birth by race and sex: 1970-2003. Source: From Arias E. National Vital Statistics Reports, Vol 54,
No 14, p. 4. Washington, D.C.: National Center for Health Statistics; 2006.
Acculturation

Defined as modifications that individuals or groups

undergo when they come in contact with another
country
Influence of environmental and behavioral factors on chronic
disease
Example: Japanese migrants experience a shift in rates
of chronic disease toward those of the host country.

Ueshima H, Okayama A, Saitoh S , et al. Differences in cardiovascular

disease risk factors between Japanese in Japan and Japanese-
Americans in Hawaii: the INTERLIPID study. J Hum Hypertens. 2003
Sep;17(9):631-9.
Socioeconomic Status

Low social class is related to excess mortality,

morbidity, and disability rates.
Factors include:
Poor housing
Crowded conditions
Racial disadvantage
Low income
Poor education
Unemployment
Lower access to health care
Mental Health and Social Class

In the U.S., the highest Social causation explanation (breeder

incidence of severe mental hypothesis)conditions associated with
illness occurs among the lower social class produce mental
lowest social classes. illness.

~ 30% of homeless have Downward drift hypothesisPersons

mental health conditions with severe mental disorders move to
impoverished areas.
> 60% of chronic homelessness
have experienced lifetime
mental health problems

Substance Abuse and Mental Health Services Agency Fact Sheet

Other Correlates of Low SES

Higher rate of infectious disease.

Higher infant mortality rate and overall mortality

rates.

Lower life expectancy.

Larger proportion of cancers with poor prognosis.

May be due to delay in seeking health care.
Characteristics of Place

Types of place comparisons:

International
Geographic (within-country) variations
Urban/rural differences
Localized occurrence of disease
International Comparisons of Disease
Frequency

World Health Organization (WHO) tracks

international variations in rates of disease.

Infectious and chronic diseases show great

variation across countries.

Variations are attributable to climate, cultural

factors, dietary habits, and health care access.
Life Expectancy by Country

Of 37 countries, the U.S.

was 26th in male life
expectancy and 25th in
female life expectancy.
Reasons for Place Variation in Disease

Gene/environment interaction
Examples: sickle-cell gene; Tay-Sachs disease

Influence of climate
Examples: skin cancer, lyme disease

Environmental factors
Example: chemical agents linked to cancer clusters
Example: cancer incidence in Japan after WWII
Characteristics of Time

Cyclic fluctuations

Point epidemics

Secular time trends

Clustering
Temporal
Spatial
Cyclic Fluctuations

Periodic changes in the frequency of diseases and

health conditions over time.

Related to changes in lifestyle of the host, seasonal

climatic changes, and virulence of the infectious
agent.

Examples: higher heart disease mortality in

winter; more accidents in summer; seasonal
variation in incidence of meningococcal disease or
influenza.
Seasonal variance in incidence of meningococcal disease in selected U.S. areas during 1989-
1991. Source: Reprinted from Centers for Disease Control and Prevention, Laboratory-Based
Surveillance for Meningococcal Disease in Selected AreasUnited States, 1989-1991. MMWR.
Vol 42, No SS-2, p. 24, June 4, 1993.
Point Epidemics

The response of a group of people circumscribed in

place and time to a common source of infection,
contamination, or other etiologic factor to which they
were exposed almost simultaneously.

Examples:
foodborne illness Jack in the Box -> E. coli
toxic substances Fen-Phen -> valvular heart disease
infectious diseases measles and whooping cough
Cases of Mycoplasma pneumoniae among clients and staff members of a sheltered workshop, by week of onset:
Ohio, June 15-September 5, 1993. Source: Reprinted from Centers for Disease Control and Prevention, Outbreaks of
Mycoplasma Pneumoniae Respiratory Infection: Ohio, Texas and New York, 1993. MMWR. Vol 42, p. 931, December 10, 1993.
Secular Time Trends

Refer to gradual changes in the frequency of a disease

over long time periods.

Example is the decline of heart disease mortality in the

U.S.
May reflect impact of public health programs,
dietary improvements, better treatment, or
unknown factors.
Secular trend: Breast cancer 1975-2007
Clustering

Case clustering--refers to an unusual aggregation of

health events grouped together in space and time.

Temporal clustering: e.g., post-vaccination

reactions, postpartum depression.

Spatial clustering: concentration of disease in a

specific geographic area
E.g. Cholera cases in London (John Snow)
E.g. Cancer clusters in Japan post-WWII
E.g. Tay-Sachs among Ashkenazi Jewish community
Gonorrhea, 1996 and Homicide, 1995

Thomas et al., 2010