Epidemiologi

Departemen Epidemiologi
Fakultas Kesehatan Masyarakat Universitas Indonesia

1
 Definisi (1)
• Tidak ada definisi tunggal
• Epidemiologi
– Dari bahasa Greek.
– Epi = atas, pada,
– demos = penduduk,
– logi = studi

– Studi distribusi dan determinan peristiwa

kesehatan dalam populasi manusia.

2
 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

4
 Definisi (4)
• Taylor (1963)
– Studi kesehatan atau penyakit dalam populasi

• McMahon, Pugh, dan Ipsen (1970)

– Studi distribusi dan determinan frekuensi
penyakit pada manusia … distribusi …
(epidemiologi deskriptif) dan determinan dari
distribusi yang tercatat (epidemiologi analitik)

5
 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,
economic, political, administrative,
Gerstman Chapter 1 legal) 6
 Public Health
• Definitions of public health refer to
Defined
– organized effort (activity)
– reduction of morbidity & mortality
– improvements in health

• Main public health competency areas

– epidemiology
– biostatistics
– health administration
– behavioral
– environmental health science

Gerstman Chapter 1 7
 Epidemiology compared
•
to…
… medicine
– Main unit of concern in epi  population
– Main unit of concern in medicine  individual
• … public health
– Epidemiology  “study of”
– Public health  “organized effort”
– Epi said to be “methodologic backbone” of public
health

Gerstman Chapter 1 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) 9

Epidemiologi  Ilmu dasar semua aspek
kesehatan masyarakat: (1)

– Penyakit infeksi
– Penyakit kronis
– Cedera intensional dan tidak intensional
– Kesehatan mental
– Nutrisi

10
Epidemiologi  Ilmu dasar semua aspek
kesehatan masyarakat: (2)

– Pendidikan dan promosi kesehatan

– Perencanaan kesehatan
– Administrasi kesehatan masyarakat
– Pelayanan pengobatan medis

11
 Ruang lingkup
• Definisi penyakit
• Kejadian penyakit
• Penyebab penyakit
• Keluaran penyakit
• Pengelolaan penyakit dan pencegahan
penyakit

12
 Aktivitas epidemiologi (1)
1. Pengumpulan dan analisis pencatatan vital
(kelahiran dan kematian)

2. Pengumpulan dan analisis data morbiditas

dari rumah sakit, lembaga kesehatan, klinik,
dokter dan industri

3. Pemantauan penyakit dan masalah

kesehatan komunitas yang lain
13
 Aktivitas epidemiologi (2)
4. Investigasi kejadian luar biasa yang
mengarahkan program pemberantasan atau
pencegahan epidemik dan masalah kesehatan
komunitas yang lain

5. Merancang dan melaksanakan penelitian

kesehatan

6. Merancang dan melaksanakan registrasi

kesehatan untuk masalah yang menjadi
perhatian seperti: cacat lahir, insidens kanker,
atau penggunaan napza 14
 Aktivitas epidemiologi (3)
7. Skrining (penapisan) untuk penyakit

8. Penilaian efektivitas keberadaan pengobatan

yang baru

9. Mendeskripsikan riwayat alamiah penyakit

10. Identifikasi individu atau kelompok pada

populasi umum terhadap peningkatan risiko
perkembangan penyakit tertentu
15
 Aktivitas epidemiologi (4)
11. Identifikasi keterkaitan etiologi penyakit

12. Identifikasi masalah kesehatan masyarakat

dan pengukuran besar distribusi,
frekuensi, atau dampak pada kesehatan
masyarakat

16
 Aktivitas epidemiologi (5)
13. Penilaian program kesehatan

14. Menyediakan data yang diperlukan untuk

perencanaan kesehatan atau pembuatan
keputusan oleh badan administrasi
kesehatan atau pembuat kebijakan
kesehatan

17
 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)
 Epidemiologists are required to have some
knowledge of:

