Epidemiology

Definitio
n study of the occurrence
"The
and distribution of health-
related events, states, and
processes in specified
populations, including the study
of the determinants influencing
such processes, and the
application of this knowledge to
control relevant health
problems.
Disease frequency

• Measurement of frequency of disease, disability or

death. and summarizing this information in the form
of rates and ratios (e.g., prevalence rate, incidence
rate, death rate, etc).
• Thus the basic measure of disease frequency is a
rate or ratio.
• These rates are essential for comparing disease
frequency in different populations or subgroups of
the same population.
• Such comparisons may yield important clues to
• disease aetiology.
This is a vital step in the development of
strategies for prevention or control of health
problems.
Distribution of disease

It is well-known that disease, or for that matter

health, is not uniformly distributed in human
populations.
The distribution of disease occurs in patterns in a
community and that the patterns may lead to the
generation of hypotheses about causative (or risk)
factors.
Study /distribution patterns in the various
subgroups of the population by time, place and
person.
The epidemiologist examines whether there has been an
increase or decrease of disease over time span; whether
there is a higher concentration of disease in one
geographic area than in others: whether the disease
The epidemiologist examines:

• whether there has been an increase or decrease of

disease over time span;
• whether there is a higher concentration of
disease in one geographic area than in others;
• whether the disease occurs more often in men
or in a particular age-group;
• whether most characteristics or behaviour of those
affected are different from those not affected.
Determinants of
disease
• A unique feature of epidemiology is to test
etiological hypotheses and identify the
underlying causes (or risk factors) of disease.
• This requires the use of epidemiological
principles and methods.
• This aspect of epidemiology is known as
• "analytical epidemiology.
• Analytical strategies help in developing
scientifically sound health programmes,
interventions and policies.
Aims of epidemiology

According to the International Epidemiological

Association (IEA),epidemiology has 3 main aims
• to describe the distribution and magnitude of health and disease
problems in human populations
• to identify etiological factors (risk factors) in the pathogenesis
of disease; and
• to provide the data essential to the planning. implementation and
evaluation of services for the prevention, control and treatment of
disease and to the setting up of priorities among those services.

In order to fulfil these aims, three rather different classes of epidemiological

studies may be mentioned: descriptive studies, analytical studies, and
experimental or intervention studies.
 Ultimate aim:
• To eliminate or reduce the health problem
or its consequences.

• To promote the health & well-being of

society as a whole.
Epidemiological approach
The epidemiological approach to problems of health &
disease is based on two major foundations:
Asking questions
Making
comparisons

1. Asking
questions

Epidemiology has been defined as a means of learning

or asking questions.. and getting answers that lead to
further questions

RELATED TO HEALTH EVENTS

What is the event? (the
problem) Where did it
happen?
When did it
RELATED TO HEALTH
ACTIONS

a. What can be done to reduce this problem and its

consequences?
b. How can it be prevented In the future?
c. What action should be taken by the community? By
the health services? By other sectors?
d. What resources are required? How are the
activities to be organised ?
e. What difficulties may arise & how might they be
overcome ?

Answer to the above questions may provide clues to

disease aetiology & help epidemiologist to guide
planning & evaluation .
2) Making comparisons

• The basic approach in epidemiology is to make

(comparisons and draw inferences.
• This may be comparison of two (or more groups) -
one group having the disease and the other group
not having the disease or comparison between
individuals.
• By making comparisons,epidemiologist tries to find
out the crucial differences in the host and
environmental factors between those affected and
not affected.
Basic
measurements
in Epidemiology
Measurements in
Epidemiology
• Measurement of mortality
• Measurement of morbidity
• Measurement of disability
• Measurement of natality
• Measurement of the presence, absence or
distribution of the characteristic or attributes of the
disease
• Measurement of medical needs, health care
facilities, utilisation of health services and other
health-related events
• Measurement of the presence, absence or
distribution of the environmental and other factors
suspected of causing the disease
• Measurement of demographic variables.
Tools of measurement

• The basic tools of measurement in

epidemiology are:

1) RATES

2) RATIOS

3) PROPORTION
RATE
• A rate measures the occurrence of some
particular event (development of disease or the
occurrence of death) in a defined population
during a given time period.
• It indicates the change in some event that takes
place in a population over a period of time

• Death rate = number of deaths in one year

* 1000

Mid-year population

• A rate comprises the following elements -

RATIO
• It expresses a relation in size between two random
quantities.
• The numerator is not a component of the denominator.
• The numerator and denominator may involve an
interval of time or may be instantaneous in time.
• Broadly, ratio is the result of dividing one quantity by
another.
• It is expressed in the form of: x:y or x/y.
• Doctor-population ratio, child-women ratio, Female-
male ratio.

