Introduction To Epidemiology Dr. Abdikani Ali Mbbs

Introduction to epidemiology
Dr. Abdikani Ali

MBBS
Presentation contents:
1. Definition of epidemiology
2. Fundamental assumptions of epidemiology
3. Key terms and purpose of epidemiology
4. Objectives of epidemiology
5. Epidemiology and disease prevention
6. Clinical epidemiology
7. Epidemiological approach
8. Two main Types of Epidemiology
What is Epidemiology?
• Greek (English)
• epi (among)
• demos (people)
• logy (study)
• Epidemiology is the study of how disease is distributed in
populations and the factors that influence or determine this
distribution
• Epidemiology is defined “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”
• This broad definition of epidemiology can be further elaborated as
follows:
• Study; includes: surveillance, observation, hypothesis testing, analytic
research and experiments.
• Distribution; refers to analysis of: times, persons, places and classes
of people affected.
• Determinants; include factors that influence health: biological,
chemical, physical, social, cultural, economic, genetic and
behavioural.
• Health status or events; refer to: diseases, causes of death, behaviors
such as use of tobacco, positive health states, reactions to preventive
regimes and provision and use of health services.
• Specified population; include those with identifiable characteristics,
such as occupational groups.
• Application to prevention and control the aims of public health—to
promote, protect, and restore health.
Does epidemiology science or Art?
• Science is a creative endeavor
• It relies on questioning, imagination, exploration
• It seeks out empirical(experimental) evidence
• It tests ideas
• Study questions
• Hypotheses
Fundamental assumptions of epidemiology
• The premise underlying epidemiology is that disease, illness, and ill
health are not randomly distributed in human populations. Rather,
each of us has certain characteristics that predispose us to, or protect
us against, a variety of different diseases.

Key terms of epidemiology
• Endemic: expected rate of disease
• Epidemic: excess of expectation rate of disease
• Pandemic: Worldwide Epidemic
Purpose of Epidemiology
• To provide a basis for developing disease control and prevention
measures for groups at risk.
• This translates into developing measures to prevent or control disease.

The objectives of Epidemiology
• First, to identify the etiology or cause of a disease and the relevant

risk factors—that is, factors that increase a person’s risk for a
disease. We want to know how the disease is transmitted from one
person to another or from a nonhuman reservoir to a human
population. Our ultimate aim is to intervene to reduce morbidity and
mortality from the disease.
• Second; to determine the extent of disease found in the community.
What is the burden of disease in the community? This question is
critical for planning health services and facilities, and for training
future health care providers.

• Third; to study the natural history and prognosis of disease. Clearly,

certain diseases are more severe than others; some may be rapidly lethal
while others may have longer durations of survival. Still others are not
fatal. We want to define the baseline natural history of a disease in
quantitative terms so that as we develop new modes of intervention, either
through treatments or through new ways of preventing complications.
• Fourth; to evaluate both existing and newly developed preventive

and therapeutic measures and modes of health care delivery.
• Fifth; to provide the foundation for developing public policy

relating to environmental problems, genetic issues, and other
considerations regarding disease prevention and health promotion.
Epidemiology and Prevention
• A major use of epidemiologic evidence is to identify subgroups in the
population who are at high risk for disease.
Why should we identify such high-risk groups?
• First, if we can identify these high-risk groups, we can direct
preventive efforts, such as screening programs for early disease
detection, to populations who are most likely to benefit from any
interventions that are developed for the disease
Epidemiology and Prevention
• Second, if we can identify such groups, we may be able to identify the
specific factors or characteristics that put them at high risk and then
try to modify those factors.
• It is important to keep in mind that such risk factors may be of two
types:
Non-modifiable factors: such as age, sex, and race, for example, are
not modifiable, although they may permit us to identify high-risk
groups
Modifiable factors; such as obesity, diet, and other lifestyle factors
may be potentially modifiable.
Primary Prevention
• Primary prevention denotes an action taken to prevent the development

of a disease in a person who is well and does not (yet) have the disease
in question. For example, we can immunize a person against certain
diseases so that the disease never develops or, if a disease is
environmentally induced, we can prevent a person’s exposure to the
environmental factor involved and thereby prevent the development of the
disease. Primary prevention is our ultimate goal.
Secondary prevention
• Secondary prevention involves identifying people in whom a disease process has
already begun but who have not yet developed clinical signs and symptoms of the
illness. This period in the natural history of a disease is called the preclinical phase of
the illness.
• Our objective with secondary prevention is to detect the disease earlier than it would
have been detected with usual care. By detecting the disease at an early stage in its
natural history, often through screening, it is hoped that treatment will be easier and/or
more effective.
Secondary prevention
• The rationale for secondary prevention is that if we can identify

disease earlier in its natural history than would ordinarily occur,
intervention measures will be more effective. Perhaps we can prevent
mortality or complications of the disease and use less invasive or less
costly treatment to do so.
Tertiary prevention
• Tertiary prevention denotes preventing complications in those who have

already developed signs and symptoms of an illness and have been
diagnosed—that is, people who are in the clinical phase of their illness.
• This is generally achieved through prompt and appropriate treatment of

