SESI 1 - Pengantar Epidemiologi
SESI 1 - Pengantar Epidemiologi
Intermediate
Departemen Epidemiologi
Fakultas Kesehatan Masyarakat Universitas Indonesia
Definisi (1)
Tidak ada definisi tunggal
Epidemiologi
Definisi (2)
Hirsch (1883)
Suatu gambaran kejadian, distribusi, dan tipe penyakit
manusia, ..
Frost (1927)
Ilmu fenomena masal penyakit infeksius, atau seperti
riwayat alamiah penyakit infeksius suatu ilmu induktif
yang tidak hanya mendeskripsikan distribusi penyakit,
melainkan kesesuaiannya dalam suatu filosofi yang
konsisten
3
Definisi (3)
Greenwood ( 1934)
Epidemiologi adalah studi penyakit sebagai
fenomena massal
Lilienfeld (1957)
Epidemiologi boleh didefinisikan sebagai studi
distribusi suatu penyakit atau kondisi dalam populasi
dan faktor yang mempengaruhi distribusi ini
Definisi (4)
Taylor (1963)
Studi kesehatan atau penyakit dalam populasi
Epidemiology Defined
Greek roots
epi = upon (as in epidermis)
demos = the people (as in demography)
ology = to speak of, to study
Literally - study of epidemics
Modern definitions of epidemiology refer to
distributions in populations (statistical)
determinants (pathophysiological, environmental,
behavioral)
control of health problems (biological, social,
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economic, political, administrative, legal)
Public
Health
Defined
Definitions of public health refer to
organized effort (activity)
reduction of morbidity & mortality
improvements in health
Main public health competency areas
epidemiology
biostatistics
health administration
behavioral
environmental health science
7
Epidemiology compared
to
medicine
public health
Epidemiology study of
Public health organized effort
Epi said to be methodologic backbone of public
health
8
Definisi (5)
Suatu ilmu dasar dari kedokteran pencegahan dan
kesehatan masyarakat yang mempelajari:
Penyakit (atau status kesehatan)
Frekuensi (enumerasi jumlah yang ada atau tingkat
perkembangan dalam periode waktu spesifik)
Determinan (faktor yang mempengaruhi distribusi)
Metode (proses yang dilakukan untuk mendeskripsikan
frekuensi dan distribusi, rasional ilmiah yang digunakan
untuk menentukan kausal distribusi penyakit dalam
populasi
Populasi (populasi manusia tertentu)
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Ruang lingkup
Definisi penyakit
Kejadian penyakit
Penyebab penyakit
Keluaran penyakit
Pengelolaan penyakit dan pencegahan
penyakit
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8.
9.
10.
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Who is an epidemiologist ?
A professional who strives to study and
control the factors that influence the
occurrence of disease or health-related
conditions and events in specified
populations and societies, has an
experience in population thinking and
epidemiologic methods, and is
knowledgeable about public health and
causal inference in health
(Porta M, Last J, Greenland S. A Dictionary of Epidemiology, 2008)
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400BC 1850
Hippocrates (400BCE)
Age of enlightenment (17th & 18th centuries)
John Graunt (1620 1674)
1850 -1900
John Snow (1813 1858)
Germ Theory (mid 19th century)
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23
Hippocrates (1)
Recognized the association
of various diseases with
environmental factors
place
water conditions
climate
eating habits
housing
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Hippocrates (2)
Introduced
epidemic
endemic
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Hippocrates (3)
Theory about the cause of disease
personal observation
Greek thinking
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Galen
(1)
Temperament
the innate qualities of the body
personality
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Galen
(2)
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30
Thomas Sydenham
(1)
1624 - 1689
Father of Epidemiology
insisted that observation should have
precedence over theory in the study
of the natural history of disease
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Demographic Approach
(pp. 1214)
Demographic Approach
John Graunt
(162074)
Deaths
Survivors
--
100
36
64
16
24
40
26
15
25
36
16
46
10
56
66
76
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Graunts Observations
Epidemiology (Schneider)
Willian Farr
Melakukan pengumpulan data secara
sistematik dan statistik kematian di Inggris
Bapak Statistik vital moderen dan surveilens
Memperluas analisis data morbidtas dan
mortalitas epidemiologi
Melihat efek status perkawinan, pekerjaan
dan ketinggian
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38
39
Downloaded from: StudentConsult (on 29 August 2009 12:10 AM)
2005 Elsevier
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Downloaded from: StudentConsult (on 29 August 2009 12:10 AM)
2005 Elsevier
Louis Pasteur
Berkontribusi dalam menguatkan teori germ penyakit
dengan mendemonstrasikan efektivitas imunisasi pada
pencegahan rabies dalam tahun 1885
Belum mampu mengisolasi virus rabies menghalau
teori miasma
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P L Panum
Studi epidemiologi klasik tentang penyakit campak di
pulau Faroe (1875)
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Ahli anestesi
Melakukan serial investigasi kolera di London
Bapak Epidemiologi Lapangan
Melakukan studi epidemik kolera (1854)
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Snows Methods
Ecological studies
compared cholera rates by region
Cohort
compared cholera rates in exposed
and non-exposed individuals
Case-control
compared water source in cases and
controls
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Snows
Ecological
Analysis
Southwark Water
Company
neighborhoods
high rates
Mixed service
intermediate rates
Lambeth Water Co.