• Eg:
The number if children with scabies at a certain
time
 PROPORTION
• Proportion is a ratio which indicates the relation in
magnitude of a part of the whole.
• The numerator is always included in the denominator.
• A proportion is usually expressed as a percentage.

Eg:
The number of children with scabies at a certain time

*100

The total number of children in the village at the same

time
Measurement
of
Morbidity
Morbidity could be measured in
terms of 3 units -

(a) persons who wereill;

(b)the illnesses (periods or spells of

illness) that thesepersons experienced;

(c)the duration (days,

weeks, etc) of these illnesses.
INCIDENCE

Incidence rate is defined as "the number of NEW cases

occurring in a defined population during a specified
period of time".

Incidence = No.of new cases of specific disease

during
a given time period

* 1000
Population at risk duration that period

For example, if there had been 500 new cases of an

illness in a population of 30,000 in a year, the
incidence rate would be:
Uses

• Useful in taking action

A. To control disease

B. For research into aetiology, pathogenesis, distribution,

efficacy of preventive & therapeutic measures.
Prevalence

The term "disease prevalence" refers specifically to

all current cases (old and new) existing at a given
point in time, or over a period of time in a given
population.

Prevalence is of two types :

◆ Point prevalence
◆ Period prevalence
 Point prevalence

• Point prevalence of a disease is defined as the number

of all current cases (old and new) of a disease at one
point of time, in relation to a defined population.
• The "point" in point prevalence, may for all practical
purposes consist of a day, several days, or even a few
weeks, depending upon the time it takes to examine
the population sample.

• Point prevalence is given by the formula:

Number of all current cases (old and new)

of a specified disease existing at a given point in
time

* 100
Estimated population at the same point in time
 Period prevalence
It measures the frequency of all current cases (old and new)
existing during a defined period of time (e.g., annual
prevalence expressed in relation to a defined population.
It includes cases arising before but extending into or
through to the year as well as those cases arising during
the year.

Period prevalence is given by the formula:

Number of existing cases (old and new) of a

specified disease during a given period of
time interval

* 100
Estimated mid-interval population at risk
Uses

• To estimate the magnitude if health/disease

problems in the community

• Identify- high rish populations

• Useful for administrative and planning process eg:
hospital beds, manpower needs, rehabilitation facilities.
Relationship between
prevalence & incidence

• Prevalence depends on 2 factors, the

incidence and duration of illness.
• P=I*D
= incidence * mean duration
• Incidence = P/D
• Duration = P/I
Measurement
of
mortality
Mortality rates and ratios
Crude death rate
• It is defined as "the number of deaths (from all
causes) per 1000 estimated mid-year population in
one year, in a given place".
• It measures the rate at which deaths are
occurring from various causes in a given
population, during a specified period.
• The crude death rate is calculated from the
formula:

Number of deaths during the year

* 1000
Mid-year population
Specific death rates

The specific death rates may be -

(a)cause or disease specific - e.g.,
tuberculosis, cancer, accident;
(b)related to specific groups - e.g., age-specific,
sex-specific, age and sex specific, etc.

• Rates can also be made specific for many other

variables such as income, religion, race, housing,
etc.

• Specific death rates can help us to identify

particular groups or groups "at-risk" preventive
action.
• Eg:

• Specific death rate due to tuberculosis:

Number of deaths from tuberculosis during calender year

*1000

Mid-year population
Case fatality rate

• Case fatality rate represents killing power of a disease

= Total number of deaths due to a particular disease

* 100
Total number of cases due to the same disease

• Typically used in acute infectious diseases (eg: food

poisoning, cholera, measles).
Proportional mortality rate
• To know what proportion of total deaths are due to a
particular cause (e.g., cancer) or what proportion of
deaths are occurring in a particular age group (e.g.,
above the age of 50 years).

• Proportional mortality rate expresses the "number

of deaths due to a particular cause (or in a specific
age group) per 100 (or 1000) total deaths".

Number of deaths from the specific disease in a

year

*100
Total deaths from all causes in that year
Survival rate

• It is the proportion of survivors in a group, (e.g., of

patients) studied and followed over a period (e.g., a
5-year period).

• Survival rate = Total number of patients alive after

5 years

*100
Total number of patients diagnosed or
treated