Good Morning !

1
Descriptive
EPIDEMIOLOGY

Dr. Manoj Jain MDS (Public Health Dentistry ) Student

Bhabha Dental College Bhopal
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 Bhabha College Of Dental Sciences, Bhopal

Guided By -
Prof. Dr. Neeraj S Chauhan

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How we view the
world…..

Pessimist: The glass is half empty.

Optimist: The glass is half full.

Epidemiologist: As compared to what ?

 CONTENTS

 Introduction
 History of epidemiology
 Aims and objective
 Principles of epidemiology
 Epidemiological approach
 Descriptive epidemiology.
 Conclusion
 References

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 INTRODUCTION

Epidemiology is the basic science of preventive and social

medicine.

Deals with study of-

 disease distribution
 causation
 health and health related events
 MEANING OF EPIDEMIOLOGY

Word is derived from Greek language -

EPI – upon
DEMOS – people
LOGY - study
 HISTORY

 Adam and eve The story of forbidden fruit…

 Hippocrates(460 – 375 BC ) was the first known epidemiologist.

 “No disease is sent by evils or demons, but is the result of natural

causes”-

 Claudius galen (130 – 200 AD) said that “ reason alone discovers some
things: experience alone discovers some things: but to find others,
requires both experience and reason.

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 Thomas syndenham (1624 - 1689): wrote the history of disease and
became the “founder of epidemiology”.

 John snow (1813- 1858): is considered the

“father of epidemiology” epidemic of cholera in London, in august
1854.

 William budd (1811 - 1880): studied the typhoid.

 Winslow and Sedgwick lectured epidemiology in 1920.

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 W.H Frost became the first professor of epidemiology in 1927.

 In 1941, Mc Alistair Gregg through epidemiologic study proved

rubella and congenital cataract.

 Foundation of epidemiology was laid down in 19th century.

 R.doll and A. Bradford hill (1950, 1964): smoking with carcinoma of

lung.

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 DEFINITIONS OF EPIDEMIOLOGY

 PARKIN (1873) :-
Defines epidemiology as “ the branch of medical science which
deals with the treatment of epidemics”.

 MAC MOHAN AND PUGH(1960):-

Defines epidemiology as “ the study of the distribution and
determinants of disease frequencies in man.

 CLARK E.G (1965) :-

Has given good present day definition of epidemiology as “ science
concerned with the study of factors that influence the occurrence and
distribution of health, disease, defect, disability or death in groups of
individuals”. 11
 AMERICAN EPIDEMIOLOGICAL SOCIETY
“ the science which concerns itself with the natural history of
disease as it is expressed in groups of persons related by some
common factors of age, sex, race, location or occupation as distinct
from development of disease in individuals”.
 JOHN M LAST (1988)
“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 control of health problems.”

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 SOME IMPORTANT DEFINITIONS

 Endemic: a disease that exists permanently in a particular

region or population. Ex-Tuberculosis in India.
 Epidemic: An outbreak of disease that attacks many peoples at
about the same time and may spread through one or several
communities. Ex- swine flu.
 Pandemic: When an epidemic spreads throughout the large
population and covering the large geographic area. Ex-
Influenza pandemics of 1918, cholera in 1962.Corona virus
infectious disease in 2019(COVID 19)
 On 11th March 2020 WHO characterized COVID 19 as
Pandemic
 Sporadic: Cases occur irregularly, haphazardly from time to
time, and generally infrequent. Ex- polio, tetanus.

 Incidence: “ No. of NEW cases occurring in a defined

population during a specified period of time”.

 Prevalance: “all current cases (new & old) existing at a given

point of time in a given population”.
COMPONENTS OF EPIDEMIOLOGY

DISEASE FREQUENCY

DISTRIBUTION OF DISEASE

DETERMINANTS OF DISEASE
 EPIDEMIOLOGICAL TRIAD

 Host

 Agent

 Environment
 AIMS OF EPIDEMIOLOGY

 As stated by International Epidemiologic Association ( IEA ).

 To describe the magnitude and distribution of the disease problem
in human populations.
 To provide data essential for planning, implementation, and
evaluation of health services and setting priorities among the
services.
 To identify risk factor or etiological agents.