the illness combined with ancillary approaches such as physical therapy
that are designed to prevent complications such as joint contractures.
Two Approaches to Prevention: A Different
View
Two possible approaches to prevention are
a) a population-based approach and
b) a high-risk approach.
Population-based approach
• In the population-based approach, a preventive measure is widely

applied to an entire population. For example, prudent dietary advice
for preventing coronary disease or advice against smoking may be
provided to an entire population.
High-risk group approach
• An alternate approach is to target a high-risk group with the preventive

measure. Thus, screening for cholesterol in children might be restricted to
children from high-risk families. Clearly, a measure that will be applied to
an entire population must be relatively inexpensive and noninvasive.
• A measure that is to be applied to a high-risk subgroup of the population

may be more expensive and is often more invasive or inconvenient.
High-risk group approach
• Population based approaches can be considered public health

approaches, whereas, high-risk approaches more often require a
clinical action to identify the high risk group to be targeted. In most
situations,
• A combination of both approaches is ideal.

Clinical Epidemiology
• Clinical Epidemiology is the application of principles of epidemiology
to clinical medicine.
• The science of making predictions about individual patients by
counting clinical events in groups of similar patients and using strong
scientific methods to ensure that the predictions are accurate.
• The purpose of clinical epidemiology is to develop and apply methods
of clinical observation that will lead to valid conclusions by avoiding
being misled by systamatic error and the play of chance.
The Epidemiologic approach
• How does the epidemiologist proceed to identify the cause of a disease?

Epidemiologic reasoning is a multistep process.
• The first step is to determine whether an association exists between exposure

to a factor (e.g., an environmental agent) or a characteristic of a person (e.g.,
an increased serum cholesterol level) and the development of the disease in
question. We do this by studying the characteristics of groups and the
characteristics of individuals.
The Epidemiologic approach
• If we find there is indeed an association between an exposure and a

disease, is it necessarily a causal relationship? No, not all associations are
causal.
• The second step, therefore, is to try to derive appropriate inferences about

a possible causal relationship from the patterns of the associations that
have been found. These steps are discussed in detail in later chapters.
Two Broad Types of Epidemiology
• Descriptive Epidemiology
• Examining the distribution of disease in a
population, and observing the basic features of
its distribution
• Analytic Epidemiology
• Testing a hypothesis about the cause of disease
by studying how exposures relate to the disease
Descriptive epidemiology: applications
Studying the frequency

and distribution of disease
To generate hypotheses To inform local public

about causes health action
(the academic focus) (the service focus)
Descriptive Epidemiology is the Antecedent to
Analytical Epidemiology
• Analytic epidemiology studies require information to ….

• know where to look
• know what to control for
• develop viable hypotheses
Three essential characteristics of disease
that we look for in descriptive studies are...
•Person
•Place
•Time
Person
• Age, gender, ethnicity

• Genetic predisposition
• Concurrent disease
• Diet, exercise, smoking
• Risk taking behavior
• SES, education, occupation
Place
• Geographic place
• presence or agents or vectors
• climate
• geology
• population density
• economic development
• nutritional practices
• medical practices
Time
• Calendar Time
• Time since an event
• Physiologic cycles
• Age (time since birth)
• Seasonality
• Temporal trends
Analytical epidemiology
Descriptive epidemiology
+
Focus on cause and effect
=
“analytical epidemiology”
Three essential characteristics that are examined to study the
cause(s) for disease in analytic epidemiology are...
•Host
•Agent
•Environment
Reference
• Gordis, L. (2014). Epidemiology (Fifth edition.). Philadelphia, PA:
Elsevier Saunders.

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Introduction to epidemiology

Dr. Abdikani Ali

• Epidemiology is the study of how disease is distributed in

populations and the factors that influence or determine this

• The premise underlying epidemiology is that disease, illness, and ill

health are not randomly distributed in human populations. Rather,

each of us has certain characteristics that predispose us to, or protect

us against, a variety of different diseases.

• To provide a basis for developing disease control and prevention

measures for groups at risk.

• This translates into developing measures to prevent or control disease.

• First, to identify the etiology or cause of a disease and the relevant

• Second; to determine the extent of disease found in the community.

What is the burden of disease in the community? This question is

future health care providers.

• Third; to study the natural history and prognosis of disease. Clearly,

• Fourth; to evaluate both existing and newly developed preventive

• Fifth; to provide the foundation for developing public policy

• Primary prevention denotes an action taken to prevent the development

• The rationale for secondary prevention is that if we can identify

• Tertiary prevention denotes preventing complications in those who have

• This is generally achieved through prompt and appropriate treatment of

a) a population-based approach and

• In the population-based approach, a preventive measure is widely

• An alternate approach is to target a high-risk group with the preventive

• A measure that is to be applied to a high-risk subgroup of the population

• Population based approaches can be considered public health

• A combination of both approaches is ideal.

• How does the epidemiologist proceed to identify the cause of a disease?

• The first step is to determine whether an association exists between exposure

• If we find there is indeed an association between an exposure and a

• The second step, therefore, is to try to derive appropriate inferences about

Studying the frequency

To generate hypotheses To inform local public

• Analytic epidemiology studies require information to ….

• Age, gender, ethnicity

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