Epidemiology

ANTONIO F. LAUDE JR, RMT,

MPH
Jan 10, 2017
 Interests of Population-
Based Data
The community or the total
population under study replaces the
individual as the focus of concern
and study.
 Interests of Population-
Based Data
The concepts and methods employed
in assessing health status that affect
program planning in health care, as
well as analysis and applications of
epidemiology data, form the basis.
 A Few Statistics
Rate, ratio, incidence, and
prevalence are common terms used
to help describe and disease among
population groups.
 Rate and Ratios
A rate is a statistic used for
describing an event, characteristic,
or happening.

In epidemiology a rate is used to

make comparisons among
populations or to compare a
subgroup of the population (specific
rate) with the total population.
 125
120,602

The numerator of a rate is the actual

number of events

The denominator is the total

population at risk such as 1000,
10,000, or 100,000 to permit
comparisons between various
population groups.
 Rate
A rate description includes time,
person/population, and place
specifications (for example, the rate
per year [time] in uninsured children
[population] in a specific city
[place]).
 A rate is
Number of events X 100,000 (or
another std. Population at risk
base number)
 Example
City As teen pregnancy specific rate
is arrived at by:

125 (number of pregnancies) or

125
120,602 (population at risk)
120,602
 Example
In epidemiology, this rate is converted to
a common base such as 100,000,
which is accomplished by multiplying
the specific rate by the common base:
125 x 100,000 = 103 or 103 teenage
120,602 pregnancies per 100,000
adolescents 14 to 19 years old
 Example
Converting city Bs specific rate of
492/194,301 to a common base of
100,000:

492 x 100,000 = 253 or 253 teenage

194,301 pregnancies per 100,000
adolescents 14 to 19 years
old
 Ratio
Health statistics are sometimes
reported as a ratio, which is simply
the comparison of one number with
another.
 Ratio
A ratio is often used to compare one
at-risk population with another.

Ratios are usually simplified by

reducing the numbers so that the
smallest number becomes 1.
 Ratios
Ratios are expressed on a common
base.

Thus the ratio of city A to city B is

103 to 253, which is expressed as
103:253.

Dividing 253 by 103 equals 2.4563,

or a ratio of 1:2.4563, which is
expressed as approximately 1:2.5.
 Question?
Suppose you were told that more
homicides occurred in Los Angeles
than in Washington, D.C.
How would you could compare the
rates, rather than just the numbers?
Would you need to know the total
population at risk for each city?
 In reality, the 2002 murder rate for
Los Angeles was 17.21 per 100,000
population compared with 46.24 per
100,000 population in Washington,
DC (Federal Bureau of Investigation,
2003).

The murder rate for Washington, D.C.

was three times higher than that for
Los Angeles.
Measures of Morbidity and Mortality

Mortality (death rates) and morbidity

(illness rates) statistics are collected
routinely and used as indicators of
the frequency of death or disease as
they occur in time, place, and
persons.
Measures of Morbidity and Mortality

The concept of morbidity also includes

measures related to specific symptoms of
a disease, days lost from work, and
number of clinic visits.

In the United States, death records are

required by law; they are tabulated by the
National Center for Health Statistics and
help determine trends in the United States.
 Incidence and Prevalence
Rates
Incidence refers to the rate at which
a specific disease develops in a
population.

An incidence rate is the number of

new cases of an illness or injury that
occurs within a specified time.
 Incidence and Prevalence
Rates
In contrast, prevalence measures all of the
existing cases at a given point of time.

Prevalence includes the incidence (new

cases) plus all of the existing cases.

The prevalence rate is influenced by how

many people become ill and by the number
of people who die or do not recover.
 Incidence and Prevalence
Rates
Prevalence is important in determining
measures of chronic illness in a population
and is affected by factors that influence the
duration of the disease.

