INTRODUCTION

TO
EPIDEMIOLOGY

Ms. Chanda Jabeen

PhD (Scholar) Epidemiology & Public Health
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LEARNING OBJECTIVES
At the end, Learner will be able to:
 Discuss History of Epidemiology.
 Define Epidemiology and its components.
 Discuss Epidemiological Basic concepts.
 Describe Aims of Epidemiology.
 Explain Uses of Epidemiology.
 Discuss Scope or the Areas of Application .
 Discuss some terms used in Epidemiology

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 EPIDEMIOLOGY
The term epidemiology derived from Greek words :

Epi Amon
g
Demos People
Logos Study
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HISTORY OF EPIDEMIOLOGY
 The history
of epidemiology has its origin in the
idea goes back to (400 B.C)

 Hippocrates
Who suggest that environment &
human Behaviors affects health.

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 1662 – John Graunt, who
published a landmark
analysis of Mortality
data.

 Itwas the first quantify

patterns of birth, death,
and disease occurrence.

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 1800 – William Farr work
by systematically
collecting and analyzing
Britain's mortality
statistics.

 Farr, considered the

father of modern vital
statistics and surveillance,
developed many of the basic
practices used today in vital
statistics and disease
classification.
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1854 -John Snow , was considered the “father of
field epidemiology.
 John Snow was conducting a
series of investigations.
 Twenty years before the development of the
microscope, Snow conducted studies of cholera
outbreaks both to discover the cause of disease and
to prevent its recurrence.

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 19th and 20th Century: epidemiological methods
applied in investigation of disease occurrence, at
that time, most investigators focused on acute
infectious diseases.
 1930s & 1940s: Non-Infectious diseases were
also investigated for their risk factors (as lung
cancer to smoking).
 1980s: Extended to the studies of injuries and
violence

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 Beginning in the 1990s after the terrorist attacks
of September 11-2001, epidemiologist have had
to consider not only natural transmission of
infectious organisms but also deliberate spread
through biological warfare and bioterrorism .

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EPIDEMIOLOGY
 Epidemiology is the study of how disease is
distributed in populations and the factors that
influence or determine this distribution. Why does
a disease develop in some people and not in
others?

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DEFINITION OF EPIDEMIOLOGY BY
WHO
 Is astudy of distribution & determinants of
health- related states or events in specified
populations, and the application of this study to
the control of health problems.

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COMPONETS OF DEFINITION

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 1. Study:
Systematic collection, analysis and
interpretation of data.

Including : observation ,hypothesis testing

, analytical research and experiments.

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 2. Distribution :
 Refer to analysis of an event by person, place & time
 Epidemiology studies distribution of diseases it
answers the question:
who, where and when?

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Who? Where? When?

Epidemiology is concerned with the frequency
and pattern of health events in a population.

A. Frequency:
refers not only to the number of cases, but also to
the relationship between the number of cases and
the size of the population

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B. Pattern:
Refers to the occurrence of health-related events by
time, place, and person.

o Time patterns: may be annual, seasonal, weekly,

daily.
o Place patterns: include geographic variation,
urban/rural differences, and location of work
sites or schools.
o Personal characteristics: such as age, sex, marital
status, and socioeconomic status, as well as
behaviors and environmental exposures.

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Determinant:
It is any factor that influence health as : chemical ,
physical, social , biological , economic , genetic,
behavior.
Epidemiology is also used to search for determinants,
which are the causes and other factors that influence
the occurrence of disease and other health-related
events.

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To search for these determinants, epidemiologists use
analytic epidemiology or epidemiologic studies to
provide the “Why?” and “How?” of such events.

?
Why HOW?
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Health-related state or event :
It is defined as anything that affects the well-being of
a population.
As : disease, cause of death, behaviors ,ect…

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 5. Specified populations :
Although epidemiologists and direct health-care
providers (clinicians) are both concerned with
occurrence and control of disease, they differ
greatly in how they view “the patient.”
 The clinician is concerned about the health of an
individual.
 The epidemiologist is concerned about the collective
health of the people in a community or population.

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6. Application :
 Epidemiology is not just “the study of” health in a
population; it also involves applying the knowledge
gained by the studies to community-based practice.
 Like the practice of medicine, the practice of
epidemiology is both a science and an art.
 To make the proper diagnosis and prescribe
appropriate treatment for a patient, the clinician
combines medical (scientific) knowledge with
experience, clinical judgment, and understanding of
the patient.

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 Similarly,the epidemiologist uses the scientific
methods of descriptive and analytic epidemiology
as well as experience, epidemiologic judgment,
and understanding of local conditions in
“diagnosing” the health of a community and
proposing appropriate, practical, and acceptable
public health interventions to control and prevent
disease in the community.