 The ultimate aim of epidemiology is

 To eliminate or reduce the health problem or its consequences and
 To promote the health and well being of society as a whole.

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 OBJECTIVES OF EPIDEMIOLOGY

 To collect, collate and analyze all data relating to agent, host and
environment – to describe epidemiological situation.

 To further analyze and describe occurrence, distribution and nature

of disease- constitute social and geographical pathology of disease.

 To probe into – in order to fill gaps for causal factors and its role at
different stages – where disease is multifactorial.

 To help administrators to channel their policies to serve various
groups of population – to meet their needs

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 PURPOSE OF EPIDEMIOLOGY

1. Distribution and magnitude of health and disease

problems.
2. Identify causes and risk factors for disease.
3. Study natural history and prognosis of disease.
4. To provide data essential for planning, implementation
and evaluation of services.
 PRINCIPLES OF EPIDEMIOLOGY

 Exact observation

 Correct interpretation

 Rationale explanation

 Scientific construction

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 STRATEGY OF EPIDEMIOLOGY

MAC MOHAN AND PUGH:

Descriptive epidemiology

 Formulation of hypothesis

 Analytical epidemiology

 Experimental epidemiology
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 EPIDEMIOLOGICAL APPROACH

Asking questions Making comparisons

Related to health events. Related to health action

•What can be done
•What is the event
•How can it be prevented in future
•What is its magnitude
• what action taken by comm, health
•Where did it happen
services, other sectors, where and whom
•When did it happen services carried out
•Who are affected •What resources are required
•Why did it happen •How activities are to be organized
•What difficulties may arise and how to over
come.
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 MAKING COMPARISIONS

 Comparability ( in age, sex,& other pertinent variables)

 Matching (done for selected characteristics that might

confound the interpretations of the results )

 Standardization ( limited to age sex and parity )

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 BASIC MEASUREMENT IN EPIDEMIOLOGY

1.Acceptable
and applicable
2.Precise and Definition of What is to be measured
valid Criteria by which it can be measured
3. Clear

Measure in epidemiology
• Mortality Requirements.
• Morbidity •Validity
• Natality •Reliability
• Presence or absence of
•Accuracy
characteristic attributes of
disease.
•Sensitivity
• Medical needs, health •Specificity
care facilities, utilization
of health services and Tools of measurements
other Environmental •Rates
factors •Ratios
• Demographic variables. •Proportions
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 TOOLS OF MEASURMENT

It measures the development of

particular event in a population at given
period of time.
•Risk of developing a condition.
•It indicates change in some event.

Rates

Death rate:
No. of deaths in one year ×1000
Mid- year population
Various categories of rates:
1. Crude rates (unstandardized rates)
2. Specific rates.
3. Standardized rates
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•It expresses a relation in size between
the random quantities.
•Numerator is not a component of
denominator.
Ratio
•Numerator and denominator involve the
time interval.
•WBCS: RBCS 1:600
•X:Y or x / y
•Sex ratio, doctor population ratio.

•Is a ratio which indicates the relation in

magnitude of a part of the whole.

Proportion •Numerator is always included in the

denominator.

No of children scabies at certain time

x100
Total no of children in that village at the same
time 26
 MEASUREMENT OF MORTALITY

 Crude death rate

 The number of deaths per thousand people in a population in a
given year.
 It is easy to calculate

 The level of mortality is used as a public health indicator.

Number of deaths
in a year in a population
X 1000
Mid- year population

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 Specific death rates
 Cause or disease specific- Eg. COVID 19 ,Tuberculosis,
HIV/AIDS, accident etc.
 Related to specific groups- Eg. Age specific, sex specific,
profession specific etc.
 Specific death rates help to identify
 Etiology
 Groups at risk
 Specific death rate due to COVID 19
 Specific death rate for males
No. of deaths of males in a year
X 1000
Mid- year population of males
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  Infant mortality rate

No. of live- born infants who

die before age 1 in a year
X 1000
No. of live births in the year
 Perinatal mortality rate

