Overview of Epidemiology & Descriptive Epidemiology 4 NOVEMBER 2015

Dr. Remigio Jay-Ar Z. Butacan IV

OUTLINE Epidemiology is data-driven and relies on a very

I. Overview of Epidemiology systematic and unbiased approach in the collection,
analysis, and interpretation of data
A. Definition
Not merely observation and data generation
B. Important concepts
C. Famous Epidemiologists 2. DISTRIBUTION
II. Descriptive Epidemiology
Frequency - refers not only to the number of health
A. Significance
events, but also to the relationship of that number to the
B. Important concepts
size of the population.
III. Descriptive Epidemiology of HIV-AIDS in the Philippines
o Measure used to compare diseases across
IV. Mini-quiz
populations
Pattern - refers to the occurrence of health-related events
OBJECTIVES by time, place and person. (DESCRIPTIVE
To explain the importance and application of epidemiology EPIDEMIOLOGY)
in the practice of medicine Answers when, where and who
To analyze various illnesses in terms of descriptive
characteristics of time, place and person. 3. DETERMINANTS
Any factor, whether event, characteristic, or other
Reference: definable entity, that brings about a change in a health
Dr. Butacans Powerpoint slides and lecture condition or other defined characteristic (ANALYTIC
EPIDEMIOLOGY)
Legend: Looks at the causes of a certain disease, answers
Remember Previous how and why
Lecturer Book Trans Com
(Exams) Trans
Epidemiologists assume that illness does not occur
randomly in a population, but happens only when the
right accumulation of risk factors or determinants
I. Overview of Epidemiology exists in an individual.

A. Definition 4. HEALTH-RELATED STATES/EVENTS

EPI: meaning on or upon May be seen as anything that affects the well-being of
DEMOS: meaning people a population
LOGOS: meaning the study of Anything medically related to the population
Basically, the study of what befalls a population Originally focused on epidemics of communicable
Merriam Webster Definition diseases but subsequently expanded to include non-
o A branch of medical science that deals with the communicable diseases, chronic diseases, injuries,
incidence, distribution, and control of disease in a maternal-child health, occupational health and
population environmental health.
o Sum of the factors controlling the presence or
absence of a disease or pathogen 5. SPECIFIED POPULATIONS
Dictionary of Epidemiology (Working definition; by Last) Focuses on the collective health of the people in a
o The study of the distribution and determinants of community or population.
health-related states or events in specified
populations, and the application of this study to the o Identifying the exposure or source that caused the
control of health problems. illness
o The number of other persons who may have been
B. Important Concepts (based on the working definition) similarly exposed
o The potential for further spread in the community
1. STUDY o Interventions to prevent additional cases or
recurrences
A quantitative discipline that relies on probability, statistics
and sound research methods.
A method of causal reasoning based on developing and
testing hypotheses.