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EPIDEMIOLOGY CONCERNED WITH

Distribution and determinants of health and

diseases
Morbidity
Mortality
Disability

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MORBIDITY & MORTALITY
 Morbidity: Refer to the sate of being diseased
or unhealthy within population
 Mortality: Refer to numbers of the people who
died within population
 Disability: is an impairment that may be
cognitive, developmental, intellectual, mental,
physical, sensory, or some combination of these.
It substantially affects a person's life activities and
may be present from birth or occur during a
person's lifetime.
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EXAMPLE

Mortality & Morbidity Mortality & Morbidity

That means disease is That means disease is un

very common and common and incidence of
incidence of death is death is low.
very high.

As: acute pencrititis As : vitiligo

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EXAMPLE

Morbidity & Mortality Morbidity & Mortality

That means disease is That means disease is

vary common and uncommon and
incidence of death is vary incidence of death is
low . high .
. As: Amyotrophic lateral
As : Diabetes sclerosis (ALS)

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AIMS OF EPIDEMIOLOGY
Epidemiology has three main aims:
1. To describe disease patterns in human
populations.
2. To identify the causes of diseases (also known
as etiology).
3. To provide data essential for the management,
evaluation and planning of services for the
prevention, control and treatment of disease

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USES OF EPIDEMIOLOGY

First, to identify the etiology or cause of a disease and

the relevant risk factors—that is, factors that
increase a person’s risk for a disease.
• We want to know how the disease is transmitted
from one person to another or from a nonhuman
reservoir to a human population.
• Our ultimate aim is to intervene to reduce
morbidity and mortality from the disease.

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 If we can identify the etiologic or causal factors
for disease and reduce or eliminate exposure to
those factors, we can develop a basis for
prevention programs.
 In addition, we can develop appropriate vaccines
and treatments, which can prevent the
transmission of the disease to others.

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To determine which in the three possible sets of
disease factors, host, agent and environment, are
important in the occurrence of a specific disease or class
of diseases, and to explore the manner in which they
interact. Epidemiological Triad

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 Agent, or microbe that causes the disease
(the “what” of the Triangle)
 Host, or organism harboring the disease
(the “who” of the Triangle) Host
 Environment, or those external Poor nutrition
Concurrent
factors that cause or allow disease disease
Low immunity
transmission
(the “where” of the Triangle)
TB
Environment
Agent Crowding
TB organism Poor ventilation
Bad sanitation
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2) To study the occurrence of disease in a
population for purposes of community diagnosis
and prognosis.

 A clinician sees a disease as it occurs in an

individual.

 The epidemiologist is interested in the individual

too, but his attention is primarily directed toward
the group.
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3) To determine the extent of disease found in the
community. What is the burden of disease in the
community? This question is critical for planning
health services and facilities, and for training future
health care providers.

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 The severity of disease in a community can be
gauged by several indices:
 whether it is a leading cause of death;
 whether it has a high case fatality or other
measure of complications;
 whether it involves a large proportion of
the young;
 whether it leaves permanent disability,
defect or impairment;
 whether it adversely affects the
economic status of a community.
 The role of the epidemiologist can be
described as that of a community
diagnostician.
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4) To describe the epidemiology of a disease or
class of diseases.
 Facts or events relating to the occurrence of a
disease (or class of diseases) constitute its
epidemiology.
 The occurrence of a disease and its severity and
outcome are resultants of a complex of interacting
factors, some of which are host factors and others,
agent and/or environmental.

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 To study the natural history and prognosis of
disease. Clearly, certain diseases are more severe
than others; some may be rapidly lethal while
others may have longer durations of survival. Still
others are not fatal.
 We want to define the baseline natural history of a
disease in quantitative terms so that as we develop
new modes of intervention, either through
treatments or through new ways of preventing
complications.

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 A description of the epidemiology of a disease
involves a thorough study of that disease in all its
aspects including its frequency in various
population, and known and suggested factors in
the premorbid, morbid and post- morbid periods.

 The premorbid period is the period preceding the

inception of a disorder.
 The morbid period, the pathological and
clinical course .
 The post-morbid period, the aftermath.
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5) To measure risk.
The epidemiologist may use rates which can show
the probability that could make :
 A person acquire a particular disease during a given
period of time (attack rate, morbidity rate, case
incidence rate).

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 A person die of a particular disease during a given
period of time (mortality rate, death rate); or if
he has a particular disease, that he will die of it
during a given period of time (case fatality rate).
 Such probabilities are measures of risk and they
are useful to know prognosis.

