Epidemiology BIOL3640

Welcome
• Dr. Kirk Hillsley
• E-mail: kirkhillsley@trentu.ca
• Student office hours – Tue 3-4pm

• TA: Ally Fracz

• TA: Tracy Ross (F05)
• Primary contact for seminars
 Course Details
• Lecture course
• Textbook: Epidemiology by Gordis, 6th edition
• 5th edition is fine
• Midterm
• Final exam
• Seminars – study reviews of different diseases / infection
outbreaks
• expand on topics covered in lectures
• Case studies
• Seminar questions
• 2% from in seminar MCQs
• 4% from take home Blackboard question
• Clinical Trials assignment, due Sun Nov 19th
• Topic: Clinical Trials Registration in Pandemic Times
Course Evaluation
• Seminars 30%
• Assignment 10%
• Midterm 25%
• Final Exam 35%
How to do well in this course?

• Take notes during lectures

• what am I saying that’s not on the slide?
• Most exam questions test an understanding of
concepts
• In reviewing lectures, ask yourself / each other questions
• What does this mean?
• What if?
• Rote memorization of lecture material is NOT
sufficient to do well in this course
 So what is epidemiology?
• NOTE: this course does NOT just cover the causes of
lots of different diseases (but many will be used as
examples in the lectures/ seminars)
• This course is mainly on the framework/rationale
underlying clinical studies
• Application of the scientific method to human health
research
• “the study of how disease is distributed in
populations and the factors that influence or
determine this distribution”
• “the study of the distribution and determinants of
health-related states or events in specified
populations and the application of this study to
control health problems”
 Epidemiology vs Public Health
• Epidemiology = studying disease in a human population
• Public health = implementation of measures to address
disease in a population
• Importance of both revealed by current pandemic
• Throughout this course we will be looking at historical
studies that reveal social inequities
• Between countries (WEIRD = Western Educated
Industrialized Rich Democratic)
Race
• Examples will be discussed throughout the course
where disease X is more prevalent in a black population
vs a white population
• But only very rarely is this anything to with genetic
differences between black and white populations
• i.e. race is NOT the risk factor
• Historical injustices / inequities are a risk factor
• Historical distrust of ‘medicine’ is a risk factor
• Tuskegee Syphilis Study
• Poverty is a risk factor
• Access to health care is a risk factor
• In other words, race is not a risk factor, RACISM is
• Structural / Institutional / Systemic racism = risk factor.
•
Where you are born isn’t just more important than all your other
characteristics, it’s more important than everything else put together
Basic epidemiological questions?
• Am I sick?
• Morbidity / Mortality
• Who? When? Where?
• Why am I feeling sick?
• Causal characteristics
• Is it transmissible? How?
• What can be done with this knowledge?
• Treatment – cure vs symptom management
• Individual
• Population
• Prevention – decrease risk vs absolute
• Individual
• Population
In human health, how do we
know things?
• GNOSIS = greek for knowledge
• 3 types of gnosis related to human health:
• DIAGNOSIS = distinguish, discern
• PROGNOSIS = forecast, prediction
• ETIOGNOSIS = causality

?
EXPOSURE OUTCOME
Why am I feeling sick?
• Acute / infectious disease

vs

• Chronic disease
Correlation vs Causation
 Correlation is not Causality
• A correlation is a statistical relationship between
two variables, A and B. The correlation may be
• Positive: • Negative:

• Neutral:

• Correlation can
• Occur by chance
• Occur repeatably and this can be shown to be causal
• Occur repeatably but not there is no causality….
Temperature = confounding
factor
Vaccine Efficacy vs. Severe disease = 1 - 5.3/16.4 = 67.5%.
Age is a confounding factor

• Most journalists do not have any background in

epidemiology / statistics
• Un / intentional reporting bias is all too easy
Clinical studies = hierarchy
But there are lots of different types of
large clinical studies  ≠ ≠ ≠ ≠
• Observational Studies
― Retrospective (back in time)
― Prospective (forward in time)
• Experimental Studies
― Randomized Controlled Trials (RCT)
- RCTs more directly test a causal relationship
between treatment and outcome
 Randomized Controlled Trials

Double blinded

Control / Treatment
Placebo
 Best quality of evidence

Study of studies
Meta- What studies are included/excluded?
analysis Garbage in, garbage out

Randomized
controlled trials

Observational studies

Case reports / case studies

Anecdotes on social media
Poor quality of evidence
But our brain works more like
this…

Relatable personal stories 

Boring data 
Hormone Replacement Therapy
• Treatment to relieve the symptoms of menopause
caused by decreasing hormone levels
• Pill, patch, or cream containing estrogens and/or
progesterone
Observational study: Retrospective
Observational study: Prospective

• Based on these observational studies, would you

use Hormone Replacement Therapy?
Results

• WHY were the conclusions of this clinical trial

different from the observational studies?
Confounders?

• Confounding factor in observational studies?

• Health / wealth of groups was different
• socioeconomic status, education, income, access to
health care, diet, exercise
So why not only do randomized
control trials (RCT)?
• Observational trials are quicker, easier, cheaper
• Can get some data that suggests it is worth a RCT
• RCTs can only be done for things that may be of
benefit
• RCTs can not be done (ethically) for things that may
harm
Study methodology
is IMPORTANT
Epidemiology  Public Political health?