neighborhoods
no cases
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Population in
1851
Deaths from
Cholera
Deaths rate
per 100,000
living
167,654
192
114
Lambeth Company
14,632
Both Company
301,149
182
60
46
O
X
47
48
SnowsCohortAnalyses
WaterSource
Southwark
Lambeth
Both
Cases
1263
98
1422
Homes
40,046
26,107
256,423
Rateper
10,000
315*
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59
Cases
61 used water from Broad St. pump
6 did not use Broad St. pump
6 could not determine if used Broad St. pump
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Snows Map
(Fig 1.14)
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Visualization Success
Stories
Illustration of John
Snows
deduction that a cholera
epidemic
was caused by a bad
water pump, circa 1854.
Horizontal lines indicate
location of deaths.
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Theory
Action
Hypothesis
Hypothesis
test
Public Health
Application
Theory
Hypothesis
Hypothesis
test
Public
Health
Application
Action
Water served as vehicle for
transmitting choler
based on time, place, and
person; compared groups
are comparable
changing the location of
water intake to avoid water
contamination
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James
Lind
Melakukan
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(1923)
Menggunakan
studi epidemiologi
observasional dan eksperimen tentang
pellagra (defisiensi asam nikotinat)
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Maturation of Epidemiology
(1910 - 1945)
Illustrative
examples
British Doctors Study (Doll & Hills studies
of the effects of smoking)
Framingham Heart Study (risk factors for
heart disease, many investigators)
Controls
OR
331 (24%)
166 (12%)
17.4
1019 (75%)
1130 (83%)
7.8
Non-smoker
7 (1%)
61 (5%)
1
68
200
240
240
240
50
50
40
40
Diabetes
No
No
Yes
Yes
Cigarettes
No
No
No
Yes
69
A
Systolic BP*
95-105
Diabetes
No
Cigarettes
No
Prior Atrial Fib. No
Prior CVD
No
B
C
D
E
F
130-148 130-148 130-148 130-148 130-148
No
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
No
No
Yes
Yes
No
No
No
No
Yes
70
A
Systolic BP*
95-105
Diabetes
No
Cigarettes
No
Prior Atrial Fib. No
Prior CVD
No
B
C
D
E
F
130-148 130-148 130-148 130-148 130-148
No
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
No
No
Yes
Yes
No
No
No
No
Yes
*BP in millimeters of mercury (mmHg)
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Risk Ratio
2.5
2
2.2
1.5
1.7
1.7
1.7
1
1.0
1.0
0.5
0
Men
Women
Adjusted for: age, total/HDL Chol. ratio, SBP, smoking, diabetes, BMI
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Aplikasi
Epidemiologi
Audit
Pelayanan
Kesehatan
Keluaran
dan
Prognosis
Kebutuhan
kesehatan
penduduk
Etiologi
Penyakit
EPIDEMIOLOGI
Lingkungan
Genetik
Life style
Riset
Pelayanan
Kesehatan
Risiko
Penyakit
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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): Formulated natural
epidemiological experiment to test the
hypothesis that cholera was transmitted by
contaminated water.
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Observational Studies:
R Doll & AB Hill. Early case-control study. Smoking and
carcinoma of the lung: Preliminary report. [Br. Med. J. 2:739, 1950]
Cohort Studies:
An approach to longitudinal studies in a community: the
Framingham study. 10,000 residents gave baseline
information. Follow-up is now 50 years. [Annals New York
Academy of Sciences 107:539;1963]
Experimental Studies:
Hypertension Detection and Follow-up Program Cooperative
Group. 10,500 subjects randomly assigned to two groups:
1. stepped care - antihypertensive therapy increased stepwise to achieve
and maintain blood pressure reduction to goal.
2. Referred care - subjects were referred to their primary care physician and
treated as usual.
mortality
final blood pressure