• Public health: because of the emphasis on disease prevention

•Clinical medicine: because of the emphasis on disease classification and
diagnosis (numerators) 
• Pathophysiology: because of the need to understand basic biological
mechanisms in disease (natural history)
• Biostatistics: because of the need to quantify disease frequency and its
relationships to antecedents (denominators, testing hypotheses)
• Social sciences: because of the need to understand the social context in which
disease occurs and presents (social determinants of health phenomena)
 §1.4 Selected Historical Figures
and Events
• Understanding medical history is an
important part of epidemiology

• This section divided into three eras

• 400BC – 1850
• 1850 - 1900
• Twentieth century epi
 Historical Figures & Events
• 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)

• Twentieth century epi

• Modern epidemiology
Gerstman 21 Chapter 1
 Sejarah perkembangan epidemiologi

• Ahli epidemiologi pertama

– Hippocrates 460 – 377 SM

• Ahli Epidemiologi yang pertama
• Menjelaskan terjadinya penyakit dari dasar yang
rasional
• Buku yang ditulis: Epidemic I, Epidemic II, On Airs,
Waters, and Places
• Memperkenalkan istilah epidemic dan endemic

22
 The First Epidemiologists
• Hippocrates
• 460 B. C. to 377 B.C.
• attempted to explain disease
occurrence on a rational basis instead
of from a supernatural view point
• Three major books
– Epidemic I
– Epidemic II
– On Airs, Waters, and Places 23
 Hippocrates (1)
• Recognized the association
of various diseases with
environmental factors
– place
– water conditions
– climate
– eating habits
– housing

24
 Hippocrates (2)
• Introduced
– epidemic
– endemic

25
 Hippocrates (3)
• Theory about the cause of disease
– personal observation
– Greek thinking
• Disease is the imbalance of body
humors
– phlegm
– blood
– yellow bile, black bile
26
 Sejarah perkembangan epidemiologi
• Galen 129 – 199 M

– Ahli bedah tentara romawi

– Bapak “Fisiologi Eksperimental”
– Faktor Prokatartik (cara hidup orang) dan temperamen
mempengaruhi kesehatan dan penyakit
– Pengaruh lingkungan (geografi dan iklim)  miasma
(istilah umum untuk partikel dalam udara)
– Malaria  udara buruk
– Teori miasma

27
 Galen (1)

• 129 - 199 A.D.

• Father of experimental physiology
• Health and Disease influenced by
– Procataritic factors
• the way of life a person led
• life style
– Temperament
• the innate qualities of the body
• personality 28
 Galen (2)

• Disease caused by Miasma

– particles in the air
– from sources
• waste
• stagnant water
• decaying animals
• theory used to explain the great
plague epidemic in Europe 29
 Sejarah perkembangan epidemiologi
Age of enlightenment (17th & 18th centuries)

• Thomas Sydenham (1624 – 1689)

– “Hippocrates Inggris”
– Bapak Epidemiologi
– Atmosfer mengakibatkan perubahan konstitusi
epidemik

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

31
Demographic Approach
(pp. 12–14)

John Graunt (1620 – 1674)

Sejarah perkembangan epidemiologi
DEMOGRAPHIC APPROACH

 Kelahiran vital statistik

 John Graunt

 Analisis data mortalitas dalam tahun 1662

 Melakukan kuantifikasi yang pertama dari pola
kelahiran, kematian dan kejadian penyakit
 Mencatat perbedaan laki-laki dan perempuan,
kematian bayi yang tinggi, perbedaan urban-
rural, dan variasi musiman

33
 Demographic Approach
17th Century Life Table
Age % surviving
6 64
16 40
26 25
36 16
46 10
56 6
John Graunt
60 3
(1620–74)
76 1
Gerstman Chapter 1 34
80 0
 Life Table of Deaths in London
Age Deaths Survivors
0 -- 100
6 36 64
16 24 40
26 15 25
36 9 16
46 6 10
56 4 6
66 3 3
76 2 1
80
Source: 1
Graunt’s Observations 0
1662
Epidemiology (Schneider)
 Graunt’s Observations

