Descriptive Epidemiology

Prepared by
Student. Ahmed Salem Al-Hattami

Under Supervision
Dr. Yahya Alansi
Prof. AbdulElah Aladree
Learning Objectives:
At the end of this lecture , we will be able to:
✓ Define Descriptive Epidemiology
✓ Identify the purposes and uses of descriptive epidemiology
✓ List The various procedures involved in descriptive studies
✓ Identify the most important Time, Place and personal
variables in Descriptive Epidemiology
✓ Describe Time Trend.
✓ Explain secular , periodic and short term .
Introduction
Descriptive Epidemiology
The best study of mankind is man. This
statement emphasizes the importance
of making the best use of observations
on individuals or populations exposed to
suspected factors of disease.
Descriptive studies are usually the first
phase of an epidemiological
investigation. These studies are
concerned with observing the
distribution of disease or health-
related characteristics in human
populations and identifying the
characteristics with which the disease
in question seems to be associated.
Definition Descriptive Epidemiology
 Descriptive epidemiology is one of the basic
types of epidemiology, which is concerned with
describing the frequency and distribution of
diseases and other health related conditions by
time, place, and person.

 The other branch of epidemiology which deals

with the causes or determinants of diseases is
called Analytical Epidemiology. It asks the
questions: how? Why?
Descriptive Epidemiology

In descriptive epidemiology, we

organize and summarize data
according to time, place, and person.
These three characteristics are
sometimes called the epidemiologic
variables.
Purposes of descriptive epidemiology
1. Provide necessary information on the
diseases prevalent in community and the
relative importance of each, and the groups
most at risk, which helps in the planning of
health services.

2. Clarify the natural history of the disease or

detect the infection chain.
Purposes of descriptive epidemiology

3. Frequency and distribution of a health -

related event
▪ What is the problem and how
important is it ?
▪ Who are affected ?
▪ When and where is the problem
distributed ?
Purposes of descriptive epidemiology

4. Formulate causal hypotheses

regarding pathogens or risk factors and
the relationship between these causes.

5. Helps identify health problems that

need further study
Uses of Descriptive Epidemiology
➢ Provide data about the types of disease related
problems in the community in terms of morbidity
and mortality rates.
➢ Help in the formulation of an etiological hypothesis.
ie, the existence of a possible causal association between a
factor and a disease is usually recognized in descriptive
studies. Thus, if the disease is observed to be more frequent
in a particular group than in others, hypotheses are
formulated to explain the increased frequency.
Uses of Descriptive Epidemiology

➢ Provide background data for planning,

organizing and evaluating preventive and
curative services.

➢ Contribute to research by describing

variations in disease occurrence by time,
place and person
Limitations of Descriptive Epidemiology

 Since there is no information of the population

at risk, nor a comparison group, neither can
risk be calculated nor can a hypothesis be
tested

 Ecological fallacy
Difference between Descriptive & Analytical study
DESCRIPTIVE STUDY ANALYTICAL STUDY
1) When was the 1) How was the
population affected population affected
? ?

