HSH205 Topic 1

Topic 1
Introduction to epidemiology and biostatistics

So what is epidemiology? And why is it important for public

health and health promotion practice?
According to Last, epidemiology is the study of the distribution and determinants of health states or
events in specified populations, and the application of this study to prevent and control health
problems. Essentially, epidemiology is concerned with the collective health of people in a community
or an area, rather than individuals and it provides data for directing public health and health promotion
action (Bailey et al 2005). An easy way to think about epidemiology is that it provides evidence of
health problems as well as evidence of the effects and impacts of interventions to address health
problems.

The meaning and scope of epidemiology

There are six main areas where epidemiology contributes to public health and health promotion:

1. Determining the extent of ill health or disease in the community. What is the burden of disease
in the community? How is it distributed? These questions are critical in the planning of health
services and programs.
2. Identifying the cause of ill health and the risk factors for disease. The ultimate aim here is to
intervene to prevent morbidity and mortality from the disease, via prevention programs. If we
can identify the causal factors or risk factors for ill health we can develop ways to reduce or
eliminate exposure to those factors.
3. Studying the natural history and prognosis of ill health. We want to know about the natural
pattern of ill health, so that we know when and how to intervene and whether our interventions
make a difference.
4. Investigating disease outbreaks or epidemics.
5. Evaluating existing and new preventive and therapeutic programs and services. Do our health
programs and services change the natural history of disease and change the outcome for the
better?
6. Providing the foundation for developing public policy and regulation. Information on the
causes of ill health, and factors that help to maintain good health, provide governments with
the basis on which to implement policies that help to maintain the health of the whole
community.

As we work our way through this unit you will see how epidemiology helps us to answer these
questions and how it contributes to public health and health promotion.

Descriptive epidemiology
Returning to our definition of epidemiology, we saw that, ‘epidemiology is the study of the
distribution and determinants of health states or events in specified populations’. Health states or
events are the diseases or conditions of interest. These are usually conditions that are present in excess
1
 HSH205 Topic 1
in the population under study. When considering the distribution or pattern of a condition in a
particular population, we are actually asking:

 Who has the condition?

 Where are they?
 When did they have it?

These questions can be summarised as person, place and time variables. Descriptive epidemiology, as
its name implies, therefore focuses on describing health states and events and their distribution.
Person, place and time are some of the key ways that epidemiologists describe the health and illness of
populations.

Person

One of the basic steps in an investigation of any health-related state or event is to count the number of
persons involved. Usually, a simple count is not sufficient. We may need to relate the number of
people affected to the size of the population through the calculation of risks or rates. Also, we may
wish to compare the number of people affected at different times or in different places. People are not
usually a homogeneous group, so we may want to express our counts in terms of the characteristics of
the people in the population. Inherent characteristics of the population such as age and sex are very
commonly used to describe subgroups of a population. Other characteristics of persons that may be of
interest include socio-economic characteristics such as education, occupation or income or
characteristics of health-related behaviours such as smoking, alcohol consumption or sun exposure.

Descriptions of the people who have the condition of interest can help us provide or deliver programs
or services to those that need them and assist us to identify the determinants or risk factors for that
condition.

Place

Describing the geographic distribution of a condition, likewise, can assist in delineating those who
may benefit from health-related interventions and provide pointers as to possible determinants or risk
factors. Useful descriptors of place may include place of residence, schools and workplaces, or
birthplaces. Administrative descriptors of place such as local government area, city, state or country
may also be useful. Analysis of data by place may provide clues as to the source of an infection or an
environmental exposure and to the possible means of transmission.

Time

Looking at the occurrence of a health state over time has a number of potential benefits. Time trends
can be used to:

 predict what may occur in the future

 provide clues as to what is causing a change in the condition’s occurrence
 examine the effectiveness of policies or programs.

Analytical epidemiology
While person, place and time can help to describe the distribution of health states or events, another
important role for epidemiology is to try to answer the question of why these states and events occur.
As we have seen under person, place and time above, the process of describing health states or events

2
 HSH205 Topic 1
is the first step to answering the why question. So, descriptive epidemiology can often provide some
clues as to the determinants (causes or risk factors) of any health state or event. Analytical
epidemiology involves a range of more sophisticated methods for investigating the determinants of
health and illness. These methods will be the focus of topics 3 to 5 of this Unit.

