Introduction to

Epidemiology
Joseph Sam Kanu
(B.Pharm Hons, M.Sc, Ph.D)
[email protected]
 Content of the presentation

 At the end of this session, students should be able to:

 Define Epidemiology
 Understand the differences between Laboratory Sciences And
Field Sciences
 Understand what Epidemiology involves
 Know the uses of Epidemiology
What is Epidemiology?
Leading Causes of Death Worldwide, 2000
(Based on number of global deaths)
1. Ischemic Heart Disease
2.
Cerebrovascular Disease
3.
Lower Respiratory Infections
4. HIV/AIDS
5. COPD
6. Perinatal Conditions
7. Diarrhoeal Diseases
8. Tuberculosis
9. Road Trafc InIuries
10. Lung Cancers
WHR 2001
 Useful Textbooks
 Required Texts:
1) Leon Gordis: Epidemiology. 4th & 5th
editions

 Others
1) Last J M, A Dictionary of Epidemiology

2) Chin J: Control of Communicable

Disease Manual, check for recent edition.

Etc, etc, etc

 Defnitions of Epidemiology

The word epidemiology comes from:

 the Greek words epi, meaning "on or upon,"

 demos, meaning "people," and
 logos, meaning "the study of."

Many definitions have been proposed; here are some of them, the
last one captures the underlying principles and the public
health spirit of epidemiology:
 Two Defnitions of an Epidemic
Last JM: A Dictionary of Epidemiology. 4th ed
THE OCCURRENCE IN A COMMUNITY OR REGION OF CASES OF
AN ILLNESS, SPECIFIC HEALTH-RELATED BEHAVIOUR, OR
OTHER HEALTH-RELATED EVENTS CLEARLY IN EXCESS OF
NORMAL EXPECTANCY.

From the Babylonian Talmud (Tractate Taanit, 21A)

A CITY THAT HAS FIFTEEN HUNDRED MILITARY AGE

MEN SUCH AS AKKO, AND THAT SUFFERS NINE DEATHS IN THREE
DAYS, THAT IS CONSIDERED A PLAGUE. A CITY WITH FIVE
HUNDRED SUCH AS AMIKO, AND HAS THREE DEATHS IN THREE
DAYS, THAT IS CONSIDERED A PLAGUE.
 Defnitions of Epidemiology

Oxford English Dictionary

THE BRANCH OF MEDICAL SCIENCE WHICH TREATS
EPIDEMICS

Kuller LH: Am J Epid 1991;134:1051

EPIDEMIOLOGY IS THE STUDY OF "EPIDEMICS" AND
THEIR PREVENTION
Anderson G,quoted in Rothman KJ: Modern
Epidemiology
THE STUDY OF THE OCCURRENCE OF ILLNESS
 Defnitions of Epidemiology

Lilienfeld A: in Foundations of Epidemiology

THE STUDY OF THE DISTRIBUTION OF A DISEASE OR A

PHYSIOLOGICAL CONDITION IN HUMAN POPULATIONS
AND OF THE FACTORS THAT INFLUENCE THIS
DISTRIBUTION

Last JM: A Dictionary of Epidemiology

THE STUDY OF THE DISTRIBUTION AND DETERMINANTS

OF HEALTH RELATED STATES AND EVENTS IN
POPULATIONS AND THE APPLICATION OF THIS STUDY TO
CONTROL OF HEALTH PROBLEMS“
 Defnitions of Epidemiology
 Epidemiology is considered a basic science of public
health.

Epidemiology is:
 a) a quantitative discipline built on a working knowledge
of probability, statistics, and sound research methods;

 b) a method of causal reasoning based on developing and

testing hypotheses pertaining to occurrence and prevention
of morbidity and mortality; and

 c) a tool for public health action to promote and protect the

public's health based on science, causal reasoning, and a
dose of practical common sense
 Defnitions of Epidemiology
The definitions of epidemiology include several terms which
reflect some of the important principles of the discipline:

 Study - Epidemiology is a scientific discipline and has at its

foundation, sound methods of scientific inquiry.

 Distribution - Epidemiology is concerned with the frequency

and pattern of health events in a population. Frequency
includes not only the number of such events in a population,
but also the rate or risk of disease in the population. Pattern
refers to the occurrence of health-related events by time,
place, and personal characteristics.

