INTRODUCTION TO

EPIDEMIOLOGY
Dr. A.G. Omisore
 Fundamental Assumption in
Epidemiology
 Disease doesn’t occur in a vacuum/ Disease is
not randomly distributed throughout a
population
◦ Epidemiology uses systematic approach
to study the differences in disease
distribution in subgroups
◦ Allows for study of causal and preventive
factors
 Conceptual Definition
 Has its origins in the idea, 1st expressed over 2000
years ago by Hippocrates and others that
environmental factors can influence the occurrence
of diseases
 Historically linked with the term epidemics (Study of

what comes upon the people)

Greek: epi (upon)
+
demos (people)
+
logos (study of)
Definition of Epidemiology
The study of the distribution and
determinants of health-related states
or events in specified human
populations and the application of this
study to the control of health problems
- J. Last: Dictionary of Epid.

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Key Words
◦ Population a group of people with a
common characteristic
◦ Disease frequency- Quantify disease
◦ Disease distribution- in terms of person,
place and time
Formulation of hypotheses concerning
causal and preventive factors.
◦ Disease determinants, Hypotheses are
tested using epidemiologic studies
◦ Disease control
 Epidemiology Defined: Key Aspects
 Distribution: Frequency (including rates & risks) &
pattern of health events (person, place, time)
 Determinants: Factors or events that are capable

of bringing about a change in health

 Population: Epid examines health events among

population groups rather than individuals

 Health-related events: infections, chronic

diseases & physiological events & various states

of health such as disability, injury, mortality
 Application: Basis for directing interventions
Who is an epidemiologist ?
A professional who strives to study and
control the factors that influence the
occurrence of disease or health-related
conditions and events in specified
populations and societies, has an
experience in population thinking and
epidemiologic methods, and is
knowledgeable about public health and
causal inference in health
(Porta M, Last J, Greenland S. A Dictionary of
Epidemiology, 2008)
Epidemiologists are required to have
some knowledge of:
 Public health: because of the emphasis on disease
prevention
 Clinical medicine: because of the emphasis on
disease classification and diagnosis (numerators) 
 Pathophysiology: because of the need to
understand basic biological mechanisms in disease
(natural history)
 Biostatistics: because of the need to quantify
disease frequency and its relationships to
antecedents (denominators, testing hypotheses)
 Social sciences: because of the need to understand
the social context in which disease occurs and
presents (social determinants of health phenomena)
The Epidemiologic Approach
Key aspects of epidemiology
 Epidemiology deals with populations
 Epidemiology involves measurement
 Epidemiologic studies involve comparison
 Epidemiology is fundamentally multidisciplinary

“Like a newspaper reporter, an epidemiologist

determines What, When, Where, Who, and Why.
However, the epidemiologist is more likely to describe
these concepts in slightly different terms: case
definition, time, place, person, and causes” - CDC.
 Epidemiology

Observational Analytical
Epidemiology: Epidemiology
What, Who, Where, When Why & How?
 Basic Process in Epidemiologic
Reasoning

Observation & Compare

Accurate Number of
Description of Cases &
Disease Distribution
Process Counting & between
compiling groups to
the cases make
Scientific
deductions
(epid &
statistical
methods)
CLASSIFICATION OF EPIDEMIOLOGY
 1. DESCRIPTIVE/
OBSERVATIONAL
 2. ANALYTICAL
. DESCRIPTIVE/ OBSERVATIONAL
 Examining the distribution of a disease in a
population, and observing the basic features
of its distribution in terms of time, place, and
person.
 We try to formulate hypothesis, look into

associations ?
 Typical study design: Community health

survey
(synonyms: cross-sectional study, descriptive
study)
 ANALYTICAL
 Testing a specific hypothesis about the relationship
of a disease to a specific cause, by conducting an
epidemiologic study that relates the exposure of
interest to the outcome of interest
 (? Cause-effect relationship)
 Typical study designs: cohort, case-control,

experimental design
 Descriptive Studies Develop
hypothesis
Increasing Knowledge of

Investigate it’s
Disease/Exposure

Case-control Studies relationship to

outcomes

Define it’s meaning

Cohort Studies with exposures

Test link
Clinical trials experimentally
Measuring Disease Frequency
Has Several Components

 Classifying and categorizing disease

 Deciding what constitutes a case of disease in a

study
 Finding a source for ascertaining the cases
 Defining the population at risk of disease
 Defining the period of time of risk of disease
 Obtaining permission to study people
 Making measurements of disease frequency
 Relating cases to population and time at risk
Historical Context & Evolution of
Epidemiology
Fiction & Facts: Theories of Disease
Causation through the Centuries
 The Wrath of God
 Theory of contagion – spread of diseases

through the air

 Humoral imbalance – body fluids out of balance
 Miasma theory – diseases are caused by

decaying maters
 Theory of spontaneous regeneration
 Germ Theory
 Epidemiological Process &
Progression

Observation & Major Progress in the Victorian Era

Accurate
Description of
Disease
Making
Process Counting Scientific
cases deductions

Pre-19th Century Notables:

