Primary Data - obtained by the investigator Hospital and medical care statistics
o Example: interviews, physical examination, Panels of cooperating physicians
laboratory exams Public health laboratory reports
o More accurate and up-to-date Absenteeism from work or school
Secondary Data - data actually gathered by other Telephone and household surveys
individuals or agencies Newspaper and news broadcasting reports
o Example: published reports, clinical/hospital
records, census Locally, data may be available from:
o more readily available but incomplete Department of Health
o confidentiality of information National Institutes of Health
Medical Specialty Societies
National Congenital Defects Registry
Surveillance Newborn Screening Program
In most health departments, routinely collected statistics Specialty Hospitals
provide the key data for monitoring morbidity and National Census and Statistics Office
mortality trends.
Surveillance System – includes a functional capacity for Descriptive Epidemiology: Person, Place and Time
data collection, analysis and dissemination linked to public The study of the amount and distribution of disease within
health programs. a population by person, place and time.
WHO (person) is affected?
WHERE (place) do the cases occur?
Epidemiologic Surveillance WHEN (time) does it happen?
Has been defined by the Centers for Disease Control
(CDC) as the ongoing systematic collection, analysis and Person
interpretation of health data essential to the planning, Age, sex, ethnic group, social class, occupation exposures,
implementation and evaluation of public health practice, marital status, family variables, etc.
closely integrated with the timely dissemination of these
data to those who need to know. Age
The most important determinant among the personal
variables
Specific Data that are Useful in Epidemiologic Studies Death rate is fairly high in infancy
Data on vital events Lowest point is between 5-14 years old
o Birth, death, marriages, divorces, adoptions, Doubling in rate from 40 and every decade of life
total births/deaths, deaths by specific causes, Chronic conditions tend to increase with age whereas the
mortality rate, case fatality rate, etc. relation of age to acute infectious diseases is less consistent
Diseases statistics Age is related to the frequency and severity of infectious
o prevalence and incidence of specific diseases diseases
Data on physiologic or pathologic conditions High rate of injury in particular age group
o Prenatal Hgb levels, blood sugar levels among
diabetics, BP readings Sex
Statistics on Health Resources and Services Death rates are higher for males than females, but
o Number of hospital beds, vaccine vials morbidity rates are higher for females
consumed, number of health center staff In utero and neonatal death rates are also higher for males
Statistics pertaining to the environment The higher death rates for males throughout life may be due
o Number of households with sanitary water to sex-linked inheritance, differences in hormonal balance,
source, number of snail breeding places, amount environment or habit patterns
of pollution in the air, level of noise in the The higher mortality rate for men are not paralleled by
factory, workers’ protective gears higher rates of illness
Demographic data Women have more episodes of illness and more physician
o Total number of population, age groups, gender, contacts than men have
rural-urban residence, occupation, income Rate of attempted suicide is higher in women but
Socio-cultural data completed suicides are more common in men
o Knowledge, attitude, practices of people Toxic shock syndrome
regarding health o Irritant tampons
Possible explanations for relatively high morbidity and low
mortality in women:
o Women seek medical care more freely and
10 Key Sources of Data for Surveillance Systems Designed by the perhaps at an earlier age of disease
WHO
Mortality registration Ethnic Group and Race
Morbidity reporting Blacks have higher rates of death caused by CHVD, VCA,
Epidemic reporting TB, SY
Laboratory investigation Whites have higher rates of death from suicide, leukemia
Individual case investigations and atherosclerosis
Epidemic field investigations
Surveys Social Class
Animal-reservoir and vector distribution studies Difference in wealth, power, prestige: difference in access
Biologic and drug utilizations to medical care and facilities
Knowledge of the population and the environment Poverty affects utilization of medical services
More common cases of mental illness in lower strata
©2007 Mikey
Occupation Prevalence = no. of existing cases of a disease / total
This influence may occur through a variety of exposures population
o Unfavorable physical conditions Incidence – refers to the proportion of the population who
Heat, cold changes in atmosphere developed the disease in a given interval time
o Chemicals Cumulative incidence = no. of new cases of disease /
o Noise population at risk
o Stress in work The higher the number of new (incident) cases, then there
Silica (pulmonary fibrosis) would be a greater number of existing (prevalent) cases
Asbestos (lung cancer)
Aniline dyes (bladder cancer)
Injury, trauma, social and psychological climate of the job
or workplace
Marital Status
Marital status is associated with level of mortality for both
sexes
Psychological and physical support from the spouse
For women, marital status may also be related to health
through differences in sexual exposure, pregnancy,
childbearing and lactation
Family Variables
Family size: larger families – especially if they are poor,
children may be in a disadvantage: higher rates of fetal,
neonatal and infant deaths, higher childhood mortality, and
a tendency to poorer intellectual performance
Birth Order: first borns tend to be more healthy and better
educated.
Personal Variables
Maternal age: etiologic importance in congenital
malformations
Parental deprivation – psychiatric, psychosomatic
disorders, TB incidence, attempted suicides and accident
repeaters
Blood type A – gastric CA, Type O – duodenal ulcer
Environmental exposure
Personality traits – medical advice, compliance
Place
Frequency of disease can be related to place of occurrence
in terms of areas set off either by natural barriers or by
political boundaries
Frequency of disease may be related to temperature,
humidity, rainfall, altitude, mineral content of soil or water
supply
Lack of iodine, mottled dental enamel
Rural-urban differences
Migrants in national and international borders
Time
Disease occurrence is usually expressed on a monthly or
annual basis
Secular trends – refers to changes over a long period of
time, years, decades
Cyclic change – refers to recurrent alterations in the
frequency of disease
Measures of Morbidity
Prevalence – the proportion of individuals with the disease
during a given point in time
The probability that a person randomly chosen from the
population will have a disease at the time he was examined
©2007 Mikey