Prescribed text reading

Carneiro, I., et al. (2011) Chapter 1: Principles of Epidemiology

Cross-sectional studies
Cross-sectional studies are the study type best suited to describe the situation in a defined population
at a single point in time. Cross-sectional studies provide a snapshot of the population at that time.

The main features of cross-sectional studies are the population of interest and the study sample.

Population of interest: This may be the general population or it may be a specific subgroup, such as
those in a particular age group, those who live in a specific area or those with a particular
characteristic in common e.g. single mothers or car drivers.

Study sample: It is not usually possible or necessary to measure health characteristic(s) for every
member of the population of interest. A subset of the population, or sample, is selected instead. The
purpose of a sample is to represent the population of interest, so that we can generalise the results
measured in the sample to the entire population of interest.

For the sample to accurately represent the population of interest, the method of selection of the sample
is crucial. The most reliable way to achieve a representative sample is to select the sample randomly
from the population of interest. We will revisit sampling in topic 2.

Prescribe text reading

Carneiro, I., et al. (2011) Chapter 7: Cross-sectional studies.

Repeat cross-sectional studies

One of the primary descriptors of health states and events is time. However, a cross-sectional study,
being a snapshot of a single point in time, cannot provide information on time trends or on the natural
history or prognosis of a disease. An alternative way of obtaining the sort of information that includes
the passage of time is the repeat cross-sectional studies approach. Instead of taking a single sample
from a population at one point in time, a new sample is drawn from the population of interest at each
time point. With repeated cross-sectional studies, measurements are made on different individuals at
each time point. This means that there may be variability between time points that is the result of the
different individuals in the sample, rather than the result of the passage of time. Regardless of this
disadvantage, repeat cross-sectional studies are still a useful means of investigating trends over time.

A number of health authorities conduct surveys at regular intervals. In fact, these surveys are repeat
cross-sectional studies. They monitor the population health status at each point in time and trends over
the entire time period.

3
 HSH205 Topic 1

Longitudinal studies
Of the uses of epidemiology that we met earlier in this topic, longitudinal studies are particularly
useful for one:

 studying the natural history and prognosis of disease.

In fact, if we think of disease broadly in terms of health events and health states, we can say that
longitudinal studies are a means of describing changes over time in any health state. They are also a
way of describing the occurrence of health related events over time. Longitudinal studies follow a
defined group through time. You can think of them as a cross-sectional study where participants are
followed in time and measures repeated.

The important features of longitudinal studies are similar to those of cross-sectional studies. The
process of sampling and obtaining study participants has the same characteristics as it does when
measures are being taken at only one point in time.

Repeat cross-sectional studies versus longitudinal studies

Repeat cross-sectional studies have some advantages and some drawbacks compared to longitudinal
study designs. As a new sample is selected at each time point, retention of the sample from time
period to time period is not an issue. However, measurements are made on different individuals at
each time point. This means that there may be variability between time points that is the result of the
different individuals in the sample, rather than the result of the passage of time. Regardless of this
disadvantage, repeat cross-sectional studies are still a useful means of investigating trends over time.

Quiz
Use this short quiz to test your understanding of the material covered in Topic 1 (please note answers
will not be provided). If you have any questions please post your questions on the Topic 1 Discussion
Board.

1. What is epidemiology?
2. What are five ways in which epidemiology contribute to public health and health promotion?
3. What are the first steps in epidemiology?
4. What are some important issues that epidemiology can address?
5. Three essential characteristics we look for in descriptive statistics are person, time and place.
Give some examples of each, which may be of interest in epidemiological studies.
6. What are the main descriptive epidemiological study designs?
7. Name the advantages and disadvantages of each study.

References
Bailey, L., Vardulaki, K., Langham, J., & Chandramohan, D. (2005). Introduction to epidemiology.
Maidenhead, England: Open University Press.

Last, J. (2007). A dictionary of public health. New York: Oxford University Press.