Introduction to the
Fundamentals of Epidemiology
Epidemiology is the study of the
determinants, distribution, and
frequency of disease
Who gets disease and why
Epidemiologists study sick and well
people to determine the crucial
difference between those who get
disease and those who are spared
Science has a analytical and
creative approach
It relies on questioning,
imagination, exploration
It seeks out empirical evidence
It tests ideas
Study questions
Hypotheses
Epidemiology weighs and balances
Epidemiology contrasts and
compares
Epidemiologists use RATES
events/population at risk
Numerator
the
number of people to whom something
happened (i.e. they got sick, died, etc.)
Denominator
thepopulation at risk -- all the people at
risk for the event
Some describe it as the study of
epidemics
What is an epidemic?
An epidemic occurs when there are
significantly more cases of the same
disease than past experience would have
predicted.
To study the cause (or etiology) of disease(s), or
conditions, disorders, disabilities, etc.
determine the primary agent responsible or
ascertain causative factors
determine the characteristics of the agent or
causative factors
define the mode of transmission
determine contributing factors
identify and determine geographic patterns
To determine, describe, and report on
the natural course of disease,
disability, injury, and death.
To aid in the planning and
development of health services and
programs
To provide administrative and
planning data
In the United States, the National
Center for Health Statistics is a data
source for information on health and
disease
[Link]
Globally, the World Health
Organization is a data source for
information on health and disease
[Link]
(number of deaths)
1. Heart Disease
2. Neoplasms
3. Cerebrovascular Disease
4. Chronic Pulmonary Disease
5. Accidents/Injuries
6. Diabetes mellitus
7. Influenza and pneumonia
8. Alzheimer’s Disease
9. Nephritis, nephrotic syndrome
10. Septicemia
(Based on number of global deaths)
1. Ischemic Heart Disease
2. Cerebrovascular Disease
[Link] Respiratory Infections
4. HIV/AIDS
5. COPD
6. Perinatal Conditions
7. Diarrhoeal Diseases
8. Tuberculosis
9. Road Traffic Injuries
10. Lung Cancers
WHR 2001
To provide a basis for developing
disease control and prevention
measures for groups at risk. This
translates into developing
measures to prevent or control
disease.
Descriptive Epidemiology
Examining the distribution of disease
in a population, and observing the
basic features of its distribution
Analytic Epidemiology
Testing a hypothesis about the cause
of disease by studying how exposures
relate to the disease
Analytic epidemiology studies
require information to ….
know where to look
know what to control for
develop viable hypotheses
Person
Place
Time
Age, gender, ethnicity
Genetic predisposition
Concurrent disease
Diet, exercise, smoking
Risk taking behavior
SES, education,
occupation
Geographic place
presence or agents or vectors
climate
geology
population density
economic development
nutritional practices
medical practices
Calendar Time
Time since an event
Physiologic cycles
Age (time since birth)
Seasonality
You have been asked to investigate
an event in which 2,220 people were
exposed and 1,520 of them died.
Your role as an epidemiologist is to
ask questions about person, place
and time.
Person: Men, women and children were all
exposed and at risk. The majority of people
who died were wealthy and young men
between 18-50 years (when compared to
survivors).
Place: All those exposed were within 1 block
of one another, the climate was cold.
Time: Mid April, people died within hours
of the precipitating exposure.
Host
Agent
Environment
Epidemiologic Homeostasis
Host
Agent Environment
Host
Host Factors
Personal traits
behaviors
genetic predisposition
Agent Environment immunologic factors
• Influence the chance
for disease or its severity
Host
Agents
Biological
Physical
Chemical
Agent Environment
• Necessary for
disease to occur
Host
Environment
External conditions
Physical or biologic
or social
Agent Environment
• Contribute to the
disease process
Due to new agent
Due to change in existing agent
(infectivity, pathogenicity, virulence)
Due to change in number of susceptibles
in the population
Due to environmental changes that affect
transmission of the agent or growth of the
agent
…are often framed under the mantle of descriptive and
analytic epidemiology
Descriptive epidemiology – person, place & time
Demographic distribution
Geographic distribution
Seasonal patterns etc.
Frequency of disease patterns
Useful for:
Allocating resources
Planning programs
Hypotheses development
Analytic epidemiology
builtaround the analysis of the
relationship between two items
Exposures
Effects (disease)
looking for determinants or
possible causes of disease
useful for
hypothesis testing