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6) To study the occurrence of disease or death with
time as a variable. Such a study is referred to as a
historical study.

 In historical studies, it often is convenient to speak of

trends, namely, secular trends and cyclic trends.

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 Secular trends– occurring only once in the
course of an age or century; taking place over an
extremely or indefinitely long period of time.
 Cyclic Trends – a sequence of events that is
repeated again and again, especially a causal
sequence; a period of time between repetitions of
an event or phenomenon that occurs regularly

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 7) In disease prevention and control.
 The epidemiologist helps to control a disease when
he identifies it, describes its epidemiology,
demonstrates its existence in a community and
investigates its source.
Primary control or disease prevention is the ideal
control measure, it aims to Prevent the initial
development of the disease.
Secondary control consists of diagnosis and treatment,
it aims to reduce the severity and prevent
complications.
Tertiary control involves rehabilitation of the
disabled and correction of defect or impairment. 44
8) To aid in the identification of clinical
syndromes.

 A syndrome is a group of signs and

symptoms that occur together and characterize
a disease.

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9) To aid in the detection of pre-
symptomatic and latent disease.

 Many diseases such as tuberculosis, diabetes,

hypertension, g cancer of the cervix, neoplasms
of the lung can be detected before the onset of
symptoms or the development of serious changes.

 The way to accomplish this is through mass

screening techniques , pre-employment physical
examinations, periodic health examinations,
special surveys and routine examinations in
hospitals and clinics.
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10) In administrative medicine and operations
research.

 One might evaluate the success of a disease control

program; the needs of a hospital in terms of
equipment, personnel and space; the quality of
medical care in a community; and the efficiency of
hospital administration

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11) To provide the foundation for developing public
policy relating to environmental problems, genetic
issues, and other considerations regarding disease
prevention and health promotion.
 Which occupations are associated with increased

risks of disease in workers, and what types of

regulation are required?

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12) To evaluate both existing and newly developed
preventive and therapeutic measures and modes of
health care delivery.
 For example, does screening men for prostate
cancer using the prostate-specific antigen (PSA)
test improve survival in people found to have
prostate cancer?

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 SCOPE OF
EPIDEMIOLOGY
Some Of Application Areas
By By methodological
physiology/disease: approach:
 Infectious  Environmental epidemiology
disease  Economic epidemiology
epidemiology  Clinical epidemiology
 Occupational  Genetic epidemiology
Injury  Nutritional epidemiology
 Cardiovascular  Conflict epidemiology
disease epidemiology  Social epidemiology
 Cancer epidemiology  Primary care epidemiology
 Epidemiology of
Aging
 Obesity/diabetes 50

epidemiology
RIGHT HAND OF COMMUNITY
MEDICINE

COMMUNITY MEDICINE

EPIDEMIOLOGY BIOSTATISTICS

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SOME BASIC TERMINOLOGIES
 Risk: The probability of having a bad outcome.
 Risk factors : A condition , physical characteristic
or behavior that increases the probability that a
currently healthy individual will develop a
particular disease. “ p value ≤ 0.05”.

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• Incidence: number of new cases of disease/total
number at risk.
• Incidence rate: represents the rate of new cases of
a condition observed within a given period.
• Prevalence: number cases (or number with
defined condition) existing at one time.
• Prevalence rate: number of such cases/total
number at risk.

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 Endemic

is defined as the habitual presence of a disease

within a given geographic area. It may also refer to
the usual occurrence of a given disease within such
an area.
• Epidemic:

– # cases in excess of expected # for population

– the uncontrolled spread of a disease (or
condition) in a community.
• Pandemic refers to a worldwide epidemic.

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 Sporadic refers to a disease that occurs
infrequently and irregularly.
 Outbreak carries the same definition of
epidemic, but is often used for a more limited
geographic area

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 Modifiable risk factors:
A risk factor that can be reduced or controlled by
intervention, thereby reducing the probability of
disease.
As : (Physical inactivity , Tobacco use ,Alcohol use ,
Unhealthy diets) .
 Non-modifiable risk factors:

A risk factor that cannot be reduced or controlled by

intervention, for example: Age , Gender , Race ,
Family history (genetics).

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 Causality:

A cause effect relationship.

In epidemiology, the cause is the exposure and the
effect is disease or death( criteria of causation )

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 Strictly Speaking, There Is No Life Science, Where
Epidemiological Approach And Principles Cannot
Be Applied.
From Womb To Tomb Epidemiology Is
Applicable

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REFERENCE
 Gordis,L. (2009). Epidemiology.
Saunders. Philadelphia, PA.
 Last JM, editor. Dictionary of epidemiology. 4th
ed. New York: Oxford University Press; 2001. p.
61.

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