Overview of Epidemiology

D.R. Regmi
regmi.devraj@cmc.edu.np
 Objectives of a Class
• To introduce curriculum of epidemiology.
• To explore about epidemiology.
 Curriculum
1. Epidemiologic studies:
 Types, nature, use and process of study
 Errors and bias
 Causation and association ,
 Relative risk and Odds Ratio
2. Strategies of epidemiology:
Ways and means
Hypothesis
Review and appraisal of epidemiological
study
Some facts about Epidemiology
• The Greek physician Hippocrates is believed
to be the first epidemiologist. He was the first
to link environmental exposures to
disease(Father of Medicine).
• 1850 John Snow:
• First epidemiologist to propose and test a
hypothesis:
“ Cholera is transmitted by a contaminated
water supply. (Father of field epidemiology.)
 Epidemiology
• Epidemiology is derived from the word
epidemic (epi=among; demos=people;
logos=study)
• Back in 3rd Century B.C.
 Definition of Epidemiology
“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.”
-John M. Last 1988.
 Understand the definition
• Study: Observing,recording,experimenting
• Distribution : Who, where, when
• Determinants: Why?
• Health related states
• Specified populations
• Application
 Definition

• “The study of the distribution,

determinants and deterrents of
morbidity and mortality in human
populations”
- William A. Oleckno.
 Epidemiological approach
• Asking questions

• Making comparisons
 Asking questions
• What is the event? ( the problem)
• What is its magnitude?
• Where did it happen?
• When did it happen?
• Who are affected?
• Why did it happen?
 Epidemiology ask?
• Person- Who?

• Place- Where?

• Time- When?

Helps us to understand: Why?

 Example of Epidemiological study
Epidemiological study into breathlessness can:
• Describe the frequency and severity of
breathlessness at different stages of disease, or in
different groups of patients; (Time, place and
person)
• Categorize different types of breathlessness;
• Describe the different factors associated with
increased breathlessness;
• Develop predictive indicators of those people most
likely to experience breathlessness; and/or
• Compare the outcomes of different treatments.
 Epidemiology: Study of Risk factors
• A behavior, environmental exposure, or
inherent human characteristic that is
associated with an important health
related condition*
• Risk factors are associated with an
increased probability of disease but
may not always cause the diseases

*Last, J. Dictionary of Epidemiology

http://www.pennmedicine.org/health_info/images/19377.jpg
 Distribution of disease: Descriptive
Epidemiology
• Person: age, sex, race/ethnicity, SES,
occupation, lifestyle,
• Place: neighborhood, state, country,
environment
• Time: date of exposure, date of diagnosis
etc
 The distinction between
epidemiology and clinical medicine