2) Where was the 2) Why was the

population affected? population affected
?
3) Who was affected?
Difference between Descriptive & Analytical study
DESCRIPTIVE STUDY ANALYTICAL STUDY
1) Only one group is 1) At least 2 groups are
studied. studied to draw
2) Before the study, there is no comparisons.
explicit hypothesis regarding 2) At the start of the study,
cause-effect relationship. there is a definite
3) The study ends with hypothesis, regarding an
exposure possibly causing
development of an outcome.
possible hypothesis
regarding cause and 3) At the end of study, we
effect relationship confirm or reject the
hypothesis with which
the study was started.
 Descriptive epidemiology describes
the distribution of health-related
events by time, place, and personal
characteristics in order to answer:
 when (time),
 where (place),
 who (person).
Descriptive Epidemiology basically ask
the questions.
a. When is the disease occurring ?
• time distribution
b. Where is it occurring?
• place distribution
c. Who is getting the disease?
• person distribution
Compiling and analyzing data by time, place, and
person is desirable for several reasons.
 First, the investigator becomes intimately familiar with the
data and with the extent of the public health problem being
investigated.
 Second, this provides a detailed description of the health of a
population that is easily communicated.
 Third, such analysis identifies the populations that are at
greatest risk of acquiring a particular disease. This information
provides important clues to the causes of the disease, and
these clues can be turned into testable hypotheses.
The various procedures involved in descriptive
studies may be outlined as below
Procedures in descriptive studies
 1. Defining the population to be studied
 2. Defining the disease under study
 3. Describing the disease by
a) time
b) place
c) person
 4. Measurement of disease
 5. Comparing with known indices
 6. Formulation of an a etiological hypothesis
Defining Population to be studied
 Descriptive studies are investigations of
populations, not individuals. 1 step hence, is to
define the Population base"
 The "defined population" can be the whole
population in an area, or a representative sample
taken from it.
 The defined population needs to be large enough
so that age, sex and other specific rates are
meaningful.
Defining Population to be studied

 The community chosen should be stable,

without migration into or out of the area.
 Community participation is an essential
component
 The population chosen, should not be overtly
different from other communities in the
region.
Cont.
Cont.
Defining the disease under study
 Once population to be studied is specified, define disease to be
studied.

 The needs of clinician & epidemiologist vary while defining the

disease.

 The epidemiologist needs an "operational definition", by which the

condition can be identified and measured in the defined population
with good degree of accuracy.

 The diagnostic methods for use in epidemiological studies must be

acceptable to the population to be studied, and applicable to their
use in large populations.
Cont.

Defining the disease under study

 With regard to certain diseases (eg, neurological diseases)
which often do not have pathognomonic signs and symptoms, disease
definition is a crucial concern for the epidemiologist. In such cases,
the epidemiologist frames his own definition keeping the objectives
of his study in view and aiming at the same time a degree of accuracy
sufficient for his purpose.

 Once established, the case definition must be adhered to

throughout the study.
Describing the disease

 Themajor variables in descriptive

epidemiology can be classified under the
headings: time, place, and person.

 To describe the occurrence of a disease

fully, the following questions must be
answered.
 Who is affected?
 Where and When do the cases occur?
Descriptive Epidemiology triangle
Main three characteristic under study are:
➢ Time

➢ Place ➢ Person
TIME DISTRIBUTION
 The pattern of disease may be described by
the time of its occurrence, i.e., by week,
month, year, the day of the week, hour of
onset, etc. It raises questions whether the
disease is seasonal in occurrence; whether
it shows periodic increase or decrease; or
whether it follows a consistent time trend.
TIME DISTRIBUTION
 Study of disease occurrence by time is a basic aspect of
epidemiologic analysis. Occurrence is usually expressed on
a monthly or annual basis. Some diseases occur
periodically or cycles. Cycles may be annual or have some
other periodicity. The most common types of periodicity
are in relation to seasonal changes, or in relation to
changes in the number of susceptible persons in a
population. Malaria is one of the example of diseases with
seasonal periodicity, where high peaks occur in relation to
the rainy season. Epidemic of malaria are common in
October and November, when stagnant water bodies are
convenient for the breeding of mosquitoes.
Time Variation of disease occurrence
{Time Patterns} may be
 Annual occurrence,
 Seasonal occurrence, and
 Monthly occurrence,
 Weekly occurrence,
 Daily occurrence, or even
 Hourly occurrence of disease may occur.
 Time Trends
Knowing time trend of a disease will help
health professionals establish control
measures.

Such studies may yield important clues about

the source or aetiology of the disease,
thereby suggesting potential preventive
measures.
 Time Trends
Epidemiologists have identified three kinds of
time trends or fluctuations in disease occurrence.

