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LEARNING OBJECTIVES
INTRODUCTION
TO ❑ At the end, Learner will be able to:
EPIDEMIOLOGY ❑ Discuss History of Epidemiology.
❑ Define Epidemiology and its components.
❑ Epidemiological Basicconcepts.
❑ Describe Aims of Epidemiology.
Akash Samuel
❑ Explain Uses of Epidemiology.
BSN, RN
❑ Discuss Scope or theAreas of Application .
Nursing Instructor AFNC
❑ Discuss some terms used in Epidemiology

EPIDEMIOLOGY History of Epidemiology

The term epidemiologyderived from Greek words : ❑ The history ofepidemiology has its origin in the
idea goes back to (400 B.C)
Epi Among
❑ Hippocrates
Who suggest that environment &
Demos human Behaviors affects health.
People
Logos
Study

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1800 – William Farr work

by systematically
❑ 1662 – John Graunt, who
collecting and analyzing
Britain's mortality
published a landmark
statistics.
analysis of Mortality data.
Farr, considered the father of
❑ Itwas the first quantify modern vital statistics and
patterns of birth, death, surveillance, developed many
and disease occurrence. of the basic practices used
today in vital statistics and
disease classification.

1854 -John Snow , was considered the “father of

field epidemiology. • 19th and 20th Century: epidemiological
John Snow was conducting a series of methods applied in investigation of disease
investigations. occurrence, at that time, most investigators
Twenty years before the development of the focused on acute infectious diseases.
microscope, Snow conducted studies of cholera • 1930s & 1940s: Non-Infectious diseases were
outbreaks both to discover the cause of disease and also investigated for their risk factors (as lung
to prevent its recurrence. cancer to smoking).
• 1980s: Extended to the studies of injuries and
violence

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Epidemiology

• Beginning in the 1990s after the terrorist attacks • Epidemiology is the study of how disease is
of September 11-2001, epidemiologist have had distributed in populations and the factors that
to consider not only natural transmission of influence or determine this distribution. Why
infectious organisms but also deliberate spread does a disease develop in some people and not in
through biological warfare and bioterrorism . others?

Definition of Epidemiology by WHO

• The study of distribution, frequency, and

determinants of health related problems and
disease in human population.

COMPONETS OF DEFINITION

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1. Study: 2. Distribution :
▪ Refer to analysis of an event by person, place & time
Systematic collection, analysis and
interpretation of data. ▪ Epidemiology studies distribution of diseases it
answers the question:
Including : observation ,hypothesistesting who, where and when?
, analytical research and experiments.

Who? Where? When

?

B. Pattern:
Refers to the occurrence of health-related events by
time, place, and person.
Epidemiology is concerned with the frequency
and pattern of health events in a population. o Time patterns: may be annual, seasonal, weekly,
daily.
o Place patterns: include geographic variation,
A. Frequency: urban/rural differences, and location of work
refers not only to the number of cases, but also to sites or schools.
the relationship between the number of cases and o Personal characteristics: such as age, sex, marital
status, and socioeconomic status, as well as
the size of the population behaviors and environmental exposures.

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To search for these determinants, epidemiologists use

Determinant:
analytic epidemiology or epidemiologic studies to
It is any factor that influence health as : chemical , provide the “Why?” and “How?” of such events.
physical, social , biological , economic , genetic,
behavior.
Epidemiology is also used to search for determinants,
which are the causes and other factors that influence
the occurrence of disease and other health-related
events.
?
Why? HOW?

5. Specified populations :
Health-related state or event : Although epidemiologists and direct health-care
providers (clinicians) are both concerned with
It is defined as anything that affects the well-being of occurrence and control of disease, they differ
a population. greatly in how they view “the patient.”
As : disease, cause of death, behaviors ,ect…
▪ The clinician is concerned about the health of an
individual.
▪ The epidemiologist is concerned about thecollective
health of the people in a community orpopulation.