 Time characteristics include annual occurrence, seasonal

occurrence, and daily or even hourly occurrence.
 Defnitions of Epidemiology
 Place characteristics include geographic variation, urban-
rural differences, and location of work sites or schools, for
example.

 Personal characteristics include demographic factors such as

age, race, sex, marital status, and socioeconomic status, as
well as behaviors ( such as occupation or risk-taking activity)
resulting in environmental exposures.

 This characterization of the distribution of health-related

states or events is one broad aspect of epidemiology called
descriptive epidemiology. Descriptive epidemiology provides
the What, Who, When and Where of health-related
events.
 Defnitions of Epidemiology
 Determinants - Epidemiology is often used to search for
causes and other factors that influence the occurrence of
health-related events such as diseases, syndromes, and
injuries.

 Analytic epidemiology attempts to provide the Why and How

of such events by comparing groups with different rates of
disease occurrence and with differences in demographic
characteristics, genetic or immunologic make-up, behaviors,
environmental exposures, and other so-called potential risk
factors.

 Under ideal circumstances, epidemiologic findings provide

sufficient evidence to direct swift and effective public health
control and prevention measures.
 Defnitions of Epidemiology
 Health-related states or events - Originally, epidemiology was
concerned with epidemics of communicable diseases. The
discipline was extended to endemic communicable diseases and
noncommunicable infectious diseases.

 Modern epidemiology has been applied to chronic diseases,

injuries, birth defects, maternal-child health, occupational
health, and environmental health.

 Now, even behaviors related to health and well-being (amount

of exercise, seat-belt use, etc.) are recognized as valid subjects
for applying epidemiologic methods.

 The term "disease" refers to the range of health-related states or

events.
 Defnitions of Epidemiology
 Specified populations - Although epidemiologists and
physicians in clinical practice are both concerned with disease
and the control of disease, they differ greatly in how they view
“the patient.”

 Clinicians are concerned with the health of an individual;

epidemiologists are concerned with the collective health of the
people in a community or other area.
 Defnitions of Epidemiology
 Specified populations -

 When faced with a patient with diarrheal disease, for example,

the clinician and the epidemiologist have different
responsibilities.

 Although both are interested in establishing the correct

diagnosis, the clinician usually focuses on treating and caring
for the individual.

 The epidemiologist focuses on the exposure (action or source

that caused the illness), the number of other persons who may
have been similarly exposed, the potential for further spread in
the community, and interventions to prevent additional cases or
recurrences.
 Defnitions of Epidemiology
 Application - Epidemiology is more than "the study of."

 As a discipline within public health, epidemiology provides

data for directing public health action.
 To treat a patient, a clinician must call upon experience and
creativity as well as scientific knowledge.
 Similarly, an epidemiologist uses the scientific methods of
descriptive and analytic epidemiology in “diagnosing” the
health of a community, but also must call upon experience
and creativity when planning how to control and prevent
disease in the community.
 As a public health discipline, epidemiology is instilled with
the spirit that epidemiologic information should be used to
promote and protect the public's health. Hence, epidemiology
involves both science and public health practice. The term
applied epidemiology is sometimes used to describe the
application or practice of epidemiology to address public
health issues.
Diferences Between Laboratory Sciences
And Field Sciences (e.g. EPI)
In the Laboratory:

• Mostly experimental
• Variables controlled by the investigator
• All variables known
• Replication easy
• Results valid
• Meaning of results for humans uncertain.
• Little need for statistical manipulation of data.
• Highly equipment intensive
 Diferences Between Laboratory
Sciences And Field Sciences (e.g. EPI)
In the Field:

 Mostly observational 
 Variables controlled by nature 
 Some variables unknown 
 Replication difcult; exact replication
impossible 
 Results often uncertain 
 Meaning of results for humans clear 
 Statistical control often very important 
 Highly labor intensive
What Is The Unique Skill
Of Epidemiologists?

