Basic principles of

Epidemiology

Didik Setiawan, PhD., Apt

- Faculty of Pharmacy,
- Center for Health Economic Studies,
Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
Reference

• Bonita, R., beaglehole, R., Kjellstrom, T., 2006, Basic

Epidemiology, World Health organization
• Schoenbach, VJ., Epidemiologic measures: Incidence &
Prevalence, Presentation
Case of cholera at London

• John snow, the first epidemiologist

Key terms in Epidemiology
 Study

Epidemiology is data-driven and relies on a systematic and

unbiased approach to the collection, analysis and
interpretation of data

Methods were draws from other scientific field:

biostatistics and informatics, biologic, economic, social
and behavioural sciences

Basic science of public health

• Relies on probabilities, statistics, and research methods
• A method of causal resoning based on developing and testing hypothesis
 Distribution

• Not only the numbers of cases but also

Frequency its relation to the size of population

• The occurence of health-related events

by time (daily, weekly or yearly), place
Pattern (urban-rural, work site, school etc) and
person (demographic, behavioral,
environmental factors etc)
Pattern
 Determinants

• The causes and other factors that influence the occurence of

disease and other health-related events.
• Epidemiologists assume that illness does not occur randomly in a
population, but happens only when risk factors or determinants
exist
Determinants Risk Factors Diseases

Economic status
Education
Worklife
Lung
Environtment Smoking
Cardiovascular
Social support Alcohol
Cancer
Genetics Diet
Stroke
Gender Physical fitness
Arthritis
Child life Social fitness
Depresion
Culture
Lifestyle
Health services
 Health Related states or events

• In epidemiology: disease absent vs disease present

• Intially focused exclusively on epidemic of communicable disease
• Now it’s expanding
 Specified Population

• Patients:
• 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
 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
Measuring disease frequency

According to dictionary of epidemiology

 Population at risk

• The people who are susceptible to a given disease are called the
population at risk, and can be defined by demographic, geographic
or environmental factors
 Incidence and prevalence

c e and
n
ide the 4th
i n c
The nce on
a l e e ar
prev y

1 2 3 4 5 6 7 8 9 10 11 12 13
Incidence and prevalence

Incidence Prevalence
Numerator Number of new cases of disease during a Number of existing cases of disease at a
specified period of time given point of time
Denominator Population at risk Population at risk
Focus Whether the event is a new case Time of Presence or absence of a disease Time
onset of the disease period is arbitrary; rather a “snapshot” in
time
Uses Expresses the risk of becoming ill The main Estimates the probability of the
measure of acute diseases or conditions, population being ill at the period of time
but also used for chronic diseases More being studied. Useful in the study of the
useful for studies of causation burden of chronic diseases and
implication for health services
Prevalence

• Number of people with the disease or condition

• at a specified time
• Prevalence = –––––––––––––––––––––––––––––––––––––– x
10n
• Number of people in the population at risk
• at the specified time
 Prevalence

Increased by Decreased by
Longer duration of the disease Shorter duartion of the disease

Prolongation of life of patients without

High case-fatality rate from disease
cure

Decrease in new cases (decrease in

In-migration of cases
incidence)

Out-migration of healthy people In-migration of healthy people

In-migration of susceptible people Out-migration of cases

Improved diagnostic facilities (better

http://sphweb.bumc.bu.edu/otlt/mph- Improved cure rate of cases
reporting)
modules/ep/ep713_diseasefrequency/Prevalence.png
Incidence

• Number of new events in a specified period

• Incidence = ––––––––––––––––––––––––––––––––––––– x 10n
• Number of persons exposed to risk
• during this period

• Sometimes it is not possible to measure disease-free periods

precisely  the denominator is calculated based on population-time
 Using counts and rates

Month No • Rate of new cases = Number of new cases / time interval

cases
1 1 • = 12 cases / 9 months
2 1 • = 1.33 cases / month
3 1 • Number of cases depends on population size (So, divide by
4 2 population and time)
5 1
• Incidence rate = number of new cases / population-time
6 1
7 1
8 2
9 2
Total 12
Prevalence and Incidence

https://i.ytimg.com/vi/1jzZe3ORdd8/maxresdefault.jpg
 Case Fatality

• Case fatality is a measure of disease severity and is defined as the

proportion of cases with a specified disease or condition who die within a
specified time

• Number of deaths from diagnosed cases in a given period

• Case Fatality = –––––––––––––––––––––––––––––––––––––––– x 100
• Number of diagnosed cases of the disease in the same
• period
Mortality

• Death rates • Data source?

• Age-specific death rates
• Infant mortality
• Child mortality
• Maternal mortality rate
• Adult mortality rate
• Life expectancy
Morbidity

• Impairment (any loss or abnormality of • Data source?

psychological, physiological or anatomical • Hospital admission and
structure or function)
discharges
• Disability (any restriction or lack (resulting from
• Outpatient and primary health
an impairment) of ability to perform an activity
in the manner or within the range considered care consultation
normal for a human being) • Specialist services (such as injury
• Handicap (a disadvantage for a given individual, treatment)
resulting from an impairment or a disability, • Registers of disease events (such
that limits or prevents the fulfilment of a role as cancer and conginetal
that is normal (depending on age, sex, and malformations)
social and cultural factors) for that individual)
Morbidity
Didik Setiawan, PhD., Apt

Email: d.didiksetiawan@gmail.com
Phone/WA: +62 81 226 700 119
www.ches.ump.ac.id