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6. Application :
• Epidemiology is not just “the study of” health in • Similarly, the epidemiologist uses the scientific
a population; it also involves applying the methods of descriptive and analytic epidemiology
knowledge gained by the studies to community- as well as experience, epidemiologic judgment,
based practice. and understanding of local conditions in
• Like the practice of medicine, the practice of “diagnosing” the health of a community and
epidemiology is both a science and an art. proposing appropriate, practical, and acceptable
• To make the proper diagnosis and prescribe public health interventions to control and prevent
appropriate treatment for a patient, the clinician disease in the community.
combines medical (scientific) knowledge with
experience, clinical judgment, and understanding
of the patient.

Goals of Epidemiology
1. Causation of disease

Web of Causation , interactions among genetic, environmental,

biological, chemical, physical, psychological, economic or cultural
factors

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Goals of Epidemiology Natural History of Disease

2. Natural History of Disease
• In pre-pathogenesis disease has not developed but
interactions occurring b/w agent, host & environment
generating stimulus & potential for disease.
• The development of morbid conditions or of disease; more
specifically the cellular events & reactions & other
pathologic mechanisms occurring in development of
disease.

“Course of a disease from onset (inception) to its

resolution”. {Pre-pathogenesis & Pathogenesis}

Natural History of disease Goals of Epidemiology

3. Describing the Health Status of Populations
• Natural history is vital for disease prevention policies.
• It underlies secondary prevention based on screening
• It provides a rationale for all health care.
• Purpose of health care, including medicine, is to influence the
natural history of disease by reducing and delaying ill-health.
✓ Disease burden
• When achieved through deliberate actions by societies the ✓ Priority health programmes
collective effort is public health. ✓ Environmental exposure
✓ Prevention and care

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Goals of Epidemiology Purposes of Epidemiology

4. Evaluating Interventions
1. Identify causes and risk factors for disease.

2. Determine the extent of disease in the community.

3. Study natural history and prognosis of disease.

4. Evaluate preventive and therapeutic measures

5. Provide foundation for public policy

Aims of Epidemiology Scope of Epidemiology

Epi. serves as a cornerstone of methodology of public health • Data-driven & relies on a systematic & unbiased approach to the
research, evidenced based medicine, means of identifying risk collection, analysis, & interpretation.
factors for diseases & determining prime treatment approaches to • Described as basic science of public health.
clinical practice. • Quantitative discipline – working knowledge of probability,
statistics, & sound research methods.
Epidemiology has three mainaims: • Method of causal reasoning based on developing & testing
1. To describe disease patterns inhuman populations. hypotheses.
2. Toidentify the causesof diseases (also known asetiology). • Grounded in fields of biology, behavioral sciences, physics, &
3. Toprovide data essentialfor the management, evaluation and ergonomics to explain health-related behaviors, states, &
planning of services for the prevention, control and treatment events.
of disease • Integral component of public health-providing foundation for
directing practical & appropriate public health action based on
this science & causal reasoning.

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Some Basic Terminologies

RIGHT HAND OF COMMUNITY
MEDICINE
• Morbidity: Refer to the sate of being diseased or unhealthy
within population
COMMUNITY MEDICINE
• Mortality: Refer to numbers of the people who died within
population
• Disability: is an impairment that may be cognitive,
developmental, intellectual, mental, physical, sensory, or some
combination of these. It substantially affects a person's life
EPIDEMIOLOGY BIOSTATISTICS activities and may be present from birth or occur during a
person's lifetime.

EXAMPLE Example

Mortality & Morbidity Mortality & Morbidity Mortality & Morbidity Mortality & Morbidity

That means disease is That means disease is un That means disease is vary That means disease is
very common and common and incidence of common and incidence of uncommon and
incidence of death is death is low. death is vary low . incidence of death is
very high. . high .
As : Diabetes As: Amyotrophic lateral
As: acute pencrititis As : vitiligo sclerosis (ALS)

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Some Basic Terminologies

• Incidence: # of new cases of disease/total # at

• Risk: The probability of having a bad outcome. risk.
• Risk factors : A condition , physical • Incidence rate: Incidence/unit of time.
characteristic or behavior that increases the • Prevalence: # cases (or # with defined condition)
probability that a currently healthy individual will existing at one time.
develop a particular disease. “ p value ≤ 0.05”. • Prevalence rate: # of such cases/total # at risk.