MEASURING DISEASE
FREQUENCY IN
POPULATIONS
 Measuring Disease Frequency
Has Several Components

 Classifying and  Defning the period of

categorizing disease time of risk of disease

 Deciding what  Obtaining permission to

constitutes a case of study people
disease in a study
  Making measurements of
 Finding a source for disease frequency
ascertaining the cases
 Relating cases to
 Defning the population population and time at
at risk of disease risk
 While the topic areas that we work in are
diverse (e.g., cancer, occupational, infectious,
heart, genetic, environmental, dental, injury,
children and women’s health), we share a
common methodology in the field of
epidemiology.
Objectives of epidemiology

1. Identify the causes of disease and the factors that increase a

person’s risk of disease

2. Describe the extent of disease found in a community

3. Describe the natural history and characteristics of a disease

4. Evaluate preventive/therapeutic measures

5. Guide policy decisions

 Purposes Of Epidemiology
(Gordis: Epidemiology, 3 Edi. p. 3-4)
1. Identify causes and risk factors for
disease.
2. Determine the extent of disease in the
community.
3. Study natural history and prognosis of
disease.
4. Evaluate preventive and therapeutic
measures
5. Provide foundation for public policy
 Uses of Epidemiology
 Seven ‘uses' of epidemiology have been described:

 In historical study of the health of the community and of the

rise and fall of diseases in the population; useful ‘projections'
into the future may also be possible.

 For community diagnosis of the presence, nature and

distribution of health and disease among the population, and the
dimensions of these in incidence, prevalence, and mortality;
taking into account that society is changing and health problems
are changing
 Uses of Epidemiology
 To study the workings of health services. This begins with the
determination of needs and resources, proceeds to analysis of
services in action and, finally, attempts to appraise. Such
studies can be comparative between various populations.

 To estimate, from the common experience, the individual's

chances and risks of disease.

 To help complete the clinical picture by including all types of

cases in proportion; by relating clinical disease to the
subclinical; by observing secular changes in the character of
disease, and its picture in other countries.
 Uses of Epidemiology
 In identifying syndromes from the distribution of clinical
phenomena among sections of the population.

 In the search for causes of health and disease, starting with the

discovery of groups with high and low rates, studying these
differences in relation to differences in ways of living; and,
where possible, testing these notions in the actual practice
among populations.
 Uses of Epidemiology
 The various uses of Epidemiology stem from the fact that in
epidemiology the group is studied and not merely particular
individuals or cases in the group.

 The definition of groups involves accounting for all members;

and this has immediate uses in the study of the natural history
of disease.

 Describing group experience of health, disease and their

circumstances is useful in itself, and it permits manifold
comparisons in time, place and society.
 Uses of Epidemiology
 There have been advances during recent years in the study of
lung and other cancers, dental caries, pneumoconiosis, of
atherosclerosis, ischaemic heart disease, hypertension, of
rheumatism, schizophrenia, the congenital malformations—to
mention some examples.

 New ground is being broken in the investigation of health, in the

determination of physiological norms, in studies of morbidity, in
family studies, in application to genetics, in the study of
psychological aspects.

 Uses of Epidemiology
 There have been improvements in techniques of sampling and
surveys, diagnostic and screening devices, methods of
prediction, in the estimation of observer validity and reliability,
the treatment of qualitative data.

 The prospective study of cohorts, the combination of survey

with case studies, international comparisons and field
experiments are being increasingly used.

 The proposition might be advanced that Public Health needs

more epidemiology; so does medicine in general; and, it may be
said, society at large.
 Uses of Epidemiology

 Public Health needs more epidemiology—this cannot be

doubted since epidemiology is the most likely basis for its
further intellectual growth.
 Uses of Epidemiology
 Medicine as a whole needs more epidemiology because it is a
social science as well as human biology and the
epidemiological is the main method of studying the social
aspects of health and disease.