Time trends include:

 I. Long-term or secular trends

 II. Periodic fluctuations, (cyclic variation ,Seasonality)

 III. Short-term or Rapid fluctuations

 Disease rates change over time. Some of these
changes occur regularly and can be predicted. For
example, the seasonal increase of influenza cases
with the onset of cold weather is a pattern that is
familiar to everyone. By knowing when flu outbreaks
will occur, health departments can time their flu shot
campaigns effectively. Other disease rates make
unpredictable changes. By examining events that
precede a disease rate increase or decrease, we may
identify causes and appropriate actions to control or
prevent further occurrence of the disease.
Long-term or secular trends
 The term "secular trend" implies changes in the
occurrence of disease (i.e., a progressive
increase or decrease) over a long period of time,
generally several years or decades. Although it
may have short-term fluctuations imposed on it,
a secular trend implies a consistent tendency to
change in a particular direction or a definite
movement in one direction.
Secular (long-term) trends:
 Graphing the annual cases or rate of a disease
over a period of years (Decades or centuries)
shows long-term or secular trends in the
occurrence of the disease.

We commonly use these trends to suggest or

predict the future incidence of a disease.
ource: Centers for Disease Control and Prevention. Summary of notifiable diseases–United
States, 2002. Published April 30, 2004, for MMWR 2002;51(No. 53): p. 59.
Long-term or secular trends

 Examples include coronary heart disease,

lung cancer and diabetes which have
shown a consistent upward trend in the
developed countries during the past 50
years or so, followed by a decline of such
diseases as tuberculosis, typhoid fever,
diphtheria and polio.
Secular (long-term) trends:
Secular (Long-term trend) is influenced by
population features e.g.
Change of degree of susceptibility e.g. by
immunization
Socioeconomic

Environmental sanitation and

Nutritional status of a population.

Death rate for Tuberculosis, 1860-1960, United
States, Source: US Bureau of the Census,
Historical Statistics of the United States; Colonial
Times to 1970 (Washington, D.C: Government
Printing Office, 1975), Part 1 pp58,63. Note:
Data between 1860 and 1900 for Massachusetts
only.
Changing TB mortality

⚫ In the last century, decline in TB mortality

was due to:
– better housing, ventilation
– improved nutrition
– medical care (streptomycin reduced
deaths in UK by 51% 1948-1971).
Recently, TB rates are increasing. why?

⚫ Environmental: (poor nutrition, housing, hygiene,

sociopolitical; wars).
⚫ Host changes: increased susceptibility (e.g.
HIV/AIDS infection), travel, migration,..
⚫ Agent changes: Development of drug resistant
strains of TB.
Periodic (cyclic variation , Seasonality)

Cyclic trend
Some diseases occur in cycles spread over short
periods of time which may be days, weeks, months
or years. For example, measles in the pre-
vaccination era appeared in cycles with major
peaks every 2-3 years and rubella every 6-9 years.
Seasonality:

By graphing the occurrence of a disease by week or

month over the course of a year or more we can
show its seasonal pattern

Example:
Cases of influenza increases in winter.
Food poisoning and diarrhea increase in summer.
Some epidemiologists
would regard seasonal
trend as a form of cyclic
trend. Table 10 shows a
typical pattern of seasonal
trend, - the outbreaks of
dengue/OF starting by
month of July and
peaking in September,
October and November,
coinciding with late
summer and rain.
Seasonality:

 Seasonal patterns may suggest hypotheses

about:
- how the infection is transmitted
- what behavioral factors increase risk
- environmental and other possible
contributors to disease occurrence.
Seasonal Pattern of Rubella, Influenza and Rotavirus
Rapid fluctuation (short time)

Usually occur in the form of point source

epidemics that appear abruptly and
ends abruptly either natural or due to
intervention.
e.g. food poisoning
The study of where
and when diseases
occur
Day of week and time of day:

Day of week and time of day:

Analysis at shorter time periods is especially important
for :
Conditions that are potentially related to occupational
or environmental exposures, which may occur at
regularly scheduled intervals.
Fatalities Associated with Farm Tractors

 In 1982, the number of

farm tractor-associated
deaths was described in
terms of time, place, and
person by using records
from an existing
surveillance system
Fatalities Associated with Farm Tractors

Goodman RA, Smith JD, Sikes RK, et al. Fatalities associated with farm tractor injuries: an epidemiologic
study. Public Health Rep 1985;100:329–33
By Hour of Day
Fatalities Associated with Farm Tractors

source: Goodman RA, Smith JD,

Sikes RK, Rogers DL, Mickey JL.
Fatalities associated with farm
tractor injuries: an
epidemiologic study. Public
Health Rep 1985;100:329–33.