No. of still births and deaths

within 7 days of life in a year
X 1000
No. of still births + live births in the year

 Maternal mortality rate

No. of deaths ass. with pregnancy

or child birth in a year
X 1000
No. of live births in the year 29
 Case fatality rate

Total no. of deaths

Due to a disease
X 100
Total no. of cases of
the same disease
 Proportional mortality rate

No. of deaths due to

a disease in a year
X 100
Total no. of deaths
In that year

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 STANDARDIZED RATES

 The overall rates adjusted for the effects of differences in population

 Composition, such as in age, sex etc.
 For comparison between two populations with different compositions
 Direct standardization
 Indirect standardization.

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 MEASUREMENT OF MORBIDITY

 “Any departure, subjective or objective, from a state of physiological well

being”- WHO

 Can be measured in terms of

 frequency, duration & severity

 Uses of morbidity data

 Describe extent & nature of the disease and thus help in determining
priorities
 Provide information, which is more useful for basic research than that of
morbidity data
 A starting point for etiological studies
 Useful for monitoring & evaluating disease control activities.
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 INCIDENCE AND PREVALENCE

 Incidence – it is defined as the number of new cases occurring in a defined

population during a specified period of time.

 Number of new cases of specific disease during in a defined population

during a given time period
× 1000
Population risk at that period

 Incidence rate refers to

 Only to new cases
 During a given period (usually one year)
 Population at risk
 Also refers to spells of diseases arising.
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 SPECIAL INCIDENCE RATES

 Attack rate
An attack rate is an incidence rate usually expressed in percentage,
used only when the population is exposed to risk for a limited period of
time such as during epidemic.
 Secondary attack rate
Defined as exposed persons developing the disease within the
range of the incubation period following exposure to a primary case.

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 USES OF INCIDENCE RATES

 Helps in taking action to control the disease.

 Give clues to research in to etiology and pathogenesis of disease.

 Helps in the study of distribution of disease.

 Useful in evaluating the efficacy of preventive and therapeutic

measures.

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 PREVALENCE

 No. of cases (both old and new) in a defined population at a specific

point in time

 PREVALENCE RATE (P):

Expressed as cases per 1000 or per 100 population
 Types of prevalence
 Point prevalence

 Period prevalence

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  Point prevalence rate.

Total no. of all current cases of a

Specific disease at a given point of time
X100
Estimated total population at
the specific point of time

 Period prevalence
 It is a measure that expresses total no. of cases of a disease known to
have existed at some time during a specified period

Total no. of all current cases of a Specific

disease at a given period of time interval
X100
Estimated total population at
the specific period of time
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 Uses of prevalence rate
 In detecting the magnitude of disease in the community

 In identifying potential high risk populations

 In administrative and planning purposes like, assessing manpower

needs in health services, delivery of health services etc.

 Limitations of prevalence rate

 Not the ideal measure for studying etiology
 Depends upon incidence and duration…

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 RELATION B/W PREVALENCE AND INCIDENCE

 Prevalence rate is dependent on both incidence rate and disease

duration.

 Assuming that the population is stable, the incidence value and the
duration is unchanging, a relationship can be established as…

Prevalence = Incidence x Avg. duration disease.

P=IXD

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P revalence and Incide nce

= prevalent cases = incident cases = deaths or recoveries

 EPIDEMIOLOGICAL STUDIES

a) Descriptive
studies
Observational i) Case
studies control study
b) Analytical
Studies
ii) Cohort
study
a) Randomized
Control Studies
Experimental
studies /
b) Field trials
Intervention
studies
c) Community
trials
42
 STEPS IN DESCRIPTIVE STUDIES
1. Defining the population to be
studied

2.Defining the disease under the

study

3. Describing the disease by

a) Time b) Place c) Person

4. Measurement of disease

5. Comparing with known indices.

6. Formulation of aetiological hypothesis

 1.DEFINING THE POPULATION

“Defined population” can be

• whole population, or
• representative sample
• specifically selected group such as age, sex, occupational
groups, school children , pregnant mothers etc.

