Basic Concepts in Epidemiology

Agnes Segunda F. Gerasmo M.D. DPAFP

Topics
I Disease Causation

II Some Useful Concepts in Epidemiology
(The Natural History of Disease)

III Ways of Classifying Ill or Disabled
Persons
Epidemiology

Study of the distribution and determinants
of health related states or events in specified
populations and the application of this study
to control of health problems.


Epidemiology
* Etiology- Cause or causes of disease.

* Importance of Causality:
1. To understand disease occurrence
and outcome.
2. To identify the links in the chain of
causality that are amenable to
intervention.
Definition of Terms
1. Cause brings about effect.

2. Causal Association- a relationship between
categories of events or characteristics in
which an alteration in the frequency or
quality of one category is followed by a
change in another.
Definition of terms
3. Statistical Association ( association in the
scientific sense)- the dependence between 2
or more events or characteristic. An
association is present if the probability of
occurrence of an event, depends upon the
occurrence of one or more other variables.

Steps to determine statistical Relationship
Statistical Association
1. Positive Association-
occurrence of higher values of one variable is
associated with the occurrence of higher
values of the other.

2. Negative Association-
occurrence of higher values of one variable is
associated with lower values of the other.
Definition of Terms
Non-causal ( Secondary) statistical Association-
results from the association of both variables
of interest with an extraneous variable.
Guidelines for Assessing Causal Association
A. Prototype Criteria/ Guidelines
Henle- Kochs Postulates:
1. The organism is always found in the disease in
question.
2. The organism is not found in any other disease.
3. The organism, isolated from one who has the
disease, and cultured through several generations
to produce disease (Animals).
B. Statistical considerations in
assessing Causation
1. Association and Causation
2 categories of events (exposure and
disease:
1. Statistical Association
2. Non- statistical association
( Not statistically associated)-
independent.

2 Categories
1. Statistically Associated

a. No Casual Association

B. Causal Association
Indirectly Associated
Directly Associated
2 Categories:
2. No statistical association- Independent
2.2. Defining Variables in Association
1. Independent variables and Dependent
Variables

2. Confounding Variables

3. Intermediate Variables
Variable
Variable characteristic of a person, object or
phenomenon that can take on different
values.
Numerical Variables- the values of these
variables are expressed in number.
Categorical Variables- the values of these
variables in catergories.
Variables
Independent variable- the variables that are
used to describe or measure the factors that
are assumed to cause or at least to influence
the problem.
- the cause

Dependent variables-use to describe or
measure the problem under study.
- the effect

Variable
A study of the relationship between smoking
and lung cancer.

Smoking-independent variable
Lung cancer- dependent variable
Variable
Confounding variable- a variable that is
associated with the problem and with a
possible cause of the problem.
It may either strengthen or weaken the
apparent relationship between the problem
and the possible cause.
Ex. A STUDY ON LOW LEVEL OF MOTHERS
EDUCATION AND MALNUTRITION.
Variable
Intermediate variable- in between the
independent and dependent variable.
2.3 Commonly Used Measures of
Association
1. Ratio measures of Association:
a. Rate Ratio
b. Risk Ratio
c. Odds Ratio

2. Difference measures of Association:
a. Rate Differences
b. Risk Differences
c. Attributable Fraction
Evidence of Causality
A. Experimental Evidence

B. Non-experimental Characteristics
Non- experimental Characteristics:
1. Temporal Sequence
2. Strength of Association
3. Dose-response to biologic agent
4. Similar Association
5. Plausible
6. Absence of Explanations


Other Concepts
1. Necessary cause versus Sufficient Cause

2. Risk Factor and Risk Indicator
II Some Useful Concepts
( The Natural History of Disease)

Natural History of Disease-
the process by which disease occur and
progress in human host.

Agent
A factor whose presence causes a disease or whose
absence cause disease.

Categories:
Physical, Chemical, Nutrient, Biologic, Genetic and
Psychological agents.

Infectious Agents:
infectivity, pathogenicity, virulence.
Agents
Non-infectious
Chemical- concentration, toxicity
Physical agents- size, shape, and intensity.
Psychological agents- chronicity and
suddenness.
Genetic Agents- homo or heterozygocity.
Environment
All external conditions and influences affecting
the life of living things.

Physical, Biological and Socioeconomic.

Provides reservoirs where agents can reside or
reproduce and modes of transmission.
Host
The individual human whom an agent produces
disease.
Disease can occur to host that is susceptible.
Lack of susceptibility maybe due:
a. Immunity
b. Inherent Resistance

Host
Immunity
a. Humoral
b. Cellular

a. Passive
B. Active

Inherent Resistance
a. anatomic or physilogic
b. Genetic or Acquired
c. Permanent
d. Temporary




Relevant Concepts in Disease
Causation
A. Biologic Considerations

Models of disease Causation ( Ecologic
models:
1. Epidemiologic Triangle


Models of Disease Causation
2. Epidemiologic Lever and Fulcrum
Models of Disease Causation
3.Wheel
Web of Causation
The Disease Process
2 periods:
1. Prepathogenesis
a. Susceptibility
B. Adaptability
2. Pathogenesis
a. Early disease
b. Early clinical Phase
c. Late clinical Phase
Natural History of Disease

Levels of Prevention
1. Primary Prevention

2. Secondary prevention

3. Tertiary Prevention
Primary Prevention
Aimed at intervening before the pathological changes
occur.

Seeks to keep the agent away from contact with the
host to eliminate or reduce host susceptibility.

Accomplished: General Health Promotion and Specific
Protection.
Secondary Prevention
to detect disease early, treat promptly and cure
disease at its earliest stage.

When cure is not possible to slow progression,
prevent complications and limit disability.

Screening the most common form.
Tertiary Prevention
To limit disability and rehabilitation of persons
for whom residual damage exists.

Activities are focused on the middle to later
phases of disease, when irreversible
pathological damage produces disability.
Comparison of Prevention for
Infectious and Non-infectious
Prevention of Infectious Dse:
Primary Prevention for communicable dse:
1. Preventing the spread of the infectious agent.
2. Increase host resistance.

Secondary Prevention
1. surveillance program
2. isolation
3. specific treatment
Comparison of Prevention
Prevention of Non-infectious
Primary Prevention-Agent is destroyed to
prevent the illness to happen or agent is
removed from the environment.
Secondary Prevention-

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