 Excess of male births

 High infant mortality

 Seasonal variation in mortality

Epidemiology (Schneider)
 Sejarah perkembangan epidemiologi

 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

37
 Sejarah perkembangan epidemiologi
Konsep kontagion dan Teori germ penyakit

– Hieronymous Frascastorius (1478 – 1553)

• Sastrawan dan dokter dari Italia
• Penyakit disebabkan oleh “germ”
• Penyakit ditransmisikan dari orang ke orang melalui suatu
partikel yang sangat kecil

– Igmatz Semmelweis (1818 – 1865)

• Ahli Obstetri dari Hungaria
• Demam nifas dapat direduksi jika para dokter mencuci tangan
sebelum menolong persalinan

38
Downloaded from: StudentConsult (on 29 August 2009 12:10 AM)
© 2005 Elsevier
Downloaded from: StudentConsult (on 29 August 2009 12:10 AM)
© 2005 Elsevier
 Sejarah perkembangan epidemiologi

• Edward Jenner
– Mendukung teori Fracastorius
– Menerima teori germ penyakit
– Penemu vaksin cacar (akhir tahun 1700)

• 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

41
 Sejarah perkembangan epidemiologi

• Studi epidemiologi klasik awal

– James Lind
• Melakukan studi epidemiologi ekperimen pada
etiologi dan pengobatan scurvy (1753)
• Makan jeruk merupakan obat untuk scurvy

– P L Panum
• Studi epidemiologi klasik tentang penyakit campak di
pulau Faroe (1875)

42
 Sejarah perkembangan epidemiologi

• John Snow (1813 – 1858)

– Ahli anestesi
– Melakukan serial investigasi kolera di London
– Bapak Epidemiologi Lapangan
– Melakukan studi epidemik kolera (1854)

43
 Snow’s 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
Snow’s
Ecological
Analysis
• Southwark Water
Company
neighborhoods 
high rates
• Mixed service 
intermediate rates
• Lambeth Water Co.
neighborhoods 
no cases
Gerstman Chapter 1 45
 Deaths from Cholera per according to water company
supplying subdistricts of London, 1853-1854

Water Company Population in Deaths from Deaths rate

1851 Cholera per 100,000
living

Southwark and Vauxhall

Company 167,654 192 114

Lambeth Company 14,632 0 0

Both Company 301,149 182 60

46
The Grand Experiment
– A retrospective study

X
 Deaths from Cholera per 10,000 according to water company supplying
actual houses, London - 1854

Water Supply Number of Deaths from Deaths in Each

Houses Cholera 10,000 Houses

Southwark and Vauxhall

Company 40,046 1,263 315

Lambeth Company 26,107 98 37

Rest of London 256,423 1,422 59

Source: Snow (55)

48
 Snow’s Cohort Study (Table 1.7, p. 25)
• Cholera mortality per 10,000 household and water
source
– Rate Southwark & Vauxhall = 1263 / 40,046 × 10,000 = 315
– Rate Lambeth = 98 / 26107 × 10,000 = 37.5
• Southwark & Vauxhall drew water from fecal
contaminated water region
• Supporting evidence for water-borne transmission
theory

49
 Snow’s Cohort Analyses

Rate per
Water Source Cases Homes 10,000
Southwark 1263 40,046 315*
Lambeth 98 26,107 37
Both 1422 256,423 59
* Rate, Southwark = 1263 / 40,046
= .0315 = 315 / 10,000
 Snow’s Case-Control Study
• Epidemic area of Golden Square area (1854 epidemic)
– Interviewed cases and non-cases to determine water source
• Cases
– 61 used water from Broad St. pump
– 6 did not use Broad St. pump
– 6 could not determine if used Broad St. pump
• Controls were less likely to use Broad St. pump water
– e.g., Among Brewer workers (non-cases), “the men were allowed
a certain quantity of malt liquor, and Mr. Huggins [the proprietor]
believes they do not drink water at all”
– Map showing proximity to pump and no. of cases (next slide)

51
Cholera Deaths – Broad St. Outbreak
Snow’s Map (Fig 1.14)
 Visualization Success Stories
Illustration of John
Snow’s
deduction that a cholera
epidemic
was caused by a bad
water pump, circa 1854.