The concept of defined population is critical because it

provides the denominator for calculating rates.
 CRITERIA

 Large enough
 Stable without migration.
 Health facility easy to access.
 Population should not be different from each other.
 2. DEFINING THE DISEASE UNDER STUDY

• The disease or condition can

‘Operational be identified and measured in
definition’ the defined population with a
degree of accuracy.

This is required so as to enable

observer to identify those who have
the disease from those who do not
have.
For example:
DEFINITION OPERATIONAL DEFINITION

 Gingivitis :-
◉ Gingivitis -  Gingival bleeding in one or more
Inflammation of the sites after gently probing the gingival
gingiva sulcus

Dental caries:-Infectious
microbial Disease of the
tooth affecting the
calcified tissue of the
tooth
 Dental caries :-
The lesion is clinically visible and
obvious.
 Explorer tip can penetrate deep
into soft yielding material. There is
discoloration or loss of translucency.
Explorer tip resists removal after
moderate to firm pressure
 3.DESCRIBING THE DISEASE UNDER STUDY

Describes the occurrence and distribution of the

disease by

The time
• year, season, month, week, day.

The place
• country,cities,towns,urban/rural.

The persons who are affected with the disease.

• age, sex, occupation, education, personal habits,Ht.,wt., B.P.
etc.
 THE BASIC TRIAD OF DESCRIPTIVE EPIDEMIOLOGY

 The three essential characteristics of disease we look for in Descriptive

Epidemiology:

 TIME

PLACE PERSON
 TIME DISTRIBUTION

3. Long term or
secular trends

2. Periodic fluctuation ( months) =

Cyclic trends /seasonal variation

1. Short term fluctuations(hours, days,

week ) = Epidemics
 1.SHORT TERM FLUCTUATION

 Occurrence of disease in an epidemic

 Epidemic is defined as “ the occurrence in a community or region
cases of an illness or other health – related events clearly in excess of
normal expectancy ”.

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 EPIDEMIC CURVE

A graph of time distribution of epidemics cases is called

“epidemic curve”
e
x
Number of cases

p
o
s
u
r
e
 EPIDEMIC CURVE SUGGESTS

1. A time relationship with exposure to a suspected source.

2. A cylindrical or seasonal pattern suggestive of a particular infection,
and common source or propagated spread of the disease.
 TYPES OF EPIDEMICS

A) Common B)Propagated
source epidemics
epidemics
• person to person
• a) Single exposure C) Slow
or ‘point source’
• arthropod vector
(modern)
epidemics • animal reservoir
epidemics
• b) Continuous or
multiple exposure
epidemics
 POINT SOURCE EPIDEMICS

All cases develop almost simultaneously following single

exposure. e.g. food poisoning, Bhopal gas tragedy.

Characteristics -
There is sudden rise and sudden fall

There are no secondary curves.

Large number of cases occur with a

narrow interval of time

All cases have the same incubation period.

Exposure is almost simultaneous and brief.

 POINT EPIDEMICS

Short-term changes
occur over limited
time frames

• Hours
• Days
• Weeks
• Months

Used for short-term exposures or diseases with short

incubation and/or illness durations
 COMMON SOURCE OUTBREAK

The Broad Cholera!

Street
Pump.
COMMON-SOURCE OUTBREAK

Sewage
contamination of
drinking water.
CONTINUOUS EXPOSURE EPIDEMICS

• Epidemic occurs from common source.

• Epidemic is not explosive.

• Exposure occurs continuously or repeatedly not

necessarily simultaneously.

• Sudden rise & gradual fall of the curve.

• Well with contaminated water in outbreak of

Fluorosis.
Number of cases COMMON SOURCE ,REPEATED EXPOSURE

Times
 PROPAGATED EPDEMICS

The propagated epidemics are most often of infectious

origin usually results from person to person transmission
of infectious agent.
e.g. COVID 19,Hepatitis A,and Measles

Characteristics :
A gradual rise & tails off over a
long period of time.

