INTRODUCTI

ON & BASIC
CONCEPTS
OF
EPIDEMIOL
OGY
BIOSTATISTICS and EPIDEMIOLOGY (BIOE
211)
COURSE UNIT 9
COLLEGE OF MEDICAL LABORATORY
SCIENCE
 Learning Objectives:
● Discuss appropriately the importance of epidemiology
● Describe clearly the different models for disease causation
● Describe correctly the history of disease
● Discuss the different levels of disease prevention, and classifications of disease
● Identify specifically the different sources of epidemiologic data
● Describe thoroughly the quality, utility, and comparability of the different data sources
Other concepts related to
causation
 NECESSARY VERSUS
SUFFICIENT CAUSE
 Necessary Cause – Factor
must be present for the disease
to occur  it must invariably
precede an effect
 Sufficient Cause – Cause that
inevitably initiates or produce an
effect  includes “component
causes”
 Any given cause may be necessary,
sufficient, both, neither
 EXAMPLE STATEMENTS

● Being a mammal is a sufficient condition

for being a human.
● Being a human is a necessary condition
for being a mammal.
● Being human is a sufficient condition for
being a mammal.
● Having three sides is necessary to form a
 Types of Causal Relationships
● Necessary and sufficient – without the factor, disease never develops
○ With the factor, disease always develops (this situation rarely occurs)

● Necessary but not sufficient – the factor in and of itself is not enough to cause
disease
○ Multiple factors are required, usually in a specific temporal sequence (such as
carcinogenesis)
● Sufficient but not necessary – the factor alone can cause disease, but so can other
factors in its absence
○ Benzene or radiation can cause leukemia without the presence of the other
● Neither sufficient nor necessary – the factor cannot cause disease on its own, nor i
 NATURAL
HISTORY OF THE
DISEASE
 NATURAL HISTORY OF DISEASE
TWO PHASES
 PREPATHOGENESIS
o Phase before man is involved.
o Through interaction of agent, host and environmental
factors, agent finally reaches man.
 PATHOGENESIS
o Includes the success invasion and establishment of the
agent in the host.
o From incubation period to production of detectable
evidence of the disease process (Clinical Horizon), until
 NATURAL HISTORY OF
•
DISEASE
“Progression of a disease process in an individual over time, in the absence of treatment”
(CDC)
--
 STAGE OF SUSCEPTIBILITY
● Pre-exposure period in the natural history of
disease, in which the individual in the population
is vulnerable or at risk to acquire the infection
and/or amenable to get exposed to and be harmed
by a health determinant. 

● During this stage, the individual in the population

does not have the disease nor the infection; only
the risk factors are present. 
Pre-Pathogenesis

Susceptibility

EXPOSURE

Adaptation
Who is at Risk?

 Risk factors
 Poor health and nutrition
 Lack of immunity
 Behaviors that increase opportunity for
exposure
Adaptation

 Failure leads to pathogenesis

 Immediate response of the body

 Immune system
 STAGE OF
PRESYMPTOMATIC
● DISEASE (Subclinical
The etiological factors stage)
(e.g. infectious agent, risk behaviours,
environmental toxins) are present in the body and are causing
pathological changes, but there are not yet any discernible signs or
symptoms.

● In this stage there is no manifest of disease but pathogenic changes have

started to occur

● The time required for the agent to establish itself, multiply and produce
toxins
 Sub-clinical stages of disease

Incubation period Latency period

o Asymptomatic o Asymptomatic
o Time between o Time between exposure
exposure to onset of to causal factor and
symptoms disease detection
o Infectious diseases o **common in NCD
 STAGE OF CLINICAL DISEASE
 Refers to the period of time at the onset of signs
or symptoms of the disease.
 Sufficient end-organ changes have occurred so
that there are recognizable signs or symptoms of
disease
 The outcomes of this stage may be recovery,
disability or death.
 It is important to subdivide this stage for better
 STAGE OF DISABILITY
 The final stage in the natural history of disease
concerns the outcome: recovery, disability or
death.

 Some diseases run their course and then resolve

completely either spontaneously or by treatment

 Any temporary or long term reduction of a

Pathogenesis
Subclinical

Clinical

Outcome
 LEVELS OF PREVENTION

Primordial
• Before risk factors

Primary
• Pre-pathogenesis

Secondary
• Subclinical or very early clinical

Tertiary
• Middle to late clinical
 Primordial Prevention
o Prevent development of risk factors

o Target: National
Policies and
Programs

Mass
Education

Individual
Education
Primary Prevention
• Prevent disease:
o Reduction of risk factors
o Immunization
o Removal of harmful agents

Target:
Secondary Prevention
o Early detection
o Prompt treatment
o Cure disease at the earliest stage

Target:
Tertiary Prevention
o Complete treatment
o Limit disability
o Rehabilitation

