Essential Epidemiology Textbook Chapter 1 Notes

Essential Epidemiology: An Introduction for Students and
Health Professionals
Chapter 1 Notes – Epidemiology is…
 2 core strands of traditional epidemiology

o Who is developing disease (and where and when)
o Why are they developing it?
 Epidemiology is:
o About measuring disease or other aspects of health, identifying causes of
the ill-health and intervening to improve health
o Provide logic and structure for analysis of health problems
A case of food poisoning
 Epidemiology is a bit like detective work in that we try to find out why and how
disease occurs.
 Data collected from the cases can make it difficult to understand which food was
responsible
 One simple way to compare it is using percentage
 2 useful epidemiology measures:
Attack rate (Number of ill ppl/Total number of ppl)
o E.g. if 45% of ppl who ate hot chicken got sick. This is known as the attack rate
for hot chicken
i.e., 45% of hot chicken eaters were “attacked” by food poisoning
Relative risk (Comparing those who are ill vs not ill)
o E.g. If 45% of ppl ate hot chicken got sick compared to 32% of ppl who did not eat
hot chicken. Hot chicken eaters were 1.4 times more likely to get sick
(45%/32% = 1.4)
Subdisciplines of epidemiology
 Many different fields of epidemiology!
Examples: Perinatal, ID, Public Health, Environmental, Nuritional, Social
Environment, Eco, Molecular (how variations in genes contribute to disease
risks), Clinical (Focus on enhancing clinical decisions to benefit individual pts
instead of populations)
 Each subdiscipline has its own unique challenges
 Although many subdisciplines, core methods and techniques of epidemiology
remain common to all subdisciplines
On epidemics
 Epidemiology – “the study (of what is) upon the people’.”

 Set of questions that are the HEART of epidemiology:
o What disease/condition is present in excess?
 Epi is all about comparison, without some reference to what is
usual, how can we identify excess?
o Who is ill? (PERSON)
o Where do they live? (PLACE)
o When did they become ill? (TIME)
o Why did they become ill?
 Solving this question is critical for public health progress but there
is no simple solution to this
An historical epidemic
 This data provides actual human experience

o But the challenge is to use these data to describe the event
systematically in terms of whom this happened to (we have no data on
place or time) and then to think about the sort of event that might have
induced such a pattern.
 Understand how to look at patterns for this data
o Learn how to describe data, interpret the patterns you observed and use
epidemiological measures to help do this.
The beginnings
 History epidemiological practice and reasoning

 Example above shows why epi reasoning/practice important. Dr.Snow was able
to deduce that by removing pump handle (i.e. stop ppl from using that water
well), it reduced cholera
 Strong and substantial differences in risks shown in a data reflect POWERFUL
PREVENTIVE/protection factors (e.g. High SES vs low)
What does epidemiology offer?
 large part of public health is about:
o monitoring the health of a community
o identifying health problems (who is becoming ill, where and when?)
o identifying what is causing the problems and then testing possible solutions to
resolve or reduce the problem.
 Epidemiology is:
o fundamental in providing the data needed to make public health judgements
o data come from studies of ‘populations’ (groups of people) of all sorts and sizes.
o largely deals with descriptions and comparisons of groups of people (can vary
widely in their genetic, behaviour and environments)
o challenge for epidemiologists is to deal with multiple influences on health in a
systematic and logical way in order to produce practical info to improve health.
Epidemiology also offers:

1) Description of Health status population
 The observation and recording of health status makes it possible to identify sudden (and
not-so-sudden) changes in the level of disease over time
 Differences between groups of people in one area, between different geographical areas
or at different time periods, can also give clues regarding the causes of disease (or
health) in those groups
 These descriptive statistics are important for health authorities/planners to consider
intervention .
2) Causation
 Best-recognised use of epidemiology is in the search for the causes of disease

(E.g. genetic, environmental factors)
 FYI in epidemiology and public health world → Environmental factors: includes non-
genetic factors, including psychological, behavioural, social, cultural traits, environmental
exposures
 Almost always some interaction between genetic and environmental factors in the
causation of disease. Thus, epidemiological tools are central to the identification of
modifiable factors that will allow preventive interventions.
c) Evaluation of interventions
 Once factor identified that causes disease, we want to know whether we can reduce a
population’s exposure to this factor and so prevent the occurrence of disease – a
‘primary’ prevention programme
 Epidemiology plays role in this process:
o Evaluation of different treatments for a particular disease (an aspect of both
mainstream and clinical epidemiology)
o Assessments of the effectiveness of health services and policies.
d) Natural history and prognosis
 Epidemiologists are concerned with the course or natural history of a disease and the
likely outcome or prognosis, both in individuals and in groups.
 Such knowledge has obvious value for discussing treatment options with individual
patients, as well as for planning and evaluating interventions
What do epidemiologists do?
Descriptive studies: person, place and time
o Person – e.g. health differences between populations
o Place -e.g. how ‘healthy’ is any given country in relation to the rest of the world
o Time e.g. changing patterns of mortality in a country over time

 By studying patterns of disease and relating them to variations in risk factors for the
disease, we can develop possible reasons why some people or places have higher
rates of disease than others or why disease rates have changed over time.
 Assessing data sometimes requires changing measures from LINEAR --> LOG SCALE
o From textbook example:. Changing scale allows us to compare relative changes
in mortality rates directly, with parallel slopes reflecting equal rates of change.
o In public health we need to think on both relative and absolute scales: they tell us
different things that are useful for different purposes.
Analytic studies
 Descriptive epidemiology may generate ideas about what is causing disease which can
then be tested further in analytic studies (looking for associations between potential
causal agents and diseases)
o E.g. Are people with higher blood pressure more likely to develop coronary heart
disease than those with normal blood pressure?
Intervention studies
 Epidemiologists test new preventive measures, programmes or treatments to see if they

actually do reduce ill health or promote good health.

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Essential Epidemiology: An Introduction for Students and

Chapter 1 Notes – Epidemiology is…

 2 core strands of traditional epidemiology

A case of food poisoning

 Epidemiology – “the study (of what is) upon the people’.”

 This data provides actual human experience

 History epidemiological practice and reasoning

What does epidemiology offer?

 large part of public health is about:

o monitoring the health of a community

o identifying health problems (who is becoming ill, where and when?)

Epidemiology also offers:

 Best-recognised use of epidemiology is in the search for the causes of disease

d) Natural history and prognosis

What do epidemiologists do?

Descriptive studies: person, place and time

o Person – e.g. health differences between populations

o Time e.g. changing patterns of mortality in a country over time

 Epidemiologists test new preventive measures, programmes or treatments to see if they

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