Transmission continues till

susceptible individuals are
exposed to infected persons.

speed of spread depends

upon Herd immunity
 PROPAGATED EPDEMICS

Initial Period of Height of Termination of

Epidemic Epidemic Epidemic
O O O O O
O O O O O
O O O O O O O O
O O O O O
O O O O O O O O O
O O O O O O O O
O O O O O O O O
O O O O O O
O O O O O O
O O O O O O O
O O O O
O O
Susceptible Immune

O Infects others O Fail to infect others

 2.PERIODIC FLUCTUATION

Periodic fluctuations

Seasonal variations Cyclic trends

Seasonal trends: Cyclic trends :

It is a prominent feature of infections. certain diseases appear in cycles
for e.g.- which may be spread over short
Measles and chickenpox periods of time like
in the early spring seasons. days, weeks, months or years.
Diarrheal diseases e.g.- epidemic of
during summer months. Measles in every 2-3 yrs,
Bells palsy in spring and Rubella in every 6 -9 yrs
winters Accidents more on week ends.
Cyclic Trends
 LONG TERM FLUCTUATIONS/SECULAR TRENDS

Changes occur over long period of time.

(usually > 10yrs).

It could be increasing or decreasing, real or apparent,

communicable diseases or non-communicable disease.

• e.g.. 1) downward trend : Plague & cholera.

2) upward trend : DM, CHD, lung cancer
 WHY WE SHOULD KNOW THE TIME TREND

• To know diseases which are increasing or

decreasing & emerging health problems.

• Can frame effective measures to control the

diseases.

• Formulate etiological hypothesis.

• Provide guidelines to health administrator in

matters of prevention or control of disease.
 PLACE DISTRIBUTION

knowledge of geographic pattern of diseases are major

important sources of clues about the etiology of disease.

International Rural–urban
variations variations

National Local
variations distributions
 PLACE DISTRIBUTION OF COMMON DISEASES

 India - cancer in oral cavity

 Britain – lung cancer
 U.S – coronary heart disease

ORAL CANCER LUNG CANCER CHD

 PLACE DISTRIBUTION OF SOME DISEASE IN INDIA

By this it is possible to identify the incidence, prevalence and

mortality rate.

It demarcate the affected area for providing the appropriate health
care services.
Ex- Kalaazar – Bihar
Sickle cell Anemia – M.P.
Palatal cancer – Andhra Pradesh
RURAL – URBAN :
Urban- Chronic bronchitis, accidents
Rural- Tuberculosis, Periodontal disease
 SPOT MAP

 It is a graphical presentation of the place distribution of the

disease of occurrence.
 “ clustering “ of cases suggest common source of infection & mode of
spread.
e.g. Investigation of cholera epidemic by John Snow of England
with help of spot map
Outbreak of COVID 19 Pandemic
Factors influencing geographical variations are culture,
standards of living, external environment and genetic
factors.
GEOGRAPHIC SPOT MAP OF COVID 19 AS OF 20 TH APRIL 2020
Total cases: 24.3 L, Total deaths: 1.67 L (April 20th)
 PERSON DISTRIBUTION

1) Age 6) Residence.
2)Race, religion & 7)Socio-Cultural
ethnicity environment.
3) Gender : Male, 8) Socio-Economic
Female. background.
4)Occupation : 9) Behavior ( lifestyle)
agricultural / 10) Stress
Industry.
11) Migration
5)Marriage : Single,
married, divorce,
separated.
 PERSON DISTRIBUTION -AGE
Certain disease are common in certain age groups,
E.g. Measles in childhood, cancer in middle age &
Atherosclerosis in old age.

Bimodality- Sometimes there may be two separate

peaks instead of one in the age incidence curve of a disease.
Eg- Hodgkin's disease and leukemia.
 PERSON DISTRIBUTION -AGE

 BIMODALITY
7
Rate per lakh population

5
4

3
2
1
0
0 10 20 30 40 50 60 70 80 90
Bimodality of Hodgkin’s disease distribution
 PERSON DISTRIBUTION-SEX
Sex