Target:
 Classification of diseases

 Method of grouping of diseases based on their specific

features

 Ensures universal criteria for diagnosing diseases

 Usually dependent on current level of knowledge about the

disease
Classification of diseases
 International
Classification of
• Diagnostic classification standard for all clinical and research purposes
• Assigns codes for diseases, disorders, injuries and other related health
conditions
Disease
 Other Classifications of Disease

 International Classification of Functioning, Disability and Health

(ICF)

 International Classification of Health Interventions (ICHI)

 Sources of
Epidemiologic
Data
Sources of Epidemiologic Data
Considerations in Choosing the Source
of Data

Research Objective
Data Quality
Sensitivity Issues
Logistics
 General Types of DATA

• Primary Data: collected by the researcher firsthand

• Secondary Data: derived from another source that

may have other objectives for collecting the data
Data Sources according to Type of Data

Primary Secondar
Data
A. Queries
Interviews
y
A. Data
Computerized
bibliographic databases
Questionnaires
FGD
B. Surveillance data
o Census
B. Observations o Registries
Direct o Hospital records
With tools o Insurance records
Secondary: Census

Advantage Disadvantage
o Info on population numbers and
o Small number of
distributions by age, sex and
others health questions that
o Allows small-area estimation can be included
and disaggregation like socio-
economic status
Secondary: Civil Registry

o Primary purpose: establishment of legal documents as required by law

o Major and most effective source of vital statistics

o **Cause of death together with ICD

 Civil Registry
Advantage
o Enables the routine production
of vital statistics essential for
improving health outcomes, as
well as the provision of small-
area data
Disadvantage
o In low and lower-middle-
income countries, civil
registry is weak or non-
existent
 Civil Registry: Birth Statistics
 Most visible evidence of a government’s existence of a person as a member of
the society.

 Uses of birth certificate data:

o Calculation of birth rates
o Maternal conditions, length of gestation, birth weight, congenital abnormalities..

 Problems: completeness of entries, unreliable data from the mother, neonatal

defects undetected at birth.
 Civil Registry: Death Statistics
 Mortality data have the advantage of being almost totally complete because
deaths are unlikely to go unrecorded.

 **Cause of Death
o Immediate cause of death: final disease, injury, complication
o Antecedent cause of death: intervening event between immediate and
underlying cause of death
o Underlying cause of death: disease that initiated chain of morbid events
Civil Registry: Death Statistics

 Uses of death certificate:

o Calculation of mortality rates
o Information on CoD

 Problems:
o Correctness of entries
o Stigma associated with certain illnesses
o Lack of standardization of diagnostic criteria
o Change of coding for CoD over time
 Notifiable Disease Statistics

 Reportable diseases
o Selected for being epidemic-prone
o Targeted for eradication or elimination
o Subject to international health regulation

 USES
o Monitor progress towards disease reduction targets
o Measure achievements of disease prevention activities
o Identify hidden outbreaks or problems so that early action
may be taken
 Notifiable Diseases
Category 1
acute flaccid paralysis, anthrax,
adverse event following
immunization, human avian
influenza, measles,
meningococcal disease, neonatal
tetanus, paralytic shellfish
poisoning, rabies, SARS,
outbreaks, clusters of diseases,
unusual diseases or threats
Category 2
Acute blood diarrhea, acute
encephalitis, acute hemorrhagic
fever, acute viral hepatitis,
bacterial meningitis, cholera,
dengue, diptheria, influenza-like,
leptospirosis, Malaria, Non-
neonatal tetanus, pertussis,
typhoid and paratyphoid fever
 Population (Sample) Survey

Advantage
o Prime data sources on risk
factors
o Possible to generate important
data on the links between health
and socio-economic
determinants
Disadvantage
o Less efficient in rare
events
o Sampling error
o Estimates for local areas
may not be possible
 Data Quality and Utility
 Nature of the data
Vital statistics, registries, surveys

 Availability of the data

Accessibility to the researcher

 Completeness of population coverage

Representativeness

 Vale and limitations

usefulness
 Data Privacy and Confidentiality

 Privacy vs. Confidentiality ?

 Republic Act 10173: Data Privacy Act of 2012

 Executive Order No. 2 s. 2016: Freedom of

Information
 Sensitive personal information (RA 10173)
 Individual’s race, ethnic origin, marital status, age,
political affiliations, etc.

 Individual’s health, education, genetic or sexual life

of a person, etc.

 Issued by government agencies like SSS number,

licenses, tax returns, etc.
Data Sharing
 Voluntary release of information by one investigator or
institution to another for purposes of scientific research

 Advantage: enhancement of knowledge

 Issues:
o Loss of control over intellectual property
o Loss of privacy and confidentiality of the research subject
Data Linkage

 Joining data from two or more sources

 Requires interoperability of data sources

o Talk with each other
o Use of common identifying features to connect data records
on a single individual
 THANK
YOU !
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