NUR 3209

PRINCIPLES OF EPIDEMIOLOGY

EPIDEMIOLOGICAL METHODS
This is the various processes used by epidemiologists in studying the distribution and
determinants of health related states and events in a specific population. The different methods
used by epidemiologists in conducting their studies are as follows.
A. Observational studies
1. Descriptive studies
 Correlational studies
 Case series/Report
 Cross sectional studies
2. Analytic Studies
 Case control studies
 Cohort studies
B. Experimental/Interventional studies
 Clinical trials
 Field trials
 Community trials
1. OBSERVATIONAL STUDIES
In observational studies, the person investigating observes and documents what he observed
without changing anything. It can be descriptive or analytic.

i. Descriptive Studies
The purpose of descriptive studies is to observe, describe, and document aspects of a situation as
it naturally occurs and sometimes to serve as a starting point for hypothesis generation or theory
development. This is further subdivided into correlational, case series/report and cross sectional
studies

 Correlational studies
This is the simplest and earliest study in epidemiology. It involves the study of the total
population which is a unit of study. It involves comparison of per capital population

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 relating to an event e.g cigarette smoking which may lead to cancer of the lungs per
capital consumption of meat which may lead cancer of the colon and comparing with
another population you may want to consider.
They are important in generating hypothesis but the same cannot be said in testing
hypothesis. Another importance is that it is very easy and fast to conduct. It cannot be
used to estimate or test individual risk but it is relatively cheap.

Correlational study research attempts to understand relationships among phenomena as

they naturally occur, without any intervention. Ex post facto research is more often
referred to as co-relational research. Basically, a correlation is an interrelationship or
association between two variables, that is, a tendency for variation in one variable to be
related to variation in another. For example, in human adults, height and weight are
correlated because there is a tendency for taller people to weigh more than shorter people.
 Case report/Series
This type of study is frequently conducted in hospital settings.

Case report: This is conducted by describing a very classical case of a particular disease e.g
one that has come out with all the possible manifestations and even complications. It
involves the management and even complications of the case. This case may be typical or
atypical in presentation.

Case series: This deals with a group of cases that have the same presentation. It is also used
to generate hypothesis, it is fast and relatively cheap. It cannot be used to make
generalization with all cases.

 Cross sectional study/Prevalence study

It has often being referred to a snap shot of event i.e it involves only the risk factors and the
outcome at the same time. It involves going to collect data of an event or a case and that is all e.g
in studying diarrheal disease in a community, it involves the observation of common cause of
diarrhea and the number of children coming with diarrheal disease.

One problem with this study is that it can be difficult in linking the risk factors and the outcome
of a case. It is used to generate hypothesis, it is fast and cheap but it does not usually involve a

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follow up of the observed cases. This method can give an idea of time, place and the number of
persons that are involved (TPP)

Cross-sectional designs involve the collection of data at one point in time: the phenomena under
study are captured during one period of data collection. Cross-sectional studies are appropriate
for describing the status of phenomena or for describing relationships among phenomena at a
fixed point in time. For example, we might be interested in determining whether psychological
symptoms in menopausal women are correlated contemporaneously with physiologic symptoms.
In cross-sectional studies designed to study change, there are frequently several alternative
explanations for the research findings—and that is precisely what good research design tries to
avoid.
ii. Analytic Studies
Analytic studies help to answer the questions how and why. It can be used to test hypothesis. It
includes case control studies and cohort studies.

 Case control studies

This involves defining a case, having a control with features leading to matching i.e the control
should be similar in characteristics with the case apart from the presence of disease. E,g of
matching include age, sex etc

There are two types of matching

1. Individual matching which is time consuming and hectic

2. Group matching e.g under 5 children. This is necessary to avoid bias and confounders
Case control involves comparing established or diagnosed cases to the control. E.g in case
control study of lung cancer, you first recruit cases with lung cancer and those without lung
cancer. Then you go to their history which one of them smoke ie the risk factors. Eventually the
result may reveal that there are smokers both in the case and control.

A case definition will help you to know who will be your case because some diseases have
changes which may be anthropometrically based, age new cases or newly diagnosed cases.

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Therefore the first thing to do in case control study is case definition. Then getting the control
and matching in which the control should have similar features with the cases in terms of age,
sex, socio economic status.

Case Control

Non Smokers Non

Smokers smokers smokers

A B C D

From case and control you will eventually come with 4 groups. You then draw a 2x2
contingency table

Case Control Total

Disease Present Disease Absent
Exposed A B A+ B
Not Exposed C D C+D
Total A+C B+D A +B+C+D
In case control study, when you want to estimate the strength of association between the risk
factors and the disease in order to get the odd ratio. To calculate the odd ratio

Odd Ratio OR = AD
BC

Interpreting odd ratio

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If the odd ratio is 1 it shows that there is no association or relationship between risk factor and
the disease. But if it is more than 1, it shows that there is an association between the risk factor
and the disease. The association increases as the number increases. But if the odd ratio is less
than 1, it shows that the risk factor is beneficial or protective to the disease.

Advantages of case control study

1. It is relatively easy to conduct

2. It is fast and cheap
3. It requires comparatively few subjects
4. There is no risk in the subjects
5. No attrition problem
6. It is useful to investigate rare diseases
7. Other etiological/risk factors can be examined at the same time ie more than one risk
factor can be examined at the same time
8. There is minimal ethical problems
Disadvantages
1. It has the problem of bias as it relies so much on past records
2. To select an appropriate control group might be difficult
3. Incidence cannot be calculated from the case control studies and because of this
incidence not being able to be calculated, you use an estimate using odd ratio
Relative risk is the incidence of that disease among exposed individual all over incidence among
non- exposed individuals. Relative risk cannot be calculated in a case control study because
incidence cannot be calculated, there are no new cases and risk group