Introduction to Epidemiology

Tsai-Chung Li http://140.128.61.14/~tcli/test.html

Introduction to Epidemiology
Definition of Epidemiology Practical Applications of Epidemiology Natural Progression in Epidemiologic Reasoning History of Epidemiology The Unique Contribution of Epidemiology

Introduction to Epidemiology
Epidemiology originates from the Greek words epi (upon)+demos (people)+logy (doctrine or study of). Definition: The study of the distribution and determinants of disease frequency in human populations.

Introduction to Epidemiology
Three components from definition:
Measurement of Disease Frequency
Quantification of the existence or occurrence of disease

Introduction to Epidemiology
Three components from definition:
Clinical outcomes
Death Disease Discomfort Disability Dissatisfaction A bad outcome if untimely A set of symptoms, physical signs and laboratory abnormalities Symptoms such as pain, nausea, dyspnea, etc Impaired ability connected to usual activities at home, work or in recreation Emotional reactions to disease and its care, such as sadness or anger

Introduction to Epidemiology
Three components from definition:
Distribution of disease
Who is getting the disease within a population Where and when the disease is occurring To describe patterns of disease as well as to formulate hypotheses concerning causal or preventive factors

Introduction to Epidemiology
Three components from definition:
Distribution of disease
Person Age Time Place

Race Sex
Occupation Education Hobbies

Point epidemic
Cyclical Secular

Geographic Longitude & latitude

Geologic Climatic

Geo-political
Urban/Rural Industry

Pollution

Introduction to Epidemiology
Three components from definition:
Distribution of disease: Time
Point epidemics: shortterm changes occur over limited time frames
Hours Days Weeks Months

Used for short-term exposures or diseases with short incubation and/or illness durations

Introduction to Epidemiology
Three components from definition:
Distribution of disease: Time
Cyclical trends: may be either long-term or short term events

Introduction to Epidemiology
Three components from definition:
Distribution of disease: Time
Cyclical trends:
Seasonal variation can be seen for some diseases or conditions falling within a calendar year

Introduction to Epidemiology
Three components from definition:
Distribution of disease: Time
Cyclical trends:
Seasonal variation can be used to suggest possible etiology
Migratory Birds?

Introduction to Epidemiology
Three components from definition:
Distribution of disease: Time
Cyclical trends:
Seasonal variation can be seen for some diseases or conditions falling within a calendar year

Introduction to Epidemiology
Three components from definition:
Distribution of disease: Place John Snow and Cholera WHERE are the rates higher? lower?
Geographic location of source Geographic location of reservoir

Introduction to Epidemiology
Three components from definition:
Determinants of Disease
Testing of an epidemiologic hypothesis

Introduction to Epidemiology
Practical Applications of Epidemiology
Assessment of the Health Status of Populations and Delivery of Health Services
Assessment of Disease Etiology

Introduction to Epidemiology
Seven Uses of Epidemiology - Director Jerry Morris (of the Medical Research Council Social Medicine
Research Unit) in British Medical Journal (BMJ) (1955)

To study the history of the health of population, and the rise and fall of diseases; useful projections into the future may also be possible
To diagnose the presence, nature and distribution of health and disease of the community

To study the working of health services: the determination of needs and resources, analysis of services in action, and appraise To estimate, from the group experience, what are the individual risks of disease, accident and defect, and the chance of avoiding them

Introduction to Epidemiology
Seven Uses of Epidemiology- Director Jerry Morris (of the
Medical Research Council Social Medicine Research Unit) in British Medical Journal (BMJ) (1955)

To identify syndromes from the distribution of clinical phenomena among sections of the population To complete the clinical picture of chronic diseases and describe their natural history

To search for causes of health and disease by computing the experience of group defined by their composition, inheritance and experience, their behavior and environments

Introduction to Epidemiology
Natural Progression in Epidemiologic Reasoning:
Suspicion concerning the possible influence of a factor on the occurrence of disease
Formulation of a specific hypothesis

Suspicion arise from clinical practice, examination of disease patterns, observations from laboratory research, or from theoretic speculation

Introduction to Epidemiology
Natural Progression in Epidemiologic Reasoning:
Test the hypothesis in epidemiologic study
Systematic collection and analysis of data involving the determination of whether a statistical association exists

Assess the validity of observed statistical association

Exclusion of possible alternative explanations such as chance, bias, and confounder

Introduction to Epidemiology
Natural Progression in Epidemiologic Reasoning:
Judge whether the statistical association represents a cause-effect relationship
Magnitude of the association, the consistency of findings from all other studies, and biologic credibility

Introduction to Epidemiology
History of Epidemiology:
Hippocrates, the father of modern medicine (5th century B.C.)
Development of human disease might be related to the external as well as personal environment of an individual

Introduction to Epidemiology
History of Epidemiology:
John Graunt, a London haberdasher (1662)
Quantified patterns of disease in a population

Published The Nature and Political Observations Made Upon the Bills of Mortality, in which he analyzed the weekly reports of births and deaths in London
Noted an excess of men compared with women for both births and deaths, the high infant mortality rate, and the seasonal variations in mortality alluded to by Hippocrates.

Introduction to Epidemiology
History of Epidemiology:
William Farr, a physician (1839)
Set up a system for routine compilation of the numbers and causes of deaths and established vital statistical data to evaluate the health problems of the general public

Addressed major methodologic issues relevant to modern epidemiologic studies such as defining the exact population at risk, choosing an appropriate comparison group, and considering whether other factors could affect the results.

Introduction to Epidemiology
History of Epidemiology:
John Snow (1854)
First investigator drew together all three components of the definition of epidemiology

He formulated and tested a hypothesis concerning the origins of an epidemic of cholera in London.
Based upon the availability of routinely collected data on the population and mortality patterns of England and he postulated that cholera was transmitted by contaminated water through a then unknown mechanism

Introduction to Epidemiology
History of Epidemiology:
The Framingham Heart Study(1949)
Among the first cohort studies Web site: www.nhlbi.gov/aboutframingham/.

Field Trial of the Salk polio vaccine was conducted (1954)

The largest formal human experiment

Stratified Analysis by Mantel and Haenszel (1959)

A statistical procedure for stratified analysis of case-control studies to control confounding factors

Introduction to Epidemiology
The Unique Contribution of Epidemiology :
Epidemiologic studies are conducted in human populations
Lab and animal researches are incapable of predicting the applicability of findings from a particular species of animals to humans

Epidemiologic research provided information for public health decisions long before the basic mechanism of a particular disease