Chapter 1 Introduction

Social Epidemiology 3673 Department of Sociology University of Utah

Epidemiology
Epidemiology:
the study of the distribution and determinants of health related states or events in specified populations and the application of this study to control of health problems.

Last, JM. A Dictionary of Epidemiology, 3rd ed. New York, NY: Oxford University Press, 1995

Epidemic
Epidemic:
An epidemic is a classification of a disease that appears as new cases in a given human population during a given period, at a rate that substantially exceeds what is expected based on recent experience restricted to a locale (outbreak), more general (an epidemic), pandemic (global).

Objectives
1. To identify the etiology 2. To determine the disease burden in the community 3. To study the natural history and prognosis of disease 4. To evaluate preventive and therapeutic measures and modes of health care delivery 5. To provide evidence for public policy relating to environmental problems

Assumption
States of health/disease are not randomly distributed within populations.

Definitions
Study
- Descriptive (what, when, where and who?) * Surveillance and observation - Analytic (why and how?) * Hypothesis-testing: observations and experiments

Distribution
- Analysis by time, place, other classifications of persons

Definitions
Determinants
- Physical, biological, social, cultural, behavioral factors - Exposure, cause, risk factor or risk marker, agent

Health-related states and events

- Diseases, causes of death, health-related behaviors, access to or use of or response to health services of all kinds - Physical and mental well-being, quality of life

Definitions
Populations
- In demography: all inhabitants of a geographic area or certain classification (gender, race, age) - In statistics: the collection of units (people, hospitals, events) from which a sample is drawn and to which statistical inference applies - In epidemiology: a group of people in whom the action of a given exposure or set of exposures is acting to produce a particular rate of disease (the group of people to whom we generalize the results of an epidemiologic study)

Applications
Public health
- Primary, secondary and tertiary prevention - Population-based and high-risk approaches

Clinical practice
- Diagnosis, prognosis and treatment

Lay practice
- Individual interpretation of risk

Epidemiologic Transition
Top 5 causes of death in 1900
1 Pneumonia 2 Tuberculosis 3 Diarrhea/enteritis 4 Heart disease 5 Stroke

Top 5 causes of death in 2004

1 Heart disease 2 Cancer 3 Stroke 4 Chronic lower respiratory diseases 5 Unintentional injury

The Epidemiologic Approach

Epidemiological reasoning
- Is there an association between exposure and disease? - Is the association causal?

Examples
- Levels of fluoride in drinking water and dental caries - Smoking, passive smoking, and lung cancer - Vigorous physical activity and heart disease - Water and cholera (John Snow) - Cowpox (Vaccinia virus) and smallpox (Edward Jenner) - Examples of social factors of health and illness?

Figure 1-7

Relationship between rate of dental caries in permanent teeth and natural fluoride content on public water supply.

Figure 1-8 DMF index (decayed, missing, and filled teeth) after 10 years of
fluoridation, 1954-1955. Newburgh artificially added fluoride to the water, while Kingston did not.

Figure 1-9 Effect of discontinuing fluoridation in Antigo, Wisconsin, November 1960. DMF-decayed, missing, and filled teeth during fluoridation (FL+) & after fluoridation was discontinued (FL-).

Edward Jenner Smallpox

Background:
400,000 people died from smallpox in the late 1700s. One-third of the survivors became blind.

Observations:
Those who survived were subsequently immune (prevention: inject healthy persons with smallpox material) Dairy maids developed a less severe illness called cowpox, but were not affected by outbreaks of smallpox (prevention: inject healthy people with cowpox)

Today:
1967: WHO began using vaccinations made from cowpox material (before then, approx 15 million people annually were afflicted by smallpox) 1980: Smallpox had been eradicated

John Snow - Cholera

Background: First week of September 1854, about 600 people living within a few blocks of the Broad Street Pump in London died of cholera. Observations: Thames River was very polluted at the time. People who received their water from the Lambeth Company (who had moved its water intake upstream to a less polluted part of the river) were far less likely to die from cholera.
318 deaths per 1000 38 deaths per 1000 Southwark & Vauxhall Company Lambeth Company

Prevention: Improved sanitation & water treatment

The Map