By Day of the Week

Figure 1.9 shows the hourly number of survivors and rescuers presenting to
local hospitals in New York following the attack on the World Trade Center on
September 11, 2001
 Legionnaires’ Disease Cases, by Day

Fraser DW, Tsai, T, Orenstein W, et al. Legionnaires’ disease: description of an epidemic of 

pneumonia. New Engl J Med 1977;297:1189–97
Interpretation of time-trends

 By surveillance or monitoring of time-trends, the epidemiologist

seeks which diseases are increasing, which decreasing, and
which are the emerging health problems and of the effectiveness
of measures to control old ones (17). He tries to formulate
etiological hypotheses, and seeks explanations whether these
changes were due to changes in the a etiological agent or
variations in diagnosis, reporting, case fatality or changes in age
distribution, or some other determinants, specific and non-
specific (e.g. , changes in quality of life, socio-economic status
and personal habits).
It will be explained by Colleague Ahmed Muthanna
Cont.
Procedures in descriptive studies
 1. Defining the population to be
studied
 2. Defining the disease under study
 3. Describing the disease by
a) time
b) place
c) person
 4. Measurement of disease
 5. Comparing with known indices
 6. Formulation of an a etiological
hypothesis
Measurement of the disease
 Its necessary to have a clear picture of the disease load in the
population.
 Information about the disease load should be available in terms of
morbidity, mortality & disability.
 Measurement of mortality is straightforward.
 Morbidity has 2 aspects: incidence & prevalence. Incidence can be
obtained from longitudinal studies' & prevalence from 'cross-sectional
studies'.
 Descriptive epidemiology thus uses a cross-sectional or longitudinal
design to estimate magnitude of health and disease problems in human
populations.
Cont.
Measurement of the disease
 ➤ CROSS-SECTIONAL STUDY : (a.k.a Prevalence study)
 Simplest form of observational study.
 Single examination of a cross-section of the population at 1 point
in time: results of which are projected on whole population.
 More useful for chronic, than short lived study.
 A cross-sectional study provides information about disease
prevalence, but not enough information about the natural
history of disease or about the rate of occurrence of new cases
(incidence).
 ➤ LONGITUDINAL STUDY : {la.k a Incidence study 1}
Comparing with known indices
➢ The essence of epidemiology is to make comparisons
and ask questions.

➢ Comparisons between different populations, and

subgroups of the same population, it is possible to arrive
at clues to disease a etiology.

➢ We can also identify or define groups which are at

increased risk for certain diseases.
Formulation of a Hypothesis
 A hypothesis is a supposition, arrived at from observation or reflection.

 It can be accepted or rejected, using the techniques of analytical epidemiology.

 An epidemiological hypothesis should specify the following:

 1. The population the characteristics of the persons to whom the hypothesis applies

 2. The specific cause being considered.

 3. The expected outcome - the disease.

 4. The dose-response relationship the amount of the cause needed to lead to a stated
incidence of the effect

 5. The time-response relationship the time period that will elapse between exposure to
the cause and observation of the effect.

 The success or failure of a research project frequently depends upon the soundness
of the hypothesis.
 Formulation of a Hypothesis
 For example :
"Cigarette smoking causes lung cancer" - is an incomplete
hypothesis.

An improved formulation
"The smoking of 30-40 cigarettes per day causes lung cancer in 10 per
cent of smokers after 20 years of exposure“

The improved formulation suggests data needed to test the hypothesis,

i.e., the number of cigarettes smoking per day, years of exposure. and
so on. The success or failure of a research project frequently depends
upon the soundness of the hypothesis .
Thanks