PRINCIPLES OF

EPIDEMIOLOGY AND
EPIDEMIOLOGICAL
METHODS
DR.MUNEEBA FAISAL
PGT,FCPSII
 HISTORY
Greek word epidemic (3rd century BC)
Epi means among
Demos means people
Logos means study
Foundation laid in 19th century
 DEFINITION
John M Last in 1988
The study of determinants and
distribution of health related states or
events in specified population and the
application of this study to the control of
health problems.
 SCOPE 0F EPIDEMIOLOGY
3Ds : dynamics of disease
distribution of disease
determinants of disease
 1.DISEASE FREQUENCY
Measured as rate and ratio
Used for making comparisons in disease
frequency between different populations
or in subgroups of the same population in
relation to suspected causal factors and
this yields important clues to aetiology.
 Disease frequency (contd)
Much of the subject matter of
measurement of disease falls in the
domain of biostatistics , which is a basic
tool of epidemiology.
 INCIDENCE
Number of new cases of a disease
occuring in a defined population during a
specified time period.
Must include the unit of time.
Use is generally restricted to acute
conditions.
 Prevalence
Refers to all current cases (old & new)
existing at a given point in time or over a
period of time in a given population.
Although referred to as a rate,
prevalence rate is really a ratio.
 Distribution
Distribution of disease is always expressed
in terms of
Time
Place
Person
Used to formulate a hypothesis
Descriptive epidemiology
 Determinants
Determinants: include all the factors that
influence the distribution of disease.
Used to identify the risk factors
Analytical epidemiology
.
 Aims of Epidemiology
To describe the distribution and size of disease
problems in human populations.
To identify etiological factors in the
pathogenesis of disease.
To identify the risk factor for disease
prevention.
To provide data essential to planning,
implementation and evaluation of services for
the prevention, control & treatment of disease.
 Types of Epidemiological Studies

Observational / Non-interventional studies

Descriptive studies:
a) Quantitative:
case report
case series
b) Qualitative studies:
focused group discussions
in-depth interviews
 Analytical studies:
Ecological or co-relational*** with population as unit
of study.
Cross-sectional or prevalence *** with individual as
unit of study.
Case control study or case reference*** with
individuals as unit of study.
Cohort study or follow-up*** with individuals as unit
of study.
 Experimental / Interventional study

Randomized controlled trials:

Types:
Clinical trial
Preventive trial
Risk factor trial
Non-randomized trials
Concurrent parallel study design
Cross-over type of study design
 Procedures in Descriptive Studies

Defining the population to be studied

Defining the disease under study
Describing the disease by
Time
Place
Person
Measurement of disease
Comparing with known indices
Formulation of an etiological hypothesis
 Case control study
Also known as backward looking or
retrospective study.
Move from effect to cause.
Steps in case control study:
1. Selection of cases
2. Selection of controls
3. Matching
4. Measurement of exposure
5. Analysis & Interpretation
 Design of case control study
Time
Direction of inquiry

Exposed Cases
(people with
Disease)
Not exposed
Population

Exposed Control
(people with
Out disease)
Not exposed
 Cohort study
Cohort: A group of people who have something in
common and remain part of group over an extended
period of time e.g.,
Military cohort, occupational cohort, age cohort etc.
Steps in a cohort study:
1. Selection of study subjects
2. Obtaining data on exposure
3. Selection of comparison groups
4. Follow-up
5. Analysis:
Incidence rates among exposed and non-exposed
Estimation of risk ( Relative & Attributable risks)
 Design of cohort study

Time
Direction of inquiry

With condition

Exposed Without condition

People
Population Without
Disease
With condition
Not exposed

Without condition
 Difference between Case Control & Cohort study
Case control study
1. From effect to cause
2. Starts with the disease
3. Tests whether suspected cause
occurs more frequently in diseased
4. First approach to test the hypothesis,
also for exploratory studies
5.Involves fewer No. of subjects
6.Yields relatively quick results
7. Suitable for rare diseases
8. Yields estimate of OR
9. Cannot yield information about
diseases other than studied
10. Relatively inexpensive
Cohort study
From cause to effect
Starts with the risk factor
Tests whether disease occurs more
frequently in exposed
Reser ved for testing of precisely
formulated hypothesis
Involves larger No. of subjects
Long follow up period needed,
delayed results
Not suitable for rare diseases
Yields incidence rate, RR, AR
Can yield information about >
one disease outcome
Expensive
 EXPERIMENTAL /INTERVENTION STUDIES

Experimental or intervention studies are similar in

approach to cohort studies excepting that the conditions
in which study is carried out are under direct control of
the investigator.
Thus experimental studies involve some action,
intervention or manipulation such as deliberate
application or withdrawal of the suspected cause or
changing variable in the causative chain in the
experimental group while making no change in the
central group and observing and comparing the outcome
of the experiment in both the groups.
 Types of Experimental Studies

Randomized controlled trials (i.e.; those

involving a process of random allocation)
2- Non Randomizes or non experimental trials
(i.e.; those departing from strict randomization
for particle purposes, but in such a manner that
non- randomization doses not seriously affect
the theoretical basis of conclusions.
 Randomized Controlled Trial

Randomized controlled trials have been

helpful in assessing the value of new
therapies to combat acute diseases in
developing countries.
 Methodology

Basic steps in RCT:

Drawing up a protocol
Selecting reference & Experimental populations
Randomization
Manipulation & Intervention
Follow-up
Assessment of outcome
 Design of a randomized controlled trial
Select suitable population ( Target population)

Select suitable sample (Experimental or study pop.)

those not eligible
Make necessary exclusions
those who don't wish to give
consent
Randomize
experimental gp. Control gp.

manipulate & Follow-up

Assessment
 Blinding
It can be done in three ways;
a- Single blind trial
b- Double blind trial
c- Triple blind trial
Ideally, of course, triple blinding should be
used but the double blinding is the most
frequently used method when a blind trial
is conducted.
TYPES OF RANDOMISED CONTROLLED
TRIALS:

1.Clinical trial
2.Preventive trials
3.Risk factor trials
4.Cessation experiments
5.Trial of etiological agents
6. Evaluation of health services
 Non-Randomized Trials

1-Uncontrolled trials
2- Natural Experiments
3-Before and after comparison studies
a- Before and after comparison studies
without control.
b-Before and after comparison studies
with control