POPULATIONS INDIVIDUALS

Define health problems Diagnosis

Distributions of Treatment
diseases Caring
Study associations Curing
Assess causation Treatment
Prevention
 Epidemiologic Studies
• Epidemiological
studies can be
classified as
1. Observational
study
2. Experimental Study
A. Observational studies : It is the first step in
an epidemiological investigation.
• Observational studies allow nature to take
its course: the investigator measures but
does not intervene.
• They are usually based on mortality
statistics and may examine patterns of
death by age, sex or ethnicity during
specified time periods or in various
countries.
• Trend of childhood mortality is shown in
next slides.
Types of Observational studies
a. Analytical Study: An analytical study goes
further by analyzing relationships between
health status and other variables.
b. Ecological Study: the units of analysis are
groups of people and useful for generating
hypotheses.
 Ecological studies can also be done by
comparing populations in different places at the
same time or, in a time series, by comparing the
same population in one place at different times.
 Data can be used from populations with widely
differing characteristics or extracted from
different data sources.
b. Cross-sectional Study: Cross-sectional
studies measure the prevalence of disease
and thus are often called prevalence studies.
Also called snap shot study.
 The measurements of exposure and effect
are made at the same time.
 It measures several exposures. Frequency
of disease and risk factors can then be
examined in relation to age, sex and ethnicity.
 The most convenient first step in
investigating the cause.
c. Case-control Study: They include people with
a disease (or other outcome variable) of
interest and a suitable control (comparison or
reference) group of people unaffected by the
disease or outcome variable.
• The study compares the occurrence of the
possible cause in cases and in controls. The
investigators collect data on disease
occurrence at one point in time and
exposures at a previous point in time.
• Case-control studies have been called
retrospective studies since the investigator is
looking backward from the disease to a
possible cause.
• A classic example of a case-control study
was the discovery of the relationship
between thalidomide and limb defects in
babies born in the Federal Republic of
Germany in 1959 and 1960.
• The study, done in 1961, compared affected
children with normal children and found
that Thalidomide caused temporary
blockage of mature blood vessels but
caused complete obliteration of immature
blood vessels in the chicken embryo,
resulting in the hallmark limb defects
d. Cohort Study: Cohort studies, also called
follow-up or incidence studies, begin with a
group of people who are free of disease, and
who are classified into subgroups according to
exposure to a potential cause of disease or
outcome.
• Variables of interest are specified and
measured and the whole cohort is followed up
to see how the subsequent development of
new cases of the disease (or other outcome)
differs between the groups with and without
exposure.
• Cohort studies provide the best information
about the causation of disease and the most
direct measurement of the risk of developing
disease.
Example of catastrophic poisoning of residents
around a pesticide factory in Bhopal, India, in
1984.
• Methyl isocyanate, leaked from a tank and
the fumes drifted into surrounding residential
areas, exposing half a million people to the
gas.
• 20 000 people died as a result of this
exposure.
• In addition, 120 000 people still suffer
pollution.
• The acute effects were easily studied with a
cross-sectional design. More subtle chronic
B. Analytical Study:
• An analytical study goes further by
analyzing relationships between health
status and other variables.
Note: Most all epidemiological studies are
analytical in character. but descriptive data in
reports of health statistics are a useful source
of ideas for epidemiological studies.
• The characteristics of several patients with a
specific disease are described but are not
compared with those of a reference population,
often stimulates the initiation of a more detailed
epidemiological study.
• For example, the description in 1981 of four
young men in U.S.with a previously rare form of
pneumonia was the first described in case sries
as the condition that became known as the
acquired immunodeficiency syndrome (AIDS).
2. Experimental studies:
• Experimental or intervention studies involve
an active attempt to change a disease
determinant such as an exposure or a
behaviour or the progress of a disease
through treatment, and are similar in design to
experiments in other sciences.
• However, they are subject to extra constraints,
since the health of the people in the study
group may be at stake.
• Example: testing covid vaccine on a selected
group of patients.
Major experimental study designs include the
following:
a. Randomized controlled trials using patients
as subjects (clinical trials),
b. Field trials in which the participants are
healthy people, and
c. Community trials in which the participants
are the communities themselves.
a. Randomized controlled trials using patients
as subjects (clinical trials):
• A randomized controlled trial is an
epidemiological experiment designed to
study the effects of a particular intervention,
usually a treatment for a specific disease
(clinical trial).
• Subjects in the study population are
randomly allocated to intervention and
control groups, and the results are assessed
by comparing outcomes.
B. Field trials:
• Field trials, in contrast to clinical trials, involve
people who are healthy but presumed to be at
risk; data collection takes place “in the field,”
usually among non-institutionalized people in
the general population.
• One of the largest field trials was that testing
the Salk vaccine for the prevention of
poliomyelitis, which involved over one million
children.
• Field trials can be used to evaluate
interventions aimed at reducing exposure
without necessarily measuring the occurrence
of health effects.
c. Community trials:
• The treatment groups are communities rather
than individuals.
• This is particularly appropriate for diseases
that are influenced by social conditions, and
for which prevention efforts target group
behaviour.
• Cardiovascular disease is a good example of
a condition appropriate for community trials
although unanticipated methodological issues
can arise in large community intervention
trials.
 References
• K Park, Social and preventive medicine
(latest edition)