EPIDEMIOLOGY

DR. VIKRANT KABIRPANTHI

1st year resident of Department of
Community Medicine NSCB Medical College Jabalpur
Email:- drvikrantpsm@gmail.com
Mob:- 919981293674
DEFINITION
The study of distribution
&determinants of health related
states or events in specified
population & the application of this
study to the control of health
problem.
Component of epidemiology

1. Disease frequency
2. Distribution of disease
3. Determinant of disease
FREQUENCY OF DISEASE
MEASURED IN RATE OR RATIO .
USED FOR COMPARISION WITH OTHER OR SAME
GROUP
VITAL STEPS IN MAKING STRATEGIES FOR
PREVENTION & CONTROL OF HEALTH PROBLEM
DISTRIBUTION OF DISEASE
Basic tenet of epidemiology is that the distribution of
disease occur in pattern in a community. In terms of
time, place & person.
It is used to generate hypotheses about causative agent
or risk factors.
This aspect of epidemiology is known as descriptive
epidemiology.
DETERMINENT OF DISEASE
The unique feature of epidemiology is to test
etiological hypotheses & identify the underlying cause
of disease .
This aspect of epidemiology is known as analytical
epidemiology.
Analytical studies help in
1. Developing scientifically sound health programme
2. Intervention
3. Policies
Aims of epidemiology
To describe the distribution & magnitude of health
and disease problem in human population
To identify etiological factors in the pathogenesis of
disease
To provide the data essential to the planning
implementation & evaluation of services for the
prevention , control & treatment of disease also fixing
priorities.
EPIDEMIOLOGICAL APPROACH

TWO MAJOR FOUNDATIONS

1. ASKING QUESTION
2. MAKING COMPARISION
ASKING QUESTION
RELATED TO HEALTH EVENT
1. What is the event?
2. What is the magnitude?
3. Where did it happen ?
4. When did it happen?
5. Who are affected ?
6. Why did it happen ?
RELATED TO HEALTH ACTION
What can be done to reduce this problem & its
consequence ?
How can be prevented in future?
What action should be taken by the community? By
the health services? By other sector? Where & for
whom these activities is to be carried out?
What resources are required? How are the activates be
carried out ?
What are the difficulties & how they will be solved?
MAKING COMPARISION
Basic approach in epidemiology is to make
comparison & draw inferences.
It yields the difference in the host & environmental
factor between those affected & not affected.
 some example:-
Randomization in RCT
Matching in CASE CONTROL & COHORT STUDIES.
Also standardization
BASIC MEASUREMENT IN EPIDEMIOLOGY
1. Mortality
2. Morbidity
3. Disability
4. Natality
5. Health related events
6. Demographic variables
7. Environmental factors
VARIATE :- Any piece of information referring to
patient or his disease is called variate.
It is of two type
1. Discrete
2. Continuous
 CIRCUMSTANCES:- Any factor in the environment
that might be suspected of causing disease e.g., air
pollution polluted water
The frequency of discrete variable or
circumstances can be expressed as a rate in
relation to population .

The frequency of continuously distributed

variables or circumstances is expressed in the form
of a frequency distribution using the summarizing
indices mean, centile, standard deviation .
TOOLS OF MEASUREMENT
1. Rate
2. Ratio
3. Proportion
RATE
Rate measures the occurrence of some particular event in a
population during a given time period.
The “rate” is basically a proportion, but with an added
relationship with time.
Rate has three element
1. Numerator
2. Denominator
3. Multipliers
 Rate has three categories
1. Crude rate:- eg death & birth rate
2. Specific rate:- eg specific causes(tuberculosis)
3. Standardized rate :- calculated by direct & indirect method.
RATIO
Relation between two random qualities
Numerator is not a component of
denominator
Example
1. sex-ratio
2. Child –women ratio
3. Doctor population ratio
PROPORTION
INDICATE THE RELATION IN MAGNITUDE OF
A PART OF THE WHOLE
NUMERATOR IS INCLUDED IN DENOMINATOR
NUMERATOR:- TOTAL EVENT
DENOMINATOR:-
RELATED TO POPULATION
RELATED TO TOTAL EVENT
Numerator
Numerator refers to the numbers of times an event
has occurred in a population , during specific time
period.
Part of denominator in rate but not in ratio.
Denominator
1. Population related
2. Event related
Population related
Mid year population
Population at risk
Person time
Person distance
Sub group of population
Event related

For example

Infant mortality rate

Case fatality rate

MORTALITY RATE & RATIO
CRUDE DEATH RATE:

 NO. OF DEATH PER 1000 MID YEAR POPULATION IN

ONE YEAR IN A GIVEN PLACE.