• Endemic
is defined as the habitual presence of a disease
within a given geographic area. It may also refer to • Sporadic refers to a disease that occurs
the usual occurrence of a given disease within such infrequently and irregularly.
an area. • Outbreak carries the same definition of
• Epidemic: epidemic, but is often used for a more limited
geographic area
– # cases in excess of expected # for population
– the uncontrolled spread of a disease (or
condition) in a community.
• Pandemic refers to a worldwide epidemic.

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Types of risk factors

• Modifiable risk factors: • Causality:
A risk factor that can be reduced or controlled by A cause effect relationship.
intervention, thereby reducing the probability of In epidemiology, the cause is the exposure and the
disease. effect is disease or death( criteria of causation )
As : (Physical inactivity , Tobacco use ,Alcohol use ,
Unhealthy diets) .
• Non-modifiable risk factors:
A risk factor that cannot be reduced or controlled by
intervention, for example: Age , Gender , Race ,
Family history (genetics).

Uses of Epidemiology Uses of Epidemiology

It is used in:
• Studying natural history of diseases in population in terms of
First, to identify the etiology or cause of a disease and
profile, time & trends.
• Determining most common causes of death, disease &
the relevant risk factors—that is, factors that
disability. increase a person’s risk for a disease.
• Community diagnosis in terms of morbidity, mortality rates & • We want to know how the disease is transmitted
ratio. from one person to another or from a nonhuman
• Determining effective control method of disease when known. reservoir to a human population.
• Provision of data for proper planning & evaluation of health • Our ultimate aim is to intervene to reduce
services.
morbidity and mortality from the disease.
• Identifying deficiencies in ongoing programs.
• Identifying the priority areas for medical research.

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To determine which in the three possible sets of

• If we can identify the etiologic or causal factors disease factors, host, agent and environment, are
for disease and reduce or eliminate exposure to important in theoccurrence of a specific disease or
those factors, we can develop a basis for class of diseases, and to explore the manner in which
prevention programs. they interact. Epidemiological Triad
• In addition, we can develop appropriate vaccines
and treatments, which can prevent the
transmission of the disease to others.

▪ Agent, or microbe that causes the disease

(the “what” of the Triangle)
• Host, or organism harboring the disease
(the “who” of the Triangle) Host
• Environment, or those external Poor nutrition
Concurrent
factors that cause or allow disease disease
Low immunity
transmission
(the “where” of the Triangle)
TB
Environment
Agent Crowding
TB organism Poor ventilation
Bad sanitation

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▪ The severity of disease in a community can be

gauged by several indices:
✓ whether it is a leading cause of death;
2) To study the occurrence of disease in a population ✓ whether it has a high case fatality or other
for purposes of community diagnosis and prognosis. measure of complications;
✓ whether it involves a large proportion of the
▪ Aclinician sees a disease as it occurs in an individual. young;
✓ whether it leaves permanent disability,
▪ The epidemiologist is interested in the individual too, defect or impairment;
but his attention is primarily directed toward the ✓ whether it adversely affects the economic status
group. of a community.
✓ The role of the epidemiologist can be described as
that of a community diagnostician.

• To study the natural history and prognosis of

4) To describe the epidemiology of a disease or class disease. Clearly, certain diseases are more severe
of diseases. than others; some may be rapidly lethal while
▪ Facts or events relating to the occurrence of a others may have longer durations of survival. Still
disease (or class of diseases) constitute its others are not fatal.
epidemiology. • We want to define the baseline natural history of a
▪ The occurrence of a disease and its severity and disease in quantitative terms so that as we develop
outcome are resultants of a complex of interacting new modes of intervention, either through
factors, some of which are host factors and others, treatments or through new ways of preventing
agent and/or environmental. complications.