Transcribers: Aquino, Arabit, Arreola, Atienza

Editors: Armada, Balbosa
[EPI][Overview of Epidemiology & Descriptive Epidemiology]
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6. APPLICATION
Applying the knowledge gained by the studies to
community-based practice.
Uses descriptive and analytic epidemiology as well as
experience, epidemiologic judgment, and understanding of
local conditions in diagnosing the health of a community
C. Famous Epidemiologists
1. JOHN GRAUNT (1620-1674) and the Population of
London
Developed early human statistical and census
methods
Credited with producing the first life table
life table - gives the probability of survival of each age
Considered as one of the first experts in epidemiology
Wrote the book Natural and Political Observations Made
upon the Bills of Mortality
o Used analysis of the mortality rolls in early modern
London to try to create a system to warn of the
spread of bubonic plague in the city
Famous book which was concerned mostly with public
health statistics
He tabulated all causes of deaths in London. He failed
in creating the system; however, he was successful in
calculating the first estimation of the population
of London through statistics. Because of that, he
was elected into the Royal Society in 1662.
2. JAMES LIND (1716-1794) and the Scurvy of the Seas
Scottish pioneer of naval hygiene in the Royal Navy
Conducted the first ever clinical trial and developed the
theory that citrus fruits cured scurvy
o Clinical trial research studies that test how well a
certain medical approach (treatment) to a disease
work in people
Scurvy is the chronic deficiency of Vitamin C, which is
essential for the synthesis of collagen.
Initially thought that scurvy is caused by the putrefaction of
the body which can be cured by providing acids
He gathered twelve scorbutic sailors and grouped them
into six groups of two and gave them the following:
o Group 1 : quart of cider
o Group 2 : twenty-five drops of elixir of vitriol (sulfuric
acid)
o Group 3 : six spoonful of vinegar
o Group 4 : half a pint of seawater
o Group 5 : two oranges and one lemon
o Group 6 : a spicy paste plus a drink of barley water
This clinical trial only lasted for 6 days. The sailors in
group 1 and 5 recovered from scurvy. Thus, the
theory that citrus fruits would cure scurvy was
developed. (Its the ascorbic acid specifically that
cures this.)
Transcribers: Aquino, Arabit, Arreola, Atienza
Editors: Armada, Balbosa
[EPI][Overview of Epidemiology & Descriptive Epidemiology]
3. JOHN SNOW (1813-1858) and the Pathogenic Power
Pump
Considered one of the fathers of modern epidemiology
Inspired fundamental changes in the water and waste
systems and a significant improvement in general
public health around the world
Used a dot map to illustrate the cluster of cholera cases
around the pump
Used statistics to illustrate the connection between the
quality of water source and cholera cases
Hallmark event of the science of epidemiology
II. Descriptive Epidemiology
A. Significance
Data familiarity
Thus, see the limitations, deficiencies, eccentricities,
and outliers in the data
Reveals the extent and pattern of the public health
problem being investigated
Creates description that can be easily communicated
with tables, graphs, and maps
This is very important when trying to convey
information to the general public.
Information provides important clues to the causes of the
disease, which can be turned into testable hypotheses
Descriptive Epidemiology is the foundation or the
starting point of Analytic Epidemiology.
B. Important concepts
For almost all diseases / illnesses, three basic
epidemiologic questions may be asked:
1. When does the disease occur? (TIME)
2. Where does the disease occur? (PLACE)
3. Who develops the disease? (PERSON)
1. TIME
The occurrence of disease changes over time. Some of
these changes occur regularly, while others are sporadic.
Health officials will be able to anticipate diseases occurring
regularly and set preventive measures
For sporadic diseases, targeted actions may be applied.
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 Three major kinds of change with time (temporal
variations) may be identified:
a. Secular trends: long-term variations (changes that
vary through long periods of time)
Figure 1. Reported cases of Salmonellosis from 1972 to 2002.
Reported cases of Salmonellosis showed an
increasing trend starting from mid-70s, peaking in the
latter 80s, then started to go down. When you look at
these long term variations (span of years), these
are secular trends.
b. Cyclic variations: periodic fluctuations on an annual
basis (seasonal variations); recurrent alterations in the
frequency of disease
2.
Figure 2. Positive cases for Influenza from 1994 to 2000, subdivided
into months.
Influenza has seasonal patterns, it will start to actually
increase around October-November and actually start
decreasing around February-March. Always expect a spike
of cases of Influenza during winter. So having that data, you
can actually prepare and inform the public.
Transcribers: Aquino, Arabit, Arreola, Atienza
Editors: Armada, Balbosa
[EPI][Overview of Epidemiology & Descriptive Epidemiology]
c. Epidemic changes: short-term trends, opposite of
secular (span of days/weeks)
Figure 3. Reported cases for Salmonella Enteritidis in Chicago in a
span of 8 days.
A relatively higher number of cases were reported at the
days immediately prior to the onset of the party, primarily
due to the presence of contaminated food at the event. As
days passed, the number of cases decreased.
Endemic rate - the usual rate of occurrence for a disease
in a population
Epidemic rate - a rapid and dramatic increase over the
endemic rate
Pandemic - a rapidly emerging outbreak of disease that
affects a wide range of geographically distributed
populations
PLACE
Describing the occurrence of disease by place provides
insight into the geographic extent of the problem and its
geographic variation.
Characterization by place refers not only to place of
residence but to any geographic location relevant to
disease occurrence.
Displaying the pattern of disease will give you the idea
of how diseases try to spread. With that you will have
an idea of how to stop the spread or reccurrence of
the disease.
Frequency of disease can be related to place of
occurrence in terms of areas set off either by natural
barriers (e.g. mountain ranges, rivers, desserts; tropical
versus temperate regions) or by political barriers (e.g.
rural-urban differences; migration of people).
Example: Malaria its vector, anopheles, tends to
thrive in free-flowing bodies of water (natural barrier);
difference between the management of HIV-Aids in the
Philippines vs management of HIV-Aids in the US due
to differences in health care policies (political barrier).
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 Example of an Epidemiologic Data presented in the
context of Person: MALE LUNG CANCER DEATHS

