Epidemiology

Introduction to Epidemiology
& Distribution of Disease
Ma Jinxiang, M.S.
Department of preventive medicine,
Guangzhou medical college

 1021311
 Epidemiology
Introduction to epidemiology
• Definition of epidemiology
• A brief history of epidemiology
• Approaches in epidemiological study
• Objectives of epidemiology
• Future and challenge of epidemiology

Distribution of disease
• Description of distribution(time, person and place)
• Patterns of epidemic
• Measures of disease frequency
 Epidemiology
Definition
Epidemiology
• epi:
– Greek root, epi, over, on
• - dem:
– Greek root deme, meaning a township, or
division, of ancient Attica; whence demos,
for people
• -logy:
– Contemporary English, a branch of learning
 Epidemiology
Definition
Epidemiology
• Epidemic - ‘all over the people’
• Epidemiology
– A branch of learning that deals with events
or conditions that are ‘all over the people’
– A branch of medicine that deals with the
cause, distribution, and control of disease
in populations (American Heritage Dictionary of the
English Language, third edition)
 Epidemiology
Definition
Epidemiology: Definitions
Epidemiology is 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 ed. Dictionary of Epidemiology
 Epidemiology
History
A brief history of epidemiology
——the rudimentary or beginning stage

• Hippocrates – (460-377B.C)
 Association between external environment and
personal characteristics and health
 “Epidemic” firstly appeared in his book –“On
airs, waters and places”
• John Graunt – 1662
 ‘Bills of Mortality’, a comparative study of
morbidity and mortality in human populations
 Epidemiology
History
A brief history of epidemiology
——the rudimentary or beginning stage

• 1747 - Lind performed first ‘experiment’ to

establish cause and treatment of scurvy
• 1768 - Jenner first vaccinated human with
cowpox
 Epidemiology
History
A brief history of epidemiology
——the establish stage of epidemiology as a branch of study

• 1850 - London Epidemiologic Society

established by William Farr and colleagues
• 1854 - Snow’s investigation of cholera
outbreak in London
• Father of modern epidemiology
• Plotted geography
• Established modern epidemiologic methods
 Epidemiology
History
A brief history of epidemiology
——the development stage of epidemiology
• 1945 - Fundamental shift in paradigm after World
War II to study chronic diseases
• 1948 - Framingham cohort study begun to study
coronary artery disease
• 1958 - Doll and Hill apply case-control study
design to establish smoking as cause of lung
cancer
• 1980 - DNA fingerprinting, Micro-computing
industry begins
• 1982 - AIDS epidemic recognized in US, Cox
proportional hazards regression analysis
 Epidemiology
History
A brief history of epidemiology
——epidemiology in china

• Wu Lien-teh was considered as pioneer and

founder in the history of epidemiology in
china.
 Epidemiology
approaches
Approaches in Epidemiological studies
Cross-sectional study
Descriptive study
Observational Ecological study
study Case-control study
Analytical study
Cohort study
Clinical trial
Experimental study
Community field trial

Theoretical study
 Epidemiology
scope
The scope and objectives of Epidemiology
• To determine the etiology or cause of a disease,
including risk factors
• To determine the frequency and extent of health
conditions and disease in the community
• To study the natural history and applied to diagnosis,
treatment and prognosis of disease
• To provide the foundation for developing public
policy and regulatory decisions relating to health
• To prevent and control of disease
 Epidemiology

Epidemiology: Future
• Molecular biology will revolutionize the way
epidemiologists evaluate gene-environment
interaction
• Micro-computing will become more
sophisticated and more widely available
• Biomedical science will make significant
advances that will require evaluation of
findings in populations
• Eco-epidemiology era – 21st century
 Epidemiology

Challenges of Modern Medicine

• Behavioral aspects of health
– Promotion of healthy lifestyles
• Diet
• Exercise
• Tobacco, alcohol, drugs
• Sexual behavior
– Management of stress
• New diseases – AIDS, SARS, West Nile
Virus, bio-terrorism
 Epidemiology
Distribution of disease
Temporal Short-term/Rapid fluctuation,
(Time) Seasonal, cyclic/periodicity,secular
Qualitative
measurements Age,sex,occupation,race/ethnicity,
Person
(three patterns behavior,education,marital status
of distribution)
International comparison,
Spatial regional difference within a
(place)
country, city/rural,endemic

Quantitative Sporadic, epidemic, pandemic

measurements
Measures of disease frequency
 Epidemiology
Time, place and person

Three patterns of distribution

• Time characteristics
We usually show time data as graph
1. Short-term/rapid fluctuation (outbreak and
epidemic)
2. Seasonality
3. Cyclicity/periodicity
4. Secular/long-term trends
 Epidemiology
Time, place and person

Three patterns of distribution

• Person characteristics
1. Age
2. Sex
3. Ethnic and racial groups
4. Behavior
 Epidemiology
Time, place and person