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▪ Adescription of the epidemiology of a disease

5) To measure risk.
involves a thorough study of that disease in all its
aspects including its frequency in various The epidemiologist may use rates which can show the
population, and known and suggested factors in the probability that could make :
premorbid, morbid and post- morbid periods. ✓ A person acquire a particular disease during a given
period of time (attack rate, morbidityrate, case
▪ The premorbid period is theperiod preceding the incidence rate).
inception of adisorder.
▪ The morbid period, the pathological andclinical
course .
▪ The post-morbid period, the aftermath.

✓ A person die of a particular disease during a given 6) To study the occurrence of disease or death with time
period of time (mortality rate, death rate); or if as a variable. Such a study is referred to as a historical
he has a particular disease, that he will die of it study.
during a given period of time (case fatality rate).
▪ In historical studies, it often is convenient to speak of
✓ Such probabilities are measures of risk and they
trends, namely, secular trends and cyclictrends.
are useful to know prognosis.

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7) In disease prevention andcontrol.

▪ The epidemiologist helps to control a disease when
• Secular trends– occurring only once in the
he identifies it, describes its epidemiology,
course of an age or century; taking place over an
demonstrates its existence in a community and
extremely or indefinitely long period of time.
investigates its source.
• Cyclic Trends – a sequence of events that is
Primary control or disease prevention is the ideal
repeated again and again, especially a causal
control measure, it aims to Prevent the initial
sequence; a period of time between repetitions of
development of the disease.
an event or phenomenon that occurs regularly
Secondary control consists of diagnosis and treatment,
it aims to reduce the severity and prevent complications.
Tertiary control involves rehabilitation of the
disabled and correction of defect or impairment.

9) To aid in the detection of pre-symptomatic

and latent disease.

8) To aid in the identification of clinical syndromes. ▪ Many diseases such as tuberculosis, diabetes,
hypertension,g cancer of the cervix, neoplasms of
Asyndrome is a group of signs and symptoms that the lung can be detected before the onset of
occur together and characterizea disease. symptoms or the development of serious changes.

▪ The way to accomplish this is through mass

screening techniques , pre-employment physical
examinations,periodic health examinations,
special surveys and routine examinations in
hospitals andclinics.

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11) To provide the foundation for developing public

10) In administrative medicine and operations research.
policy relating to environmental problems, genetic
issues, and other considerations regarding disease
▪ One might evaluate the success of a disease control
prevention and health promotion.
program; the needs of a hospital in terms of
equipment, personnel and space; the quality of • Which occupations are associated with increased
medical care in a community; and the efficiency of risks of disease in workers, and what types of
hospital administration regulation are required?

Scope of Epidemiology

12) To evaluate both existing and newly developed Some Of ApplicationAreas

preventive and therapeutic measures and modes of Byphysiology/disease: By methodological
health care delivery. approach:
• For example, does screening men for prostate ▪ Infectious disease ▪ Environmental epidemiology
cancer using the prostate-specific antigen (PSA) epidemiology ▪ Economic epidemiology
▪ Occupational Injury ▪ Clinical epidemiology
test improve survival in people found to have ▪ Cardiovascular disease ▪ Genetic epidemiology
prostate cancer? epidemiology ▪ Nutritional epidemiology
▪ Cancer epidemiology ▪ Conflict epidemiology
▪ Epidemiology of Aging ▪ Social epidemiology
▪ Obesity/diabetes epidemiology ▪ Primary care epidemiology

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Reference
❑ Strictly Speaking, There Is No Life Science, Where
• Gordis, L. (2009). Epidemiology. EpidemiologicalApproach And Principles Cannot Be
Saunders. Philadelphia, PA. Applied.
• Last JM, editor. Dictionary of epidemiology. 4th From Womb To Tomb Epidemiology Is
ed. New York: Oxford University Press; 2001. p. Applicable
61.

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