Introduction To Epidemiology

Introduction to Epidemiology
Background
• We can study health and disease by
-Observing effects on individuals
• Laboratory investigation of experimental animals
• Measuring the distribution of health problems in the
population
Origin
“Epidemiology” from Greek :
Epi = upon; Demos = people
‘epidemic’ = “upon the people” , Logos = study
Epidemiologists first concern was to investigate, control
and prevent epidemics
Two basic assumptions about disease:
• Disease does not occur at random
• Disease has causal and preventive factors
What is epidemiology?
• Epidemiology is a fundamental science of public
health.
• Epidemiology has made major contributions to
improving population health.
• Epidemiology is essential to the process of identifying
and mapping emerging diseases.
What is epidemiology?
• Epidemiology is “the study of the distribution and
determinants of health-related states or events in
specified populations, and the application of this
study to the prevention and control of health
problems”
Epidemiology and public health
• Public health, broadly speaking, refers to collective
actions to improve population health.
• Epidemiology, one of the tools for improving public
health, is used in several ways.
• Early studies in epidemiology were concerned with the
causes (etiology) of communicable diseases, and such
work continues to be essential since it can lead to the
identification of preventive methods.
Causation of disease
• Although some diseases are caused solely by genetic
factors, most result from an interaction between genetic
and environmental factors.
• Diabetes, for example, has both genetic and environmental
components.
• Environment broadly includes any biological, chemical,
physical, psychological, economic or cultural factors
affecting this interplay, and epidemiology is used to study
their influence and the effects of preventive interventions
Natural history of disease
• Epidemiology is also concerned with the course and outcome (natural
history) of diseases in individuals and groups
Natural history of disease
Health status of populations
• Epidemiology is often used to describe the health status of
population groups.
• Knowledge of the disease burden in populations is essential for
health authorities, who seek to use limited resources to the
best possible effect by identifying priority health programmes
for prevention and care.
• In some specialist areas, such as environmental and
occupational epidemiology, the emphasis is on studies of
populations with particular types of environmental exposure.
Health status of populations
• Describing the health status of populations
Evaluating interventions
• Epidemiologists can evaluate the effectiveness and efficiency
of health services
• This means determining things such as the appropriate length
of stay in hospital for specific conditions, the value of treating
high blood pressure, the efficiency of sanitation measures to
control diarrhoeal diseases
Evaluating interventions
• Applying epidemiological principles and methods to
problems encountered in the practice of medicine has
led to the development of clinical epidemiology
pharmacoepidemiology, molecular epidemiology, and
genetic epidemiology
Molecular and genetic epidemiology
Molecular epidemiology measures exposure to specific

substances and early biological response, by:
• evaluating host characteristics mediating response to
external agents, and
• using biochemical markers of a specific effect to refine
disease categories.
Genetic epidemiology deals with the etiology, distribution, and
control of disease in groups of relatives, and with inherited
causes of disease in populations.
Genetic epidemiological research in family or population studies
aims to establish:
• a genetic component to the disorder,
• the relative size of that genetic effect in relation to other
sources of variation in disease risk, and
• the responsible gene(s).
Public health genetics include:
• population screening programs,
• organizing and evaluating services for patients with genetic
disorders, and
• the impact of genetics on medical practice.
Classification
Two broad categories:
a) Descriptive epidemiology: the study of the frequency
(amount) and distribution of health related states
within a population by person, place and time
b) Analytic epidemiology: more focused study of health
related problems or reasons for relatively high or low
frequency in specific groups.
Epidemiological questions
To describe the occurrence of disease fully, some broad
questions must be asked:
a) Who is affected?
b) When do the cases occur?
c) Where do the cases occur?
d) What health events are occurring
e) Why is it occurring
f) How can it be influenced
Epidemiology Definition (cont’d)
Distribution
• characterizing the distribution of health status
in terms of age, gender, race etc.
Determinants
• any factor that brings about a change in a
health condition or other defined outcomes.
Epidemiology Definition (cont’d)
Disease
• deviation from physical, mental or emotional health expands to
include conditions such as injuries, birth defects, health
outcome etc.
Population
• group of people often geographically defined
Determinants of disease occurrence: includes
both causes and factors that influence the risk
of disease
Determinants of disease
• Disease is as a result of the epidemiologic triad
(Agent, Host and Environment)
• Infection occurs only when the AGENT is encountered
by a susceptible Host in an ENVIRONMENT that is
favourable
DYNAMICS OF DISEASE TRANSMISSION
• Human disease does not arise

in a vacuum.
• It results from an interaction of
the host (e.g. a person), the
agent (e.g. a bacterium) and
the environment (e.g.
contaminated water supply)
HOST
VECTOR
ENVIRONMENT
AGENT
Distribution of disease
• Frequencies of values or categories of measurement with
respect to time, place and persons
• Involves measuring disease distribution
• Requires information
- count (quantification)
- size of population
- time period
Frequency
• Involves measuring disease distribution
• Requires mathematical calculation
- ratio
- proportion
- rate
Uses of Epidemiology:
• Historical study - is community health getting better
or worse? We can only decide by comparing
experiences over time.
• Community diagnosis
• Working of health services
- availability, accessibility, utilization, effectiveness, efficacy,
efficiency
• Individual risks and chances of getting disease
• Completing the clinical picture
- constructing a model
• Identification of syndromes “lumping and splitting”
• Search for causes
• Evaluation of presenting s/s of disease
- by analysing data in hospital charts
• Clinical decision making - involves use of decision
trees
Achievements in epidemiology
Smallpox
• An understanding of the epidemiology of smallpox was central to its
eradication, in particular, by:
• providing information about the distribution of cases and the model,
mechanisms and levels of transmission;
• mapping outbreaks of the disease;
• evaluating control measures
Achievements in epidemiology
• Rheumatic fever and rheumatic heart disease
• Iodine deficiency diseases
• Tobacco use, asbestos and lung cancer
• Hip fractures
• HIV/AIDS
• Sudden acute respiratory syndrome (SARS)
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Introduction to Epidemiology

Molecular epidemiology measures exposure to specific

• Human disease does not arise

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