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Epidemiology, Concepts and Applications

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Epidemiology, Concepts and Applications

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hv8k7dfzcm
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Epidemiology,

Concepts and Applications


Dr Faris Al Lami
MBChB MSc PhD FFPH
Objectives
• Define Epidemiology
• Describe the main uses of Epidemiology
• Describe the main types of Epidemiology
• Describe Person, Place and Time Model
• Describe Agent, Host and Environment Model
Definition
“The study of the distribution and determinants
of health-related states or events in specified
populations, and the application of this study to
control of health problems”
Last’s Dictionary
Epidemiology
EPI DEMO LOGOS
Upon, on, befall People, population, man the Study of

The study of anything that happens to


people
“That which befalls man”
Epidemiology
• Describes
➢health events
➢cause and risk factors of disease
➢clinical pattern of disease
❖Identify syndromes
✓Identify control and/or preventive measures
So, Epidemiology
• Is the basic science of public health

• Provides insight regarding the nature, causes,


and extent of health and disease

• Provides information needed to plan and


target resources appropriately
History of Epidemiology
HIPPOCRATES (400 BC): “On Airs, Waters, and Places” –
Hypothesized that disease might be associated with
the physical environment, including seasonal
variation in illness.

JOHN GRAUNT (1662): “Nature and Political


Observations Made Upon the Bills of Mortality” –
First to employ quantitative methods in describing
population vital statistics.

JOHN SNOW (1850): Describe and test the hypothesis


that cholera was transmitted by contaminated water.
History of Epidemiology (cont.)

DOLL & HILL (1950): Describe and test the


association between smoking and lung
cancer.

FRANCES at al. (1950): Field trial of the


Poliomyelitis vaccine in school children.

DAWBER et al. (1955): Study risk factors for


cardiovascular disease in the Framingham
Heart Study.
Uses of Epidemiology (1)
1. Community diagnosis; i.e., what are the major
health problems occurring in a community
2. Establishing the history of a disease in a
population; e.g., identifying the periodicity of an
infectious disease
3. Describing the natural history of disease in the
individual; e.g., infection-asymptomatic phase-
clinical disease-death)
4. Describing the clinical picture of disease; i.e., who
gets the disease, who dies from the disease, and
what the outcome of the disease is.
Uses of Epidemiology (2)
5. Estimating risk; e.g., what factors increase the
risk of heart disease, automobile accidents,
and violence
6. Identifying syndromes and precursors; e.g.,
the relationship of high blood pressure to
stroke, kidney disease, and heart disease
7. Evaluating prevention/intervention
programs; e.g., vaccine and clinical trials
8. Investigating epidemics/diseases of
unknown etiology
Kinds of Epidemiology

• Descriptive Study of the occurrence and


distribution of disease

Determine risk factors of


• Analytic disease.

Manipulation of the cause is


• Experimental should be followed by an
alteration in the effect not due
to chance
Basic Triad of Descriptive
Epidemiology
– □ Person: Who is getting sick?
– □ Place: Where is the sickness
occurring?
– □ Time: When is the sickness
occurring?
• PPT = person, place, time
• PERSON
• PLACE
• TIME
Person
Age Hobbies
Sex Pets
Occupation Travel
Immunization status Personal Habits
Underlying disease Stress
Medication Family unit
Nutritional status School
Socioeconomic factors Genetics
Crowding Religion
Place (where ?)
• Geographically restricted or widespread
• Climate effects (temperature, humidity,
combined effects..)
• Urban / sub-urban-squatter / rural
• Relation to environmental exposure
(water, food supply, etc)
• Multiple clusters or one?
Time (when ?)

• Changing or stable?

• Clustered (epidemic) or evenly


distributed (endemic)?

• Time-trends: Point source,


propagated, seasonal, secular,
combinations
Secular Trend, The long-time trend of disease occurrence
Tetanus – by year, USA, 1955-2000
During 2000, a total of 35 cases of tetanus were reported.

900

800

700

600

500

400

300

200

100

1955 1960 1965 1970 1975 1980 1985 1990 1995 2000
Year
Seasonal
• A cyclic variation in disease
frequency by time of year & season.

➢Seasonal fluctuations in,


❖Environmental factors
❖Occupational activities
❖Recreational activities
Whooping Cough - Four-monthly admissions,
1954-1973
Epidemic
An increase in occurrence of the disease
above the expected in a defined
geographic area within a defined time
period
Endemic, Epidemic and Pandemic
• Endemic - The habitual presence (or usual occurrence) of a
disease within a given geographic area
• Epidemic - The occurrence of a disease clearly in
excess of normal expectancy, and generated
from a common or propagated source
• Pandemic - A worldwide epidemic affecting an exceptionally
high proportion of the global population

Number
of Cases
of
Disease

Time
Natural History of Disease
Onset of Usual time of
symptoms diagnosis
Exposure
Pathologic
changes

Stage of Stage of Stage of Stage of


susceptibility subclinical clinical recovery,
disease disease disability or
death

PRIMARY
PREVENTION SECONDARY
PREVENTION TERTIARY
PREVENTION
Natural History of Disease

STAGE 1: Susceptibility

DESCRIPTION: Risk factors which assist


the development of
disease exist, but disease
has not developed

EXAMPLE: Smoking
Natural History of Disease (cont’d)

STAGE 2: Presymptomatic disease

DESCRIPTION: Changes have occurred


to lead toward illness but
disease is not yet
clinically detectable

EXAMPLE: Alveoli deteriorate


Natural History of Disease (cont’d)

STAGE 3: Clinical Disease

DESCRIPTION: Detectable signs and/or


symptoms of disease exist

EXAMPLE: Emphysema detected by


pulmonary function test
Natural History of Disease (cont’d)

STAGE 4: Disability

DESCRIPTION: Disease has progressed to


the point of causing a
residual effect

EXAMPLE: Person has difficulty


breathing
The Epidemiology Triangle

Time
Agents

Biological (micro-organisms)
Physical (temperature, radiation,
trauma, others)
Chemical (acids, alkalis, poisons,
tobacco, others)
Environmental (nutrients in diet,
allergens, others)
Psychological experiences
Host Factors

• Genetic endowment
• Immunologic status
• Personal characteristics
• Personal behavior
• Definitive versus intermediate
(in vector-borne diseases)
Environment
• Living conditions (housing, crowding,
water supply, sewage, etc)
• Atmosphere / climate
• Modes of communication:
phenomena in the environment that
bring host and agent together, such
as: vector, vehicle, reservoir, etc)

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