Epidemiology: an overview

Linlin Lindayani, PhD

 What is epidemiology?
The study of the distribution and determinants of health
related states and events in populations and the application
of this study to control of health problems
Last JM: A Dictionary of Epidemiology

The study of the distribution of a disease or a physiological

condition in human populations and of the factors that
influence this distribution
Lilienfeld A: in Foundations of Epidemiology
 Has origins in the study of epidemics
The branch of medical science which
treats of epidemics
Oxford English Dictionary

Epidemiology is the study of "epidemics"

and their prevention
Kuller LH: Am J Epid 1991;134:1051
Ebola in West Africa 2014

WHO Ebola Response

Team, NEJM 2014
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 Epidemiology
The study of the distribution and determinants of health
related states and events in populations and the application
of this study to control of health problems
Last JM: A Dictionary of Epidemiology 4th Ed. 2001
 Purposes of Epidemiology

1. To investigate nature / extent of health-

related phenomena in the community /
identify priorities
2. To study natural history and prognosis
of health-related problems
3. To identify causes and risk factors
4. To recommend / assist in application of /
evaluate best interventions (preventive
and therapeutic measures)
5. To provide foundation for public policy
 SIKLUS ILMIAH/EMPIRIK
1. STUDI DESKRIPTIF
Penghimpuan & analisa data

ANALISA HASIL 2. PENGEMBANGAN MODEL &

UTK PENGUSULAN STUDI FORMULASI HIPOTESIS
DESKRIPTIF & HIPOTESIS BARU

3.STUDI ANALITIK
(eksperimental & observasional)
UNTUK MENGUJI HIPOTESIS
Demographic Transitions

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Demographic Transitions

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 Health related states and events
Epidemics of communicable diseases – original focus

Current scope:
- endemic communicable diseases
- non-communicable infectious diseases
- chronic diseases, injuries, birth defects, maternal-child
health, occupational health, and environmental health
- health-related behaviors: exercise, seat belt use,
- …..
 Distribution
Includes frequency and pattern

Frequency: the number of health events (e.g. number of cases of

diabetes in a population), also the relationship of that number to the size
of the population

Pattern: the occurrence of health-related events by time, place, and

person
Time patterns : annual, seasonal, weekly, daily, hourly, weekday versus
weekend,
Place patterns: geographic variation, urban/rural differences, and
location of work sites or schools
Personal characteristics: demographic factors (age, sex, marital status,
and socioeconomic status), as well as behaviors and environmental exposures
 Determinants
Causes and other factors that influence the occurrence of
disease and other health-related events

Illness does not occur randomly in a population, but happens

only when the right accumulation of risk factors or
determinants exists in an individual
 Two Broad Types of Epidemiology
DESCRIPTIVE EPIDEMIOLOGY
Examining the distribution of
a disease in a population,
and observing the basic
features of its distribution in
terms of time, place, and
person
Typical study design:
community health survey
(approximate synonyms -
cross-sectional study,
descriptive study)
ANALYTIC EPIDEMIOLOGY
Testing a specific hypothesis
about the relationship of a
disease to a putative cause,
by conducting an
epidemiologic study that
relates the exposure of
interest to the disease of
interest
Typical study designs:
cohort, case-control
 The 5W's of descriptive epidemiology

• What = health issue of concern

• Who = person
• Where = place
• When = time
• Why/how = causes, risk factors, modes of
transmission
 Analytic epidemiology
Tests hypotheses about:
• Why
• How

Comparing groups with different rates of disease

occurrence and with differences in demographic
characteristics, genetic or immunologic make-up,
behaviors, environmental exposures, and other potential
risk factors
Three essential characteristics of
disease that we look for in
descriptive studies are...

• Person
• Place
• Time
 Person

• Age, gender, ethnicity

• Genetic predisposition
• Concurrent disease
• Diet, exercise, smoking
• Risk taking behavior
• SES, education, occupation
 Place
• Geographic place
– presence or agents or vectors
– climate
– geology
– population density
– economic development
– nutritional practices
– medical practices
 Time

• Calendar Time
• Time since an event
• Physiologic cycles
• Age (time since birth)
• Seasonality
• Temporal trends
 Example

• You have been asked to investigate an

event in which 2,220 people were exposed
and 1,520 of them died.
• Your role as an epidemiologist is to ask
questions about person, place and time.
How do we ask questions?

Surveys
-of survivors
-of next-of-kin
-of other related persons
 with questions you learn that ...
• Person: Men, women and children were all
exposed and at risk. The majority of people
who died were wealthy and young men
between 18-50 years (when compared to
survivors).
• Place: All those exposed were within 1 block of
one another, the climate was cold.
• Time: Mid April, people died within hours of
the precipitating exposure.
 Three essential characteristics that are
examined to study the cause(s) for disease in
analytic epidemiology are...

• Host
• Agent
• Environment
 Epidemiologic Homeostasis
Host

Agent Environment
 The Epidemiologic Triangle

Host
Host Factors
Personal traits
behaviors
genetic predisposition
Agent Environment immunologic factors

• Influence the chance for

disease or its severity
 The Epidemiologic Triangle

Host

Agents
Biological
Physical
Chemical
Agent Environment

• Necessary for
disease to occur
 The Epidemiologic Triangle

Host

Environment
External conditions
Physical or biologic
or social
Agent Environment

• Contribute to the
disease process