Figure 4. Representation of the spot map utilized by John Snow to

visualize the cholera outbreak in London.
Bigger blot = higher reported mortality. Blue dots = different
locations of the pump. Green dot = pump of interest. From
here, it can be seen that mortalities particularly surround a
pump (pump of interest). Upon investigation of said pump, it
was found that the pump was dug just 3 meters away from a Figure 5. Trend of Lung Cancer deaths in the US.
cess pit (septic tank). The septic tank leaked fecal matter to This data shows that male lung cancer deaths
the water source, which was the true reason for the cholera significantly outnumber female lung cancer deaths.
outbreak. Upon terminating the use of the water pump, the It presented two variations: Gender and the trend in
further spread of cholera was stopped. the 1930s to the last year of the previous millennium.

3. PERSON III. Descriptive Epidemiology of HIV/AIDS in the

Person variation in reporting epidemiologic data deals Philippines
with the organization and analysis which presents data
through: The Global trend of HIV-AIDS is decreasing across all
a. Inherent characteristics continents. However the Philippines is part of the 7 unique
o Age, sex, race countries in the world which shows more than 25% increase
b. Biologic characteristics in HIV cases over the past 13 years together with:
o Immune status 1. Armenia
c. Acquired characteristics 2. Bangladesh
o Marital status, educational attainment 3. Georgia
d. Activities 4. Kazhakstan
o Occupation, leisure activities, use of 5. Kyrgystan
medications/tobacco/drugs 6. Tajikistan
e. Living conditions 7. Philippines
o Socioeconomic status, access to medical care
Descriptive epidemiology allows efficient information
dissemination to the public by effectively presenting data
through graphs and figures.

Transcribers: Aquino, Arabit, Arreola, Atienza

Editors: Armada, Balbosa
[EPI][Overview of Epidemiology & Descriptive Epidemiology]
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 IV. Mini Quiz

1. Questions answered by DESCRIPTIVE EPIDEMIOLOGY

include the following EXCEPT:
A. What specific age groups are affected by the
disease?
B. Is there a specific region in the country where the
disease predominantly occurs?
C. How was the disease transmitted?
D. Has there been an increase in the prevalence of the
illness in the last five years?
Figure 6: Cases of HIV in the Philippines
Pink asymptomatic cases 2. Which pattern of disease distribution according to TIME
Black full blown AIDS would be most appropriate to monitor for chronic NON-
From 1984-2014, COMMUNICABLE DISEASES like malignant neoplasms?
o 20,424 cumulative cases of HIV in the Philippines --- A. Short-term fluctuation
18,567 of which are asymptomatic cases and 1,857 B. Secular trend
are full blown AIDS cases. C. Seasonal pattern
o Asymptomatic carriers may transmit the disease by D. All of the above
unprotected sexual contact
o Gender and age variation affects HIV cases. 3. Which pattern of disease distribution according to TIME
would be most appropriate to monitor for
COMMUNICABLE diseases like leptospirosis?
A. Short-term fluctuation
B. Secular trend
C. Seasonal pattern
D. Epidemic curve

4. A rapidly emerging disease outbreak that affects a wide

range of geographically distributed populations is referred
Figure 7. Reported HIV cases for males and females (1984-2014) to as a/an:
Age group with the most number of cases with HIV: 25-29 A. Endemic disease
years old B. Epidemic disease
Males have a significantly higher incidence rate than C. Pandemic disease
females D. None of the above

Answers:
1. C (Descriptive epidemiology is mainly concerned with the
time, place and person)
Figure 8. Proportion of HIV-AIDS cases represented by a cluster using 2. B
sexuality as a variable. 3. C (Short-term fluctuation is synonymous to epidemic
Cream heterosexual individuals changes)
Maroon bisexual individuals 4. C
Lavender homosexual individuals
The number of heterosexuals diagnosed with HIV-AIDS
had steadily decreased in the last 5 years
The number of bisexuals and homosexuals diagnosed with
HIV-AIDS had a significant increase in the last 5 years
At present, homosexual transmission is the predominating
mode of HIV-AIDS transmission, followed by the bisexual type.
Transcribers: Aquino, Arabit, Arreola, Atienza
Editors: Armada, Balbosa
[EPI][Overview of Epidemiology & Descriptive Epidemiology]
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