1. Gender differentials in the prevalence of dental caries and restorative

dental treatment
RESULT: Girls presented higher caries indices in permanent teeth than
boys of the same age.
 PERSON DISTRIBUTION -ETHNICITY
Incidence of caries also varies with various races.
For examples: American blacks and whites, eating same type of food,
living in the same geographical area and under similar conditions,
blacks have less caries incidence than whites.
 PERSON DISTRIBUTION-SOCIAL CLASS
According to ANNELI MILÉN -
Children in the upper social class - lower risk of having caries.
In contrast, children in the lower social class had a higher risk of
caries.
 PERSON DISTRIBUTION-OCCUPATION

Holding of needles in the mouth as done by tailors or thread biting

among tailors have been found to conduce to notching of anterior
tooth.
Dental laboratory technicians are prone to Silicosis due to use of wide
range of materials and techniques.
 4.MEASUREMENT OF DISEASE

‘Disease load’ in population

Measurement of mortality

Measurement of morbidity

Incidence (Longitudinal study)

Prevalence (Cross-Sectional study)
 5.COMPARING WITH KNOWN INDICES

By making comparison between

• Different populations or
• Subgroups of the same population

1.It is possible to arrive at clues to disease aetiology.

2. Identify groups which are at ‘high risk’ for the

disease.
 6.FORMULATION OF HYPOTHESIS

 A hypothesis is a supposition , arrived from observation or reflection.

 Is the careful constructed statement about phenomenon in the
population .
 It can be accepted or rejected using technique of analytical
epidemiology.
 6.FORMULATION OF HYPOTHESIS

An epidemiological hypothesis should specify

• Population ( characteristics of persons )

• The specific cause
• The expected outcome – disease
• The dose- response relationship
• Time- response relationship

 e.g. “Cigarette smoking causes lung cancer”-it is an incomplete

hypothesis.

 The smoking of 30-40 cigarettes per day causes lung cancer in

10% of smokers after 20 years of exposures-complete
hypothesis
 CROSS SECTIONAL STUDY

 Simplest form of the study.

 Based on single examination .
 Known as “prevalence study”.
 Distribution of disease in population rather than its etiology.
Can be done by-
1. Interview survey
Trained interviewers
Telephone surveys
E- mailed questionnaires
2. Mass screening programme
 CROSS SECTIONAL STUDY

Advantages Disadvantages
1. Quick 1. Suitable mainly for long
2. Easy to perform lasting diseases.
3. Determine Prevalence of risk 2. Rapidly fatal are less likely to
factors found, known as Neyman bias
or long lasting bias.
3. Do not offer evidence of
relationship between risk
factors & disease.
4. Little information about
natural history of disease &
incidence rate.
USES-
1. Determine frequency of prevalent cases.
2. Measure current health status.
3. Use for chronic disease
4. Can be use to determine the knowledge, attitude and health practices
of various population regarding AIDS & HIV.
5. Useful for hypothesis generation
 LONGITUDINAL STUDIES

 Observation is repeated on the same population over the prolonged

period of time by mean of follow up examinations.

 Provide valuable information.

 USES:

 To study natural history of disease and its future outcomes.

 To identify risk factor of the disease.
 To find out incidence rate or occurrence of new cases of disease in the
community.
 But longitudinal study are more difficult to organize and more time
consuming.
 LONGITUDINAL STUDIES

Advantages Disadvantages

1. Natural history can be studied 1. Time consuming

2. Determine risk factors. 2. Costly
3. Incidence rate
 USES OF DESCRIPTIVE EPIDEMIOLOGY
 Provide data regarding magnitude of disease & type of disease
problem in terms of morbidity , mortality & ratio.
 Provide etiology & help in an etiological hypothesis.
 Provide background data for planning organizing, evaluating
preventive and curative services.
 They contribute to research by describing variation in disease
occurrence by time , place and person.
 CONCLUSION

Descriptive epidemiology uses observation on population exposed to

suspected factors, thus providing clues to the etiology which is
investigated in further studies which help in planning and organizing the
preventive and curative services.
 REFRENCES

1. Preventive and social medicine by PARK

2. Clinical research, a user guide to researching , analyzing and publishing
clinical data by Smith.
3. Epidemiology, Biostatistics and preventive medicine by Jekel.
4. Essentials of preventive and social medicine, Soben Peter.