Beruflich Dokumente
Kultur Dokumente
Joko Mulyanto
Department of Public Health & Community Medicine
Jenderal Soedirman University School of Medicine
Introduction
• Epidemiology is basic science
concerned with the pattern of disease in
human population.
• Distribution of disease by person, place,
and time.
• Assumptions
- Disease does not occur randomly
- Disease has identifiable cause
> can be altered
> prevent from development
Epidemiology is defined as…
• Applying population-based
information to optimize patient care.
• Use epidemiological methods in
clinical setting.
• The basis of evidence-based
medicine.
How is epidemiology used in
clinical medicine ?
• Describe the natural history of disease.
• Discuss the causality of disease.
• Provide disease surveillance.
• Evaluate diagnostic testing.
• Evaluate therapy of disease
• Evaluate prognosis of disease.
• Economic evaluation and decision
analysis.
Observational & Analytical
Epidemiology
• Descriptive epidemiology
- The occurrence of disease
• Etiological epidemiology
- Cause of disease
• Experimental epidemiology
- Assessment of therapy
Epidemiological analysis
• Chance
• Bias
• Confounding
• Frequency measure
• Measure of association.
• Causal inference.
Chance
• Selection Bias.
Non-comparable criteria used to enroll
participants.
• Information Bias.
Non-comparable information is obtained from
the study groups due to interviewer bias or due
to recall bias.
Confounding
• a mixing of effects between the exposure and
the disease
- by other factors associated with both the exposure
and the disease
- the effects of the two processes are not separated
Gambling Cancer
Smoking,
Alcohol
Frequency Measurement
• Cumulative incidence
a measure of the occurrence of new cases in a
population
• Incidence density
the rapidity with which new cases develop; one person
year of experience (PYOE)
Measure of Association
• frequency measurements are
compared and summarized
• to determine the magnitude of the
observed association between risk
factor and outcome
• useful in judging the likelihood that
the exposure is a significant
clinically factor in the development
of the outcome of interest.
Type of Measures of
Association
• Ratio
- Relative Risk
> Risk Ratio
> Rate Ratio
- Odd Ratio
• Difference
- Attributable Risk
> Attributable Risk Fraction
> Population Attributable Risk Fraction
Relative Risk
• Disease surveillance
> cross-sectional
• Natural history of disease, causality
of disease
> cohort study, case-control
• Diagnostic testing
> SR, RCT, cohort study, case-control
Choice of Study Design
• Therapy evaluation
> SR,RCT, cohort study, case control, case-
series
• Prognostic evaluation
> cohort study, survival analysis, case-series
Cross Sectional Study
CURRENT
Exposed Disease
No Exposed No Disease
Case - Control
PAST CURRENT
Exposed
Disease
No exposed
Exposed
No Disease
No Exposed
Cohort Study (Prospective)
CURRENT Follow-Up FUTURE
Disease
Exposed
No disease
Subject
Disease
No Exposed
No disease
Cohort Study (Retrospective)
PAST CURRENT
Disease
Exposed
No disease
Subject
Disease
No Exposed
No disease
Clinical Trial
Effect (+)
Treatment
Effect ( - )
Subject R
Effect (+)
Control
Effect ( - )
Diagnostic Test
Disease
Yes No
Positive TP FP
Diagnostic
Result
Negative FN TN
Survival Analysis
CURRENT Follow Up FUTURE
Time Interval
Death
Disease
Censored
Death
Survive Censored
Survive
References
MacMahon, B., Pugh, T.F. (1970). Epidemiology:
Principles and Methods. Little Brown & Co.:
Boston
Risser, W., Risser, J. (1999). Introduction to
clinical epidemiology.
Rothman, K.J. (1986). Modern Epidemiology.
Little Brown & Co: Boston.
Sastroasmoro, S., Ismael, S. ( 2002). Dasar-dasar
Metodologi Penelitian Klinis. Sagung Seto:
Jakarta.
Silman, A.J.Epidemiological studies: A practical
guide. Cambridge University Press: London.
THANK YOU
djokomoeljanto©2006