Descriptive Epidemiology

Dr. Saurabh Kumar

Assistant Professor
Department of Community Medicine

Objectives of Descriptive Epidemiology

To evaluate trends in health and disease and

allow comparisons among countries and
subgroups within countries

To provide a basis for planning, provision and

evaluation of services

To identify problems to be studied by analytic

methods and to test hypotheses related to
those problems

Epidemiology (Schneider)

Descriptive Studies
Relatively inexpensive and less time-consuming than analytic
studies, they describe

Who gets sick and/or who does not

Where rates are highest and lowest
Temporal patterns of disease
Seasonality
Secular trends which are affected by

Changes in diagnostic techniques

Changes in the accuracy of the denominator data
Changes in the age distribution of the population
Changes in survival from improved treatment or disease mutation
Changes in actual disease incidence

Epidemiology (Schneider)

Forecast of Cancer Deaths

Thousands of Deaths

600
510

500

443

400

382

300
200
100
0

41

65

85

118

158

211

268

311

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Years

Forecast of cancer deaths if present trends continue

(Data from the American Cancer Society)

Cancer Death Rates by Site, United States, 1930-87

Figure 5-1. Cancer death rates by site, United States,

1930-1987. Source: American Cancer Society (1991).

Possible Reasons for Changes in Trends

Artifactual

Errors in numerator due to

Changes in the recognition of disease
Changes in the rules and procedures for classification
of causes of death
Changes in the classification code of causes of death
Changes in accuracy of reporting age at death
Errors in the denominator due to error in the
enumeration of the population

Epidemiology (Schneider)

Death Rates
for Individuals
with
Diabetes
Figure 3-27. Drop in
death rates for diabetes
among 55 to 64 year old
men and women, United
States, 1930-1960, due to
changes in ICD coding.
(From US Public Health
Service publication no.
1000, series 3, No. 1.
Washington, DC, US
Government Printing
Office, 1964.)

Possible Reasons for Changes in

Trends (cont.)
Real
Changes in age distribution of the population
Changes in survivorship
Changes in incidence of disease resulting
from
Genetic factors
Environmental factors
Epidemiology (Schneider)

Infant
Mortality
Rates by
Race

Figure 3-3 Infant

mortality rates by
race: United States,
1950-1991. Source:
Reprinted from
National Center for
Health Statistics,
Advance Report of
Final Mortality
Statistics, 1991,
Monthly Vital
Statistics Report, Vol.
42, No. 2, p. 11, 1993.

Case Reports

Case reports report of a single individual

with some atypical findings

Advantages

Limitations

You cannot test for statistical association because

there is no relevant comparison group

Epidemiology (Schneider)

Case Series

A case-series aggregates individual cases in one

report.

Sometimes, the appearance of several similar

cases in a short period heralds an epidemic.

For example, a cluster of homosexual men in Los

Angeles with a similar clinical syndrome alerted the
medical community to the AIDS epidemic in North
America

Epidemiology (Schneider)

Cross-Sectional Studies
Cross sectional studies or prevalence studies measure disease and exposure
simultaneously in a well-defined population

Advantages

Prevalence studies cut across the general population, not simply those seeking
medical care

They are good for identifying the prevalence of common outcomes, such as arthritis,
blood pressure or allergies

Limitations

You cannot determine whether exposure preceded disease

Since you determine prevalent rather than incident cases, results will be influenced
by survival factors

Remember: P = I x D

Factors Influencing Prevalence

Increased by:

Decreased by:

Longer duration of the

disease
Prolongation of life of
patients without cure

Shorter duration of
disease

Increase in new cases

(increase in incidence)

Decrease in new
cases (decrease in
incidence)

High case-fatality
rate from disease

In-migration of cases
Out-migration of healthy
people
In-migration of
susceptible people
Improved diagnostic
facilities
(better reporting)

In-migration of
healthy people
Out-migration of
cases
Improved cure rate
of cases

Prevalence of Congenital
Malformations Across Maternal Age

Prevalence of Cigarette Smoking Among

Successive Birth Cohorts

Comparing Cross-Sectional and

Longitudinal Data
How you organize your data depends on your research question.
Cross Sectional
Data

Cohort or
Longitudinal

45

40

35

30

25

1955

1960

1965

1970

1975

Year of Examination

Data

30 Year Olds in
Successive
Years

Correlational Studies

Correlational studies (ecological studies) use

measures that represent characteristics of entire
populations (areal aggregates) to describe outcomes
in relation to some factor of interest such as age, time,
utilization of services, or exposures

ADVANTAGES

You can generate hypotheses for case-control studies

and environmental studies

You can target high-risk populations, time-periods, or

geographic regions for future studies

Epidemiology (Schneider)

Correlational Studies (cont.)

LIMITATIONS

Because data are for groups, you cannot link disease and
exposure in individuals

Example: Percentage of teenagers taking drivers education and

fatal teenage car accidents study done by National Safety Council

You cannot control for potential confounders

Data represent average exposures rather than individual

exposures, so you cannot determine a dose-response
relationship

Caution must be taken to avoid drawing inappropriate

conclusions, or ecological fallacy

Epidemiology (Schneider)

Breast Cancer Mortality and Dietary Fat Intake

Surveillance

Surveillance can be thought of as watchfulness over

a community.

A more formal definition is the ongoing systematic

collection, collation, analysis, and interpretation of
health data essential to the planning,
implementation, and evaluation of public health
practice, closely integrated with the timely
dissemination of these data to those who need to
know.

Epidemiology (Schneider)

Pros And Cons

Often, the data are already available and thus

inexpensive and efficient to use.

Furthermore, few ethical difficulties exist.

Temporal associations between putative causes

and effects might be unclear.

A dangerous pitfall is that the investigators might

draw causal inferences when none is possible.

Epidemiology (Schneider)

Uses

Trend analysis

Trend analysis is often provided by ongoing

surveillance.

Examples include the emerging epidemic of syphilis

in the Russian Federation, and the international
epidemic of multiple births, prematurity, and low
birthweight caused by assisted reproductive
technologies

Epidemiology (Schneider)

Uses

Planning

A second use is health-care planning. For example,

the introduction of laparoscopy, coupled with bad
press about oral contraceptives and intrauterine
devices, tripled US rates of tubal sterilisation in the
1970s.

Hospitals and ambulatory surgery centres had a

surge in demand for operations, yet less need for
hospital beds.

Epidemiology (Schneider)

Uses

Clues about cause

Observant clinicians noted an association between

high concentrations of oxygen in incubators and
blindness in babies; this finding led to analytical
studies, then a randomised controlled trial,
confirming the association.

Epidemiology (Schneider)