Horizontal lines indicate

location of deaths.

From Visual Explanations by Edward

Tufte, Graphics Press, 1997
54
 John Snow: A Classic Epidemiologic
Study
• The Father of field epidemiology

•investigating the outbreak of cholera in Gloden Square of London

descriptive epidemology --> hypothesis generation --> hypothesis
testing ---> public health application

55
Golden Square Cholera Outbreak: John Snow (2)

• Theory • Action
– Hypothesis – Water was the source of
– Hypothesis disease
test – Correlation of the
– Public Health distribution of cholera case
Application households and the location
of water pumps
– Removed the handle of the
pump in Broad Street
56
 London Cholera Outbreak: John Snow (3)

• Theory • Action
– Hypothesis – Water served as vehicle for
– Hypothesis transmitting choler
test – based on time, place, and
– Public person; compared groups
Health are comparable
Application – changing the location of
water intake to avoid water
contamination
57
 Sejarah perkembangan epidemiologi

 Studi epidemiologi klasik awal

 James Lind
 Melakukan studi epidemiologi ekperimen
pada etiologi dan pengobatan scurvy (1753)
 Makan jeruk merupakan obat untuk scurvy

58
Sejarah perkembangan epidemiologi
Sejarah perkembangan epidemiologi
Sejarah perkembangan epidemiologi
 Sejarah perkembangan epidemiologi

 Goldberger (1923)
 Menggunakan studi epidemiologi
observasional dan eksperimen tentang
pellagra (defisiensi asam nikotinat)

62
 Joseph Goldberger (1874-1929)

used observational and experimental

epidemiologic methods to identify
vitamin deficiency as the cause of
pellagra;

identified diets high in cereals and

canned food as a risk factor; proved
sources of fresh animal protein and
legums were effective in prevention;
first nutritional epidemiologist.
 Sejarah perkembangan epidemiologi

 Hill, Doll, Wynder, Cornfield and other Post world war II

epidemiologists. World War II is a convenient watershed to
mark the risk of the "modern epidemiologists", since this
coincides with the emergence of chronic disease as major
causes of morbidity and mortality;

 focuses on individual risk factors; hallmarked by studies

on :

• smoking and lung cancer, The Surgeon General's

Report on Smoking and Health,
• the Framingham heart studies,
• water fluoridation trials, and
• the poliomyelitis field trials of 1954.
 Maturation of Epidemiology
(1910 - 1945)

Key methodologic developments include the

advancement of epidemiologic theory,
 outbreak investigation methods,
 methods to study non-infectious diseases
(case-control and cohort methods),
 the introduction of randomized clinical trials,
and new survey methods developed by
Goldberger in the study of pellagra).
 Also, changes in the education of physicians
and health care took place in the 1910s and
1920s, respectively
 Last half of 20th Century
("Modern Epidemiology")

 The epidemiologic transition from acute

contagious to chronic non-contagious
causes of morbidity effected the way
epidemiologists studied disease

 Illustrative examples
 British Doctors Study (Doll & Hills studies
of the effects of smoking)
 Framingham Heart Study (risk factors for
heart disease, many investigators)
Sejarah perkembangan epidemiologi

 Doll dan Hill (1950)

 Studi Merokok dan kaitannya dengan kanker paru dan studi
penyakit kardiovaskular pada penduduk Framingham,
Massachusetts
 (Dawber, Kannel, dan Lyell, 1963. Gordon, Castelli,
Hjortland, Kannel, dan Dawber, 1977)
 Riset epidemiologi pada penyakit kronik
 (Freedman, Chear, Srinivasan, Webber, dan Berenson,
1985)
 Bogalusa Heart Study
 (Stamler, Wentworth, dan Neaton, 1986)
 Multiple Risk Factor Intervention Trial

