Jan
Risser,
PhD
Spring, 1999
Will
Definition of Epidemiology
Jan
Risser,
PhD
Spring, 1999
Will
Definition of Epidemiology
Jan
Risser,
PhD
Spring, 1999
Will
Aims of epidemiologic research
Environmental Factors
(Socioeconomic Status, Work Environment)
Epidemiology & Clinical Medicine
Epidemiology is used in clinical medicine to:
describe the natural history of diseases
discuss disease causality
- proximate: biological mechanisms of disease
- distal: social and environmental causes of disease
provide disease surveillance
- essential for evaluating community health problems -
- and setting disease control priorities
[Greenberg RS (ed.) Medical Epidemiology, 1993]
Jan
Risser,
PhD
Spring, 1999
Will
Epidemiology & Clinical Medicine
Jan
Risser,
PhD
Spring, 1999
Will
Epidemiologic Process
Jan
Risser,
PhD
Spring, 1999
Will
Brief History of Epidemiology
Epidemiology of Chronic Diseases
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.
Descriptive epidemiology
the occurrence of disease (cross-sectional)
Etiologic epidemiology (quasi-experimental)
cause of disease (cohort, case-control)
Experimental epidemiology
assessment of therapy (cohort, randomized clinical
trial)
Jan
Risser,
PhD
Spring, 1999
Will
Research Design Used in Epidemiology
Jan
Risser,
PhD
Spring, 1999
Will
BIAS
systematic errors in collecting or interpreting data
such that there is deviation of results or inferences
from the truth.
selection bias: noncomparable criteria used to
enroll participants.
information bias: noncomparable information is
obtained due to interviewer bias or due to recall bias
Jan
Risser,
PhD
Spring, 1999
Will
BIAS
Bias results from systematic flaws in study design,
data collection, or the analysis or interpretation of
results.
Jan
Risser,
PhD
Spring, 1999
Will
Selection BIAS
Selection bias
Hospital Mean duration Labor
deliveries of labor complications
Season
Summer 180 8.0 hr 7.8% (14/180)
Winter 240 10.5 hr 11.7% (28/240)
Jan
Risser,
PhD
Spring, 1999
Will
Selection BIAS
Jan
Risser,
PhD
Spring, 1999
Will
Information BIAS
Jan
Risser,
PhD
Spring, 1999
Will
Confounding
Confounding results when the effect of an
exposure on the disease (or outcome) is distorted
because of the association of exposure with other
factor(s) that influence the outcome under study.
Jan
Risser,
PhD
Spring, 1999
Will
Confounding
[Biomedical Bestiary: Michael, Boyce & Wilcox, Little Brown. 1984]
Gambling Cancer
Smoking,
Unobserved association
Alcohol, True association
other
Factors
Jan
Risser,
PhD
Spring, 1999
Will