MEASURE THE RATE AT WHICH DEATH ARE

OCCURING FROM VARIOUS CAUSES IN A GIVEN
POPULATION
NO. OF DEATH DURING YEAR x1000
MID YEAR POPULATION
SPECIFIC DEATH RATE
 CAUSE OR DISEASE SPECIFIC
RELATED TO SPECIFIC GROUP

INFORM ABOUT GROUP AT RISK

PERMIT COMPARISION BETWEEN SAME
POPULATION
CASE FATALITY RATE(RATIO)
REPRESENT KILLING POWER OF DISEASE
RATIO DEATH TO CASES
USED IN ACUTE INFECTIONS
 HOW IT IS DIFFERENT FROM MORTALITY RATE ?
IN MR, DENOMINATOR INCLUDE DISEASED +
NON DISEASED
ALSO MEASURE ANY BENEFIT FROM NEW
THEARPY
PROPORTIONAL MORTALITY RATE (RATIO)
CALCULATED FOR BROAD DISEASE GROUP
USED WHEN POPULATION DATA IS NOT
AVAILABLE
SURVIVAL RATE
IT IS PROPORTION OF SURVIVOR IN A GROUP
STUDIED & FOLLOWED OVER A PERIOD

IT IS CALCULATED FROM DATE OF DIAGNOSIS

OR DATE OF START OF TREATMENT.

ASSESMENT OF STANDERED OF THERAPY.

SPECIAL ATTENTION ON CANCER STUDIES.

MEASUREMENT OF MORBIDITY
Morbidity is defined as any departure , subjective or
objective , from the state of physiological well being.
Morbidity can be measure in terms of :-
a) Person who are ill
b) Period or spells of illness
c) Duration of illness of these illness
 These three aspect are measured in terms of
1. Frequency
2. Duration
3. Severity
Frequency is measured in terms of incidence & prevalence .

Duration is measured in terms of average number of illness

Severity of the disease is indicated by case fatality rate.

Incidence
Defined as number of new cases in defined population
during specific period of time.
Time is expressed in final expression.
 multiplier is arbitrally taken for shake of convenience
Incidence is measure of risk in a specific group.
Denominator represent people at risk.
Two type of denominators
1. People at risk observed for full time
2. People at risk not observed for full time.
 DID NOT HAVE THE DISEASE

DEVELOPED DISEASE {NEW INCIDENCE

DID NOT DEVELOPED DISEASE
CASES}
Cumulative incidence
The incidence rate calculated using a period of time
during which all of the individuals in the population
are considered to be at risk for the out come is called as
CUMULATIVE INCIDENCE
Also measure of risk .
Used for short term time interval follow up
Incidence density
When different individuals are observed for different
length of time incidence rate we calculate is known as
INCIDENCE DENSITY
Denominator is sum of unit of time for which each
individual at risk was observed. Called as person time
USES OF INCIDENCE
1. When studying the natural history of a disease (e.g. natural
history of the course of HIV infection) or the course of a
natural phenomena (e.g. growth and development of children).
2. When evaluating a prognostic factor.
3. When assessing the role of a risk factor in a disease, especially
after initial prevalence studies have given an indication of an
association.
4. When evaluating the effectiveness of a treatment modality.
5. When evaluating the effectiveness of a preventive modality.
6. When evaluating the effectiveness of a screening programme.
PREVALENCE
The total no of all individuals who have an attribute or
disease at a particular time(or period of time) divided
by the population at risk of having the attribute or
disease at this point of time or mid way through the
period.
Prevalence is of two type
1. Point prevalence
2. Period prevalence
Point prevalence
No. of all current cases (old & new)of a disease at one
point of time in relation to defined population

no. of all current cases of a specified population at

point of time
= x100
estimated population at same point of time
Period prevalence
It measure the frequency of all current cases existing
during a defined period of time expressed in relation
to a defined population

no. of existing cases of a specified disease during a

given period of time interval
= x100
estimated mid – interval population
USES OF PREVELENCE
When assessing the “load” of a disease or risk factor in
a community or in a health care facility.
For planning the health and hospital services.
Prevalence helps us in deciding the correct clinical
approach, based on the “commonness” as shown by
prevalence
Prevalence measures help the clinician become aware
of new diseases in a population, and the particular
age / sex/ occupational groups
Prevalence measures are good for development of
hypothesis regarding a possible exposure - outcome
relationship and also for initial exploration of a
hypothesis through cross – sectional analytic studies.
REFRENCES-
PARK 20th EDITION
TEXT BOOK OF PUBLIC HEALTH
LEON GORDIS 4th EDITION
THANK
YOU