Chapter 1

Introduction
Major Contents
 Definition of Epidemiology
 Main Methods of Epidemiology
 Contributions of Epidemiology to the
Medical Science
Section 1 Definition of Epidemiology

 Definition
 Distinguish classical Epidemiology
and clinical Epidemiology
 Branch of Epidemiology
 Definition :

Epidemiology is a discipline to study

distribution (or occurrence and
development) of diseases and health
conditions in human populations and
the factors influencing the
distribution as well as to study the
measures for the prevention and
control of disease and promotion of
health.
Three points:
 1. Objects: human population,not

individual
Classifying of medicine Study level

Elementary Medicine molecular or sub

molecular
Immunology Biochemistry;

Cell biology
Clinical Medicine individual patients
Internal Medicine;surgery
Preventive Medicine populations
Epidemiology;
Environmental Hygiene
2.Range and Content
Range: infectious diseases, noninfectious

diseases, and health conditions

Content: distribution of diseases and
health conditions; influencing
factors
3.Aim
Aim of Epidemiology is to prevent
and control diseases, and to
promote health.
 Distinguish between classical
Epidemiology and clinical Epidemiology
Classical Epidemiology:Study the
community origins of health
population,particularly those related to
nutrition, the environment,human
behavior,social, and spiritual state of a
population.
Clinical Epidemiology is to use
similar designs and statistical
tools.However, their objects are
patients, aim is to improve the
diagnosis and treatment of
diseases and the prognosis for
patients.
For example: esophagus cancer
Classical Epi: Epidemiologiests usually
study a population of some cities or
counties, survey the distribution of
this cancer. At which time ,in which
population, on which place,
incidence rate is highest? Then, to
study what reasons cause this
result.
And then, according to those
reasons,carrying out measures to
decrease incidence rate or prevent
the appearances of esophagus
cancer.
Clinical Epi:
Aims are how to improve the
diagnosis method and find patients
as soon as early, and to study which
method is better or best to treat this
disease, to estimate the patients’
prognosis, such as may he be dead
quickly? May he be mended? How
much time maybe he lives?
Branches of Epidemiology
With the developing of Epi and other
disciplines, more and more methods
and theories of Epi are applied and
produce some branches of Epi.
Such as, Environmental Hygienic Epi;
Labor Hygienic Epi; Occupational
Epi.
If Epidemiology is applied to study
some diseases,there are Tumer
Epi; Vascular Disease Epi.
Section 2 Methods of
Epidemiology

Descriptive Study
Observational Methods
Analysis Study
Clinical Trial
Experimental Methods Field Trial
Community Trial
 1.Observational Methods
Descriptive Study(Descriptive Epidemiology)
Main job: to descript the distribution of
diseases or health condition in different
place, population and time.
How can we get these datum?
We can use methods as below:cross-sectional
study or ecology study.
Main aim: to supply clues of cause of
diseases.
If we know the distribution of
disease,we can know the incidence
rate is more in which place,which
population and which time. Then we
survey or study the factor which
exists more frequency in this
population or place. Maybe, this
factor is the risk factor of this
disease.
For example: lung cancer
At the begin,we don’t know the cause
of lung cancer.
Through descriptive study, we can
know the characters of distribution
of this disease.
Population: incidence rate
in male>female
in older>younger
Place: consumption of tobacco is
more,incidence rate is higher.
Time: current year> before time

Raise clue or hypotheses of cause:

Smoking?

True or not? Analytic Study

 Case-Control Study
Aim: to test the hypotheses of cause of
disease.
Steps of case-control study:
① Selecting two groups of subjects:
patients group (who have the interested
disease)
controls group ( without the disease)
② Surveying the exposures history
which maybe have relationship with
the disease using questionnaire.
③ Comparing the frequencies of
exposure in two groups.
④ If group1> group 2 : draw a
conclusion---there are relationship
between the exposure and the
disease.
Pay attention to : not a cause-effect
association.
   Cohort Studies
Aim:also to test the hypotheses
,moreover test cause-effect
association, because the direction is
prospective.
Steps of cohort study:
① Selecting two groups:
exposure group (presence of exposure to

a particular factor)
Non-exposure group (absence of factor)
② Following-up for a specified period time:
In general,the follow-up period must be at
least several years in order to allow for
an adequate number to develop the
outcome,so that meaningful
comparisons can be made.
③ Comparing the incidence rates of
researching disease between exposure
group and non-exposure group.
④ If group 1 > group 2 , draw a
conclusion: there is a cause-effect
association between exposure and
disease.
2.Experimental Study

Experimental studies may be viewed as a type of

prospective cohort study because participants
are identified on the basis of their exposure
status and followed to determine whether they
develop the disease. The distinguishing feature
of this study is that the exposure status of each
participant is assigned by the investigator.
 Steps of experimental studies:
① Selecting a number of objects and then
divided them into two groups at random.
Experimental group ( must be treated
by one or more
intervention factors)
Control group ( untreated or control
factors)
②Following-up a certain period of
time , and determined the incidence
rates of disease of two groups.
③ Comparing the incidence rates of
two groups.
④Judging the effect of interventions.
Three types:
Study unite Aim
Clinical trial individuals of patients to estimate a kind of
new drug or treatment
method

Field trial health individual who to estimate the effect of a

has no interesting disease kind of vaccine

Community trial population to estimate or judge a

kind of prevention
method
 Section 3 Contributions of
Epidemiology to the Medical Science

 Investigating the Models of

Transmission of A New Disease
 Determining Preventable
Causes(or risk factors) of Disease
 Preventing and Controlling Diseases
 1.Investigating the Models of
Transmission of A New Disease

Usually refer to infectious diseases.

When a new disease emerges in some
population ,the first step we want to
do is to control and eliminate it. But
we must know the cause or
transmission of this disease. Then ,
We can take steps according to this.
However, to determine the cause of a
disease need a very long time,it’s so
complicate. Maybe, when we know
the cause ,there are so many people
have suffered from this disease,even
died from it. It’s too late.
On the contrary, studying the
transmission mode of a new disease
maybe simply a little. From the
transmission mode, we can know
the agent spread from one person to
another by which route.
If we have known the transmission of
agent, we can take steps to cut the
transmission route to control this
disease.
For example:
AIDS(Acquired Immuno-deficiency
Syndrome)
The first patient appeared in 1981.
Agent---HIV was found and separated
in 1983.
Till now, so many people have suffered
from HIV,however we have no
methods for this virus.
Transmission route: sexual
activity;sharing of needles
;exchange of blood and blood
products.
Prevention and controlling methods:
use condoms;avoid sharing
needles;and institute programs to
exchange needles and screen blood.
2.Determining Preventable
Causes(or risk factor) of Disease

Particularly refers to noninfectious

diseases,such as hypertension,
coronary heart disease(CHD),and
cancers.
For these diseases, maybe we don’t
know the true or direct cause, but if
we know the risk factors of this
diseases we can prevent them.
Risk factor refers to the factor which
can increase the incidence rate of
disease , if it is not exist ,the
incidence rate will decrease.
So risk factor is the preventable cause
of disease.
For example: CHD
Till now, we don’t know the true cause
of CHD.But we can using
epidemiology methods to investigate
the risk factors.
Researchers found that hypertension,
smoking can increase the incidence
rate of CHD. Then we can take steps
according to these factors. Such as
getting rid of smoking, decreasing
blood pressure by use of drugs or
other methods.
We can see the incidence rate
decrease also. So, we call
hypertension and smoking are the
preventable causes of CHD.
3.Preventing and Controlling Diseases