Three patterns of distribution

• Place characteristics
1. International comparison
2. Regional difference within a country
3. Urban/rural
4. Endemic
 Epidemiology
Time, place and person

Three patterns of distribution

• Integrated description of time,
person and place
1. Migrant epidemiology
2. Birth cohort study
 Epidemiology
Patterns of epidemic

•Sporadic–
Is one that occurs only occasionally in population.
Occurring upon occasion or in a scattered, isolated
or seemingly random way.
 Epidemiology
Patterns of epidemic
•Epidemic –
is the occurrence of more cases of disease than would
normally be expected in a specific place or group of
people over a given period of time.
•Pandemic –
is an epidemic that becomes very widespread and
affects a whole region, a continent, or the world. For
example, AIDS is now pandemic in Africa.
•outbreak –
A cluster that is unexplained, often used
interchangeably with epidemic
 Epidemiology
Measures of disease frequency

• Ratio
• Proportion
• Rate

What, who is in the denominator ? ???

 Epidemiology
Measures of disease frequency

Measures of disease occurence(1)

• Epidemiology :
– « Study of the occurrence of illness »

• Two types of measures :

– Prevalence
Measures population disease status
– Incidence
Assess frequency of disease onset
 Epidemiology
Measures of disease frequency

Measure Definition
Prevalence The proportion of individuals in a
population at risk with a disease at a
single point in time
 Point prevalence
 Period prevalence
Incidence The rate of new cases in a population at
risk during a given period of time
 Cumulative incidence
 Incidence density
 Epidemiology
Measures of disease frequency

Prevalence
Number of cases of disease(old and new) at a
specific time

Population exposed at that time

Example of bilharziasis in Guadeloupe in 1979:

Population 350,000
Cases 96,200
Prevalence 27.6%
 Epidemiology
Measures of disease frequency

Point Prevalence Proportion of individuals with

disease at a single point in time.
Rarely achievable
Period Prevalence Proportion of individuals in a
defined population that have the
disease during an observation
period.
 Epidemiology

Incidence
Number of NEW cases of disease during a period

Population exposed during this period

Incidence Proportion (cumulative incidence),
express the probability or risk of illness

Example of bilharziasis in Guadeloupe in 1979:

Population 350,000
New cases 1,250
Cumulative incidence 3.6/1000 per year
Prevalence 27.6%
 Epidemiology
Measures of disease frequency
Attack Rate
• Cumulative incidence during an outbreak
Usually expressed for the entire epidemic
period, from the first to the last case

Ex: Outbreak of cholera in country X

in March 1999
– Number of cases = 490
– Population at risk = 18,600
– Attack rate = 2.6%
 Epidemiology
Measures of disease frequency
Relationship between
Incidence, Prevalence and Disease Duration
Incidence

Prevalence Deaths,
Duration Cured,
Lost...
Merci à Jean-Luc Grenier - CEPIQ98
 Epidemiology
Measures of disease frequency

Examples
10
9
8
7
6
5
4
3
2
1
0
Jan Feb Mar Apr May Jun Jul

Ratio males/women=8/2 Prevalence March1 =3/10

Proportion of women=2/10=20% Prevalence March-July =7/10
Incidence March-July =4/7
 Epidemiology
Measures of disease frequency

Infection rate
The incidence rate of manifest plus inapparent infections
(the latter determined by seroepidemiology). See also
attack rate.
Secondary attack rate
The number of cases of an infection that occur among
contacts within the incubation period following
exposure to a primary case in relation to the total
number of exposed contacts. See also attack rate.
 Epidemiology
Measures of disease frequency

Measures of disease mortality

Crude Total number of deaths
Mortality = X 100,000
Rate mid-interval Population

Cause-Specific Deaths attributed to a

= specific cause X 100,000
Mortality Rate
Population
# of deaths between birth
Infant and one year of age X 100,000
mortality =
Rate # of live births during the
same time interval
 Epidemiology
Measures of disease frequency

Proportionate Deaths attributed to a specific cause

Mortality = X 100
Deaths from all causes

Case number of deaths from a

fatality = certain disease X 100,000
Ratio Number of cases of that
disease occurring within the
same specified time period
 Epidemiology
Measures of disease frequency

Survival rate
The percentage of people in a study or treatment group
who are alive for a given period of time after diagnosis.
This is commonly expressed as 5-year survival
 Epidemiology
Homework:
1, Definition of epidemiology
2, Methods in epidemiological study and their difference
3, Definition of distribution of disease and how to describe
time, person and place.
4, Patterns of epidemic (sporadic, epidemic, outbreak and
pandemic)
5, Difference between prevalence and incidence
6, Difference between mortality rate and case fatality ratio
7, the association between prevalence, incidence and duration
of disease