Introduction to epidemiology

What is epidemiology?
The study of epidemics? The study of diseases? The study of diseases of the skin?

Something scientists and academics use to confuse other people?

Definition of epidemiology
The study of the distribution and determinants of health related states or events in specified populations and the application of this study to control health problems - James Last
A Dictionary of Epidemiology

Unpacking that definition

Study: Observing,recording,experimenting Distribution : Who, where, when Determinants: Why? Health related states Specified populations Application

Epidemiology asks or uses:

Person- Who? Place- Where? Time- When? Helps us to understand: Why?

Specified populations
How many people in this room are infected with the HIV virus? How many people in Karachi are infected ? How many people in Pakistan are infected?

Why is it important to specify the population

In order to be able to compare between two populations, we need to know what the defined population is For example,if we say 50 people in this room have an infection compared with 100 people in the next room, does it mean that infections are less common in this room?

Selling Soap
By STEPHEN J. DUBNER and STEVEN D. LEVITT

In one Australian medical study, doctors selfreported their hand-washing rate at 73 percent, whereas when these same doctors were observed, their actual rate was a paltry 9 percent.
The New York Times, September 24, 2006

 Descriptive
Describe the occurrence of disease in populations

Analytical
Identify & explain the causes of disease Risk factors

The two are interrelated

Description Analytical Analytical Descriptive Many epidemiological studies are hybrids of the descriptive & analytical methods

Descriptive Epidemiology
Collection of all data describing the occurrence of disease Person
Disease predominates in smokers Disease predominates immunocompromised individuals

Place
Disease is associated with an arid climate Disease is associated with a tropical climate

Time
Disease is associated with the date of the company picnic A particular year

Analytical Epidemiology
Investigate particular causes of diseases Quantify risk factors

Analytical Epidemiology

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Uses of epidemiology
Disease surveillance Causation Natural history of disease Description of health status in populations Evaluation of interventions

Use of epidemiology
(Disease surveillance) 1. Frequency with which the disease occurs 2. Definition of the disease 3. Size of the population from which the cases develop 4. Completeness of the reporting of the cases.

Numerators and denominators

(N/d) Numerator the top half of the fraction Denominator- the bottom number in the fraction

Numerators and denominators 2

There may be fewer people in this room than in the next room Lets assume that there are 100 people in this room and 1000 people in the next room So 50 people with infections out of 100 people in this room means half (50/100) of the people in this room have infections 100 people with infections out of a 1000 in the next room means only a tenth (100/1000) of the next room have colds

Measuring disease frequency

There are 2 main measures used Prevalence Incidence

Prevalence and incidence

Prevalence - the number of people with a particular condition, habit at a specified time within a defined population eg prevalence of colds,smoking Incidence - the number of NEW cases of a condition/habit in a defined population over a specified period of time

Distinguishing between incidence and prevalence

Prevalence includes both old and new cases and is usually expressed as a percentage Incidence includes only NEW cases and is expressed as the number of cases per population per year

Time period and population must be specified

Prevalence
Prevalence of colds in this class Number of cases (people with colds) = 3 Population of class = 30 Prevalence = 3/30 Expressed as a percentage = 3/30 X 100 =10%

Incidence
Number of cases of newly diagnosed HIV infection in a city in 2009 is 900

Population of the city is 100 000 Incidence of HIV is 900 per 100 000 in 2009

Rates
Rates are another means of expressing measurement 3 broad types of rates commonly used in epidemiology Crude rates Specific rates Standardized rates

Crude rates
Looking at the death records in Newtown which has a population of 100 000 we find that 500 people died in 2005 In neighbouring OldTown with the same population of 100 000, there were 800 deaths in 2005

Comparing crude rates

Newtown had a crude death rate of 500 per 100 000 Oldtown had a crude death rate of 800 per 100 000 Oldtown appears to have a higher death rate than Newtown, but do the crude rates tell the whole story?

Newtown Age group 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80-90 TOTAL 200 150 50 20 15 10 20 35 500

Oldtown

Number of deaths 30 20 40 20 90 150 250 200 800

Delving deeper specific rates

Looking at the number of deaths in different age groups we get a different picture The majority of deaths in Oldtown occurred in people over the age of 60 The majority of deaths in Newtown occurred in people under the age of 40

Specific rates
Specific rates give us more detail by looking at the occurrence of events in a subgroup of the population In the example, we used age groups, but could have used gender, ethnicity, occupation, etc

Comparing rates - standardisation

Going back to the example, we know that there were different patterns in the deaths recorded in the two towns But we may find it difficult to compare rates between the two towns Why?

Why standardize ?
Perhaps Oldtown is a retirement town with many old people and few young people? Perhaps Newtown has very few old people and is a barracks town consisting largely of soldiers going for UN Msn? To enable valid comparison, we need to be comparing like with like hence standardization

What are standardized rates?

Standardized rates are rates that take into account the structure of the population and adjust for differences in population structure Rates can be age-standardized, sexstandardized, etc

 Epidemiology is about the understanding of disease development and the methods used to uncover the etiology, progression, and treatment of the disease

 Epidemiology is the 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

Collecting, analyzing, & reporting data on rates of occurrence, mortality, morbidity and transmission of infections Reportable, notifiable diseases must be reported to country health authorities

Summary
Epidemiology uses person, time and place to study how illness and health are distributed in populations In epidemiology, specifying populations and time periods is important When interpreting epidemiology, always check that like is being compared with like