Thus prevalence rates have relevance for

planning for health care services,
resources, and facilities; for determining
health care personnel needs; and for
evaluating treatments that prolong life.
 Incidence and Prevalence
Rates
Conversely, incidence rates are used
as tools for studying patterns of both
acute and chronic illness.
 Incidence and Prevalence
Rates
Incidence rates are important because
they reflect a direct measure of the
magnitude of new illness in a population
and provide assessments about the risk
associated with particular illnesses.
Because they reflect only the
development of a disease, incidence rates
until now have remained unchanged by
new medical treatment patterns.
 Incidence and Prevalence
Rates
However, increasing use of genetic
screening techniques that may
influence reproductive choices has
the potential to decrease incidence
rates of certain diseases, such as
cystic fibrosis or Tay-Sachs disease.
 Crude, Adjusted, and
Specific Rates
A rate can be expressed for the total
population (crude or adjusted rate) or
for a subgroup of the population
(specific rate).
 Frequently Used Mortality
Rates
Crude death rate =
Total number of deaths during a year
X 100
Total population at mid-year
Cause-specific death rate =
Total number of deaths from
specific cause during a year X 1000
Total population at mid-year
 Frequently Used Mortality
Rates
Age-specific death rate =
Total number of deaths from a specific cause
X 1000
Total mid-year population of a given age group
Maternal death rate =
Total number of maternal deaths X 1000
Total number of live births
 Frequently Used Mortality
Rates
Infant mortality rate =
Total number of death of children <1 year X 1000
Total number of live births during the same year
Neonatal death rate =
Total number of deaths, birth to 28 days of age X 1000
Total number of live births plus fetal deaths during the
year
Fetal death rate =
Total number of deaths during 20-28 weeks gestation X
1000
Total number of live births plus fetal deaths during year
 Types of Epidemiologic
Investigations
People who are engaged in
epidemiologic research frequently
observe rather than manipulate
variables believed to influence the
health of the human population.
 An observational methodology
means that the researcher has far
less control of the factors under
study and that extraneous factors
may also be included in the study
design.
 Epidemiologic studies, however, do
identify nonrandom patterns of
health and disease and serve as the
basis for determining the
circumstances in which experimental
studies would be beneficial; they also
are of value in planning and
evaluating health care services.
Epidemiologic studies can be divided
into three major types.

Descriptive studies
Analytic studies
Experimental trials
 Descriptive Studies
Customarily describe the amount and
distribution of disease within a population.
This approach relies primarily on existing
data and answers the following questions:
Who is affected (person)?
Where is the disease distributed in the
human population (place)?
When is the disease present (time)?
What is the overall effect of the disease
(population)?
Figure 1.4 Reported Cases of
Salmonellosis per 100,000
Population, by Year United
States, 19722002
 Analytic Studies
Begin to answer questions about
cause-and-effect relationships
between potential risk factors and a
specific health phenomenon or
disease condition.
Hypotheses, which are statements of
possible relationships, are used to
predict the causal association among
the variables.
 Analytic Studies
Being able to predict risk thus points
to factors that, if changed, may
prevent the disease from occurring
or reduce its risk.
The hypotheses are tested through
retrospective studies, cross-sectional
studies, or prospective studies.
 Experimental Trials
If the evidence suggests that some
relationships are appropriate for
further study to confirm cause and
effect, an experimental study,
usually called a clinical or
experimental trial, may be
conducted.
 Experimental Trials
Experimental trials always begin
with carefully designed questions,
hypotheses, and research protocols
that specify the criteria for selection
of the people (subject) to be studied,
the procedures for random
assignment of the experimental and
control groups, the treatment
procedure, the follow-up of subjects,
and the details of the data analyses.
 Experimental Trials
In experimental studies, the researcher always
manipulates variables, such as an intervention
or a health teaching approach, with the
experimental and control groups.
An example of an experimental epidemiologic
study is the Physicians Health Study. In this
study, 22,071 male physicians ages 40 to 84
were randomized into one of four treatment
groups to study the effects of aspirin and B-
carotene on cardiovascular disease (Lloyd-
Jones et.al,2001).
 Experimental Trials
Because of ethical concerns about
not causing suffering or exacerbation
of illness, experimental studies
usually involved the testing of
hypothesis related to disease
prevention, health promotion, or, in
some situations, the treatment of a
specific disease.