•Hippocrates – “On Air, Water & Soil” & Epidemics”
•Thomas Syndeham
•Fracastorius
 Victorian Era & Progress in the
Science of Epidemiology
Development of epidemiologic techniques for:
◦ Describing diseases
◦ Identification of causes of diseases
◦ Developing records to keep track of diseases
◦ Preventing diseases
 Formation of the London Epidemiological Society
in 1850
 Jakob Henle was the 1st to put forth postulates
for considering the pathogens that cause disease
(1840)
 Epidemiological Process &
Progression

Observation &
Description of
Disease
Process
Counting Making
cases Scientific
deductions

• John Graunt: Bill of mortality– stat. approach to disease

prev
• Sir William Petty: Pioneer of life tables
• William Farr: Developed the epid use of vital statistics
JOHN GRAUNT
 John Graunt- founder of vital statistics
 1662 Publication - quantified pattern of disease/
mortality in population.
 Publication based on “Bills of mortality” – a weekly
count of people who died since 1592
Observed excess of male births
High infants mortality
Proportional mortality
Seasonal variation in mortality
Urban-rural variation
William Farr
 Compiler of statistical abstracts in
Britain from 1839- 1880.
 Annual counts of births, marriages&
deaths done
 Used these as numerators and census
data as population data.
 Thus, crude rates were obtained.
 Examined the effects of altitude,
location (densely& sparsely populated
areas)& marital status on health
 Epidemiological Process &
Progression
Observation &
Description of Making
Disease Scientific
Counting
Process deductions
cases

• Investigating causes & Epidemiologic methods:

- Natural Experiments e.g. John Snow & Cholera
-Identification of Specific agents e.g. Robert Koch & TB
- Nutrition e.g. James Lind & Scurvy, Goldberg & pellagra
- Chronic disease: Richard Doll & Bradford Hill – use of

case-control method
Table 1: John Snow’s Table on
Cholera Epidemic in London
Number of Deaths from Deaths per
houses Cholera 10,000
houses
Southwark 40,046 1,263 315
& Vauxhall
Coy.
Lambeth 26,107 98 37
Company

Rest of 256,423 1,422 59

London
◦ John Snow in 1854-
 Formulated and tested hypothesis concerning the
origins of Cholera epidemics in London 20 years
before microscope was discovered
 Described as the father of Field epidemiology
 Used spot maps to show case distribution
 Demonstrated water was the source of infection
 Remove handle of pump to control epidemics
Doll & Hill Data on Smoking & Ca
Lung: Case-Control Approach
Male lung Male patients,
patients other diseases

Smokers 647 (99.7%) 622 (95.8%)

Nonsmokers 2 27

Total 649 649

Wynder & Graham’s Data on Smoking & Ca
Lung: Case-Control Approach

Male lung Male patients,

patients other diseases

Smokers 584 (96.5%) 575 (73.7%)

Nonsmokers 21 205

Total 605 780

Eras & Paradigms in the Evolution of
Epidemiology
 Sanitary statistics: (19th Century)
 Infectious disease (late 19th –mid 20th C. )
 Chronic disease epid (2nd half of 20th C.)
 Molecular genetics (late 20th C.)
 Eco-epidemiology (? Paradigm for the
21st century)
 Eras in Epidemiology & Preventive
Heath Actions
Era Health interventions

Sanitary statistics Sewage, sanitation, drain

Infectious disease Interrupt transmission
Chronic disease Control risk factors by modifying
lifestyle, agent or environment
Molecular genetics Gene therapy, targeting high risk
groups? Drug development

‘Ecoepidemiology’ Social action

Epidemiologic Triad of Disease Causation

Agent

Host Environment
 AGENTS

 Biological (micro-organisms)
 Physical (temperature, radiation, trauma, others)
 Chemical (acids, alkalis, poisons, tobacco, others)
 Environmental (nutrients in diet, allergens, others)
 Psychological experiences
 HOST FACTORS

 Genetic endowment
 Immunologic status
 Personal characteristics
 Personal behavior
 Definitive versus intermediate (in vector-borne

diseases)
 ENVIRONMENT
 Living conditions (housing, crowding, water
supply, refuse, sewage, etc)
 Atmosphere / climate
 Modes of communication: phenomena in the

environment that bring host and agent together,

such as: vector, vehicle, reservoir, etc)
 Uses of Epidemiology
 To investigate nature / extent of health-related
phenomena in the community. To diagnose
community health Problem
 To study natural history, aetiology and prognosis

of health-related problems
 To identify causes and risk factors
 To recommend / assist in application of / evaluate

best interventions (preventive and therapeutic

measures)
 To provide foundation for public policy/ To

identify health priorities

 To plan and evaluate health services

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Conclusion
 Health & deviations from a healthy state
is not a random process striking
without direction and with equal
probability
 Epidemiology involves the search for a
relationship between factors associated
with health conditions
 Epidemiology involves quantitative and

multi-disciplinary approach
 Epidemiologists are trained skeptics
 Conclusion (ii)
Epidemiology is the
scientific building blocks of
the fields of public health &
preventive medicine
– Stolley & Lasky
Thank you for your attention