Descriptive epidemiology

What: health issue of concern

Who: person
Where: place
When: time
Why/how: causes, risk factors,
modes of transmission
“every novice newspaper reporter is
taught that a story is incomplete if it does
not describe the what, who, where, when,
and why/how of a situation”

….whether it be a suicide case or

a house fire, or a political issue.
Epidemiologists strive for similar
comprehensiveness in characterizing an
epidemiologic event,
whether it be epidemic of
dengue or a local increase in
sexually transmitted infections
However, epidemiologists tend to use
synonyms for the five W’s listed above:
what.. case definition,
who…person,
where…place,
when…time, and
why/how…causes/risk factors/modes
of transmission.
Descriptive epidemiology covers
time, place, and person.
Compiling and analyzing data by time, place, and
person is desirable for several reasons.
First, by looking at the data carefully, the
epidemiologist becomes very familiar with the data.
He or she can see what the data can or cannot
reveal based on the variables available,
Second, the epidemiologist learns the extent and
pattern of the public health problem being
investigated — which months, which neighborhood,
and which groups of people have the most and least
cases.
• Third, the epidemiologist creates a detailed
description of the health of a population that can be
easily communicated with tables, graphs, and
maps.
• Fourth, the epidemiologist can identify areas or
groups within the population that have high rates of
disease. This information in turn provides
important clues to the causes of the disease,
and these clues can be turned into testable
hypotheses.
Time
The occurrence of disease changes over time.
Some of these changes occur regularly, while others
are unpredictable.
For diseases that occur seasonally, health officials
can anticipate their occurrence and implement
control and prevention measures, such as an
influenza vaccination campaign or mosquito spraying.
For diseases that occur sporadically, investigators
can conduct studies to identify the causes and modes
of spread, and then develop appropriately targeted
actions to control or prevent further occurrence of the
disease.
Time
In either situation, displaying the patterns of disease
occurrence by time is critical for monitoring
disease occurrence in the community and for
assessing whether the public health interventions
made a difference.
Time data are displayed with
a two-dimensional graph.
The vertical or y-axis shows
the number or rate of cases;
the horizontal or x-axis
shows the time periods such as
years, months, or days.
The number or rate of cases is plotted over time.
Graphs of disease occurrence over time are
usually plotted as line graphs.
HIV+ and AIDS Case CY: 2011-2014 (Jan-Aug)
Ilocos Sur

14 13
12 12
12
10
8 6 HIV
6 AIDS

4 2 2
2 1
0
0
2011 2012 2013 2014

AIDS is the END STAGE of HIV Infection

Each day, 13 people become patients for life

500
2013: 13 new cases a day 401
400
Average No. of New Cases

2012: 9 new cases a day

300 278
2010: Four new cases a day
196
200
2009: Two new cases a day 131
100 2007: One new case a day
29 44 63
15 15 16 17 18 26
10
0 2000: One new case every 3 days
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year *Source:
Philippine HIV Registry - DOH
Place
Describing the occurrence of disease by place
provides insight into the geographic extent
of the problem and its geographic
variation.
Characterization by place refers not only to
place of residence but to any geographic
location relevant to disease occurrence.
Such locations include place of diagnosis or
report, birthplace, site of employment, school
district, hospital unit, or recent travel
destinations.
Place
The unit may be as large as a continent or
country or as small as a street address,
hospital wing, or operating room.
Sometimes place refers not to a specific
location at all but to a place category
such as urban or rural, domestic or
foreign.
Analyzing data by place can identify
communities at increased risk of disease.
 Even if the data cannot reveal why these people
have an increased risk, it can help generate
hypotheses to test with additional studies.
 For example, is a community at increased risk
because of characteristics of the people in the
community such as genetic susceptibility, lack of
immunity, risky behaviors, or exposure to local
toxins or contaminated food?
 Person
Because personal characteristics may affect
illness, organization and analysis of data by
“person” may use …
..inherent characteristics of people (for example,
age, sex, race),
...biologic characteristics (immune status),
…acquired characteristics (marital status),
…activities (occupation, leisure activities, use of
medications/tobacco/drugs),
…or the conditions under which they live
(socioeconomic status, access to medical care).
 Can the increased risk, particularly of a
communicable disease, be attributed to
characteristics of the causative agent
such as a particularly virulent strain,
hospitable breeding sites, or availability of
the vector that transmits the organism to
humans?

 Orcan the increased risk be attributed to

the environment that brings the agent
and the host together, such as crowding in
urban areas that increases the risk of
disease transmission from person to
person?
 Person
Age and sex are included in almost all data sets
and are the two most commonly analyzed
“person” characteristics.
However, depending on the disease and the data
available, analyses of other person variables are
usually necessary.

Usually epidemiologists begin the analysis of

person
data by looking at each variable (age/sex)
separately.
Sometimes, two variables such as age and sex
can be examined simultaneously.
 Sex.
Males have higher rates of illness and death
than do females for many diseases.
For some diseases, this sex-related difference
is because of genetic, hormonal, anatomic, or
other inherent differences between the sexes.
These inherent differences affect susceptibility
or physiologic responses.
For example, premenopausal women have a
lower risk of heart disease than men of the
same age.
This difference has been attributed to higher
estrogen levels in women.
 Ethnic and racial groups.
Sometimes epidemiologists are interested in
analyzing person data by biologic, cultural or
social groupings such as race, nationality,
religion, or social groups such as tribes and
other geographically or socially isolated
groups.

Differences in racial, ethnic, or other group

variables may reflect differences in
susceptibility or exposure, or differences in
other factors that influence the risk of
disease, such as socioeconomic status and
access to health care.
 Socioeconomic status.
Socioeconomic status is difficult to quantify.
It is made up of many variables such as
occupation, family income, educational
achievement or census track, living conditions,
and social standing.
The variables that are easiest to measure may
not accurately reflect the overall concept.
Nevertheless, epidemiologists commonly use
occupation, family income, and educational
achievement, while recognizing that these
variables do not measure socioeconomic status
precisely.
 Socioeconomic status.
The frequency of many adverse health conditions
increases with decreasing socioeconomic status.
For example, tuberculosis is more common among
persons in lower socioeconomic strata.
Infant mortality and maternal mortality are both
associated with lower income.

These patterns may reflect more harmful

exposures, lower resistance, and less
access to health care.
 Socioeconomic status.
A few adverse health conditions occur more
frequently among persons of higher
socioeconomic status.

Differences in exposure account for at least

some if not most of the differences in the
frequency of these conditions.
…hence the government’s focus on the poor
…end