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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?
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
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)
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.
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.
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.)
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
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)