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EPIDEMIOLOGY- INTRODUCTION

What is Epidemiology? Epi


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Among
People Study

What is Epidemiology?
Study of disease occurrence in human population

Study of the distribution and determinants of health related states or events in a specified population.

Epidemiology
Exposure:
Any characteristic associated with either an increased or decreased occurrence of disease or event of interest. -Risk factor/ Protective factor

Outcome
A broad term for any defined disease, state of health, health- related event or death

Multiple outcomes?
NB: The exposure of interest in one study may be the outcome in another.

Research Questions?
Does smoking increases the risk of lung cancer?

Does less salt intake protect against hypertension?

Fundamental assumptions
Disease occurrence is not random.

Diseases have causal factors (risk or protective) which can be identified through systematic research
It is possible to change the disease occurrence by influencing causal factors

Epidemiology
Primary units are groups of people 3 questions Who? - Person When? - Time Where? - Place

Historical Notes
o John Snow (Father of Epidemiology) o Cholera epidemic in London1853-54

o Formulated & tested the hypothesis about the origin.


o Compared cholera death rates in different areas in London. o On the basis of available data source, he postulated that cholera was transmitted through contaminated water

Development of modern epidemiology


The broadening of the term Epidemic
Any disease or any disease determinant

Endemic: The habitual presence of a disease with in a given geographical area. Epidemic: An increase in incidence above the expected in a defined geographic area within a defined time period. Pandemic: Worldwide Epidemic

Need for new methodology - Long latency time (time between exposure and clinical appearance of disease) - Multi-factorial etiology (Genetic, environmental, lifestyle, psychosocial, etc)

Pioneers of Modern Epidemiology Case-control design:


Developed to address long latency periods

Smoking and lung cancer Doll and Hill -1945

Cohort design:
Collecting exposure information prior to the event
Framingham Heart study Great Britain Male Physician study (Doll & Hill since 1951) Seven countries study (first ecological and later cohort study)

Richard Doll and A. Bradford Hill. Smoking and carcinoma of the lung, British Medical Journal 1950: Sept 30.

(Republished Bull WHO 1999; 77:84-93).

Global disease burden: Changing disease pattern

Urbanization Changing lifestyles Aging Socio-economic networking New diseases

Specific Objectives of Epidemiology


To determine the magnitude of disease To identify the etiology or the cause of a disease and its risk factors To study the natural history and prognosis of the disease To evaluate both existing and new preventive and therapeutic measures and new modes of health care delivery To provide foundation for developing public policy and making regularity decisions relating to environmental problems

Epidemiological Triad of a disease

Agent
Vector

Host

Environment A disease is the product of an interaction of the human host, an infectious or other type of agent and the environment that promotes the exposure.

Examples of Agents of Disease

Nutritive excesses or deficiencies (Cholesterol, vitamins, proteins) Chemical agents (carbon monoxide, drugs, medications) Physical agents (Ionizing radiation) Infectious agents (hookworm, malaria, tuberculosis, syphilis, polio, rabies, mumps, etc.)

Examples of Host Factors


Age Personal behavior (diet, recreation, use of resources, etc) Immunologic state Genetic endowment

Examples of Environmental Factors


Crowding Atmosphere Modes of communication phenomena in the environment that bring host and agent together, such as:
Vector Reservoir, etc.

Information in Epidemiological studies

Collect information on 3 types of variables


Primary exposure(s) of interest Other exposure(s) that influences outcome : Potential confounder The outcome(s)

Types of exposure
Genetic traits (eg: Blood group) Demographic variables (sex, age, ethinicity, SES, etc) Reproductive variables Diet & body fluid Physical activity Smoking & alcohol habits Past medication (eg: oral contraceptive use) Environmental exposure Occupational exposure, etc.

Measurement of exposure
By personal interview/ self administered questionnaire/ diaries of behavior/ reference to records/ biological measurements. Information on - Nature of the exposure - Dose/ amount - Time (beginning/ end point)

Sources of exposure
Questionnaires - Self administered - Interviewer administered Diaries Detailed records of exposure kept by the subject Records Medical/ birth/ death certification records, etc

Sources of exposure
Biological measurements Laboratory assays to ascertain exposure to infectious agent HPV (Cervical cancer) & Helicobacter Pylori (Stomach cancer) Measurements in the environment Include agents in air (air pollutants, dust), water (Fluoride), soil ( elements), food (nutrient composition) etc.

Measurement of outcome
Questionnaire/ telephone calls Periodic personal interviews with clinical check ups- Biological measurements

Hospital records/ death certificate

Data
Different types of Data? Sources of data Census Registration of vital events (Death certification: International Classification of Diseases) Sample Registration System? Hospital records Cancer registries (Hospital/Population based) Record linkage : (Information on individuals from birth to death is available in records using personal identifier)

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