 Moreover, epidemiology is rich with suggestions for clinical

and laboratory research and it offers many possibilities for
testing hypotheses emerging from these. The main relations of
epidemiology with clinical medicine may be restated thus
 Uses of Epidemiology
 The main relations of epidemiology with clinical medicine may
be restated thus:
 Epidemiology is the study of populations and all cases that can
be defined in them.
 These cases will often include, and in their due proportion,
cases differing in type from those presenting to particular
clinical attention (early disease, minor, the symptom-less cases,
the somehow peculiar).
 The epidemiological method can also be used to identify
subclinical manifestations and again in proper proportion to
the clinical. Epidemiology thus helps to complete the clinical
picture and natural history of disease.
 Uses of Epidemiology
 Epidemiology supplements the clinical picture by asking
questions that cannot be asked in clinical medicine about the
health of the community and of sections of it, present and past:
it provides a different view of the world of medicine. Clinical
problems are set in community perspective; health problems are
revealed and indication may be given where among the
population they might best be studied. Measurements can be
made of the need for clinical services and how the needs are
being met, thus providing an indicator of the quality of medical
care.
 Uses of Epidemiology
 Finally, epidemiology by identifying harmful ways of living,
and by pointing the road to healthier ways, helps to abolish the
clinical picture. One of the most urgent social needs of the day
is to identify rules of healthy living that might reduce the
burden of the metabolic, malignant and ‘degenerative' diseases
which are so characteristic a feature of our society. This is the
main field today for the use of epidemiology.
 Uses of Epidemiology
 In summary, Epidemiology and the information generated
by epidemiologic methods have many uses which include:

 Population or community health assessment - To set policy

and plan programs, public health officials must assess the health
of the population or community they serve and must determine
whether health services are available, accessible, effective, and
efficient. To do this, they must find answers to many questions:
 What are the actual and potential health problems in the community?
 Where are they?
 Who is at risk?
 Which problems are declining over time?
 Which ones are increasing or have the potential to increase?
 How do these patterns relate to the level and distribution of services
available?
 Uses of Epidemiology
 Individual decisions - People may not realize that they use
epidemiologic information in their daily decisions. When they
decide to stop smoking, take the stairs instead of the elevator,
order a salad instead of a cheeseburger, or choose one method
of contraception instead of another, they may be influenced,
consciously or unconsciously, by epidemiologists’ assessments
of risk
 Since World War II, epidemiologists have provided information
related to all these decisions.

 Hundreds of epidemiologic findings are directly relevant to the

choices that people make every day, choices that affect their
health over a lifetime.
 Uses of Epidemiology
 Completing the clinical picture - When studying a disease
outbreak, epidemiologists depend on clinical physicians and
laboratory scientists for the proper diagnosis of individual patients.
 But epidemiologists also contribute to physicians' understanding of
the clinical picture and natural history of disease.
 For example, in late 1989 three patients in New Mexico were diagnosed as
having myalgia (severe muscle pains in chest or abdomen) and unexplained
eosinophilia (an increase in the number of one type of white blood cell). Their
physician could not identify the cause of their symptoms, or put a name to the
disorder. With considerable success, epidemiologists found other cases of
eosinophilia-myalgia syndrome, more fully describing the illness, its
complications, and its rate of mortality.
 Similarly, epidemiologists have documented the course of HIV infection
 They have also documented the numerous conditions that are associated with
cigarette smoking - from pulmonary and heart disease to lung and cervical
cancer.
 Uses of Epidemiology
 Search for causes - Much of epidemiologic research is devoted to a
search for causes, factors that influence one's risk of disease.
 Often the goal is to identify a cause so that appropriate public health
action might be taken.
 While epidemiology can not necessarily prove a causal relationship
between an exposure and a disease, it often provides enough
information to support effective action.
– Examples include John Snow’s removal of the pump handle in nineteenth
century London to combat cholera and the withdrawal of a specific brand of
tampon that was linked by epidemiologists to toxic shock syndrome in the
1970s-1980s
 Just as often, epidemiology and laboratory science converge to
provide the evidence needed to establish causation
 Uses of Epidemiology

 For example, a team of epidemiologists were able to identify a

variety of risk factors during an outbreak of a pneumonia among
persons attending the American Legion Convention in Philadelphia
in 1976. However, the outbreak was not “solved” until the
Legionnaires’ bacillus was identified in the laboratory almost 6
months later.
References:

 Cates WJ. Epidemiology: Applying principles to clinical

practice. Contemp Ob/Gyn 1982; 20:147-161.
 Last JM, ed. Dictionary of Epidemiology, Third edition. New
York: Oxford U. Press, 1995:55.
 MacMahon B., Pugh TF. Epidemiology: principles and
methods. Boston: Little Brown and Company, 1970:1.
The End!!!

Thank you!