67
 Doll and Hill, 1952
Lung cancer Controls OR
cases

Smoke 25+ per 331 (24%) 166 (12%) 17.4

day

Smoke 5-24 per 1019 (75%) 1130 (83%) 7.8

day

Non-smoker 7 (1%) 61 (5%) 1

Estimated 10-Year CHD Risk in
55-Year-Old Adults According to Levels of
Various Risk Factors Framingham Heart Study

A B C D
Blood Pressure (mm Hg) 120/80 140/90 140/90 140/90
Total Cholesterol (mg/dL) 200 240 240 240
HDL Cholesterol (mg/dL) 50 50 40 40
Diabetes No No Yes Yes
Cigarettes No No No Yes
 Estimated 10-Year Stroke Risk in 55-Year-Old Adults
According to Levels of Various Risk Factors
E s tim a te d 1 0 -Y e a r R a te (% )
Framingham Heart Study
30 27
25 22.4
19.1
20
14.8
15

10 8.4
5.4 6.3
4 3.5
5 2.6 2
1.1
0

A B C D E F
Men Women

A B C D E F
Systolic BP* 95-105 130-148 130-148 130-148 130-148 130-148
Diabetes No No Yes Yes Yes Yes
Cigarettes No No No Yes Yes Yes
Prior Atrial Fib. No No No No Yes Yes
Prior CVD No No No No No Yes

Source: Stroke 1991;22:312-318. *BP in millimeters of mercury (mmHg)

 A B C D E F
Systolic BP* 95-105 130-148 130-148 130-148 130-148 130-148
Diabetes No No Yes Yes Yes Yes
Cigarettes No No No Yes Yes Yes
Prior Atrial Fib. No No No No Yes Yes
Prior CVD No No No No No Yes

*BP in millimeters of mercury (mmHg)

Estimated 10-year stroke risk in 55-year-old adults

according to levels of various risk factors (FHS).
Source: Wolf et al., Stroke.1991;22:312-318.
 Offspring CVD Risk by Parental CVD
Status: Framingham Study
Parental CVD <55
Risk Ratio men, <65 Women

2.5
2.5 NONE
MATERNAL
22 PATERNAL
2.2
1.5
1.7 1.7 1.7

11
1.0 1.0
0.5
0.5

00
Men
MEN Women
WOMEN
Adjusted for: age, total/HDL Chol. ratio, SBP, smoking, diabetes, BMI
 Kebutuhan
Aplikasi kesehatan
Epidemiologi Audit
penduduk
Etiologi
Pelayanan
Penyakit
Kesehatan

EPIDEMIOLOGI
Keluaran Riset
dan Pelayanan
Prognosis Kesehatan

Lingkungan
Risiko
Genetik
Penyakit
Life style

73
Kontribusi epidemiologi (1)

 Penyelidikan modus transmisi penyakit baru

 Penentuan sebab-sebab penyakit yang dapat
dicegah
 Penentuan riwayat alamiah penyakit
 Pengamatan spektrum penyakit

74
Kontribusi epidemiologi (2)

 Penilaian intervensi kesehatan komunitas

 Penyusunan prioritas pemberantasan penyakit
 Perbaikan diagnosis, pengobatan dan
prognosis penyakit klinis
 Peningkatan riset pelayanan kesehatan
 Penyediaan saksi ahli dalam pengadilan

75
 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.
 History of Epidemiology (cont.)

DOLL & HILL (1950): Used a case-control

design to describe and test the association
between smoking and lung cancer.

FRANCES at al. (1950): Huge formal field trial of

the Poliomyelitis vaccine in school children.

DAWBER et al. (1955): Used the cohort design

to study risk factors for cardiovascular
disease in the Framingham Heart Study.
Brief History of Epidemiology
Classical Infectious Diseases Epidemiology
– Edward Jenner (1749-1823)
» developed a vaccine against smallpox using cow pox
 160 years before virus was identified
– John Snow (1813-1858)
» described the association between dirty water and cholera
 44 years before vibrio was identified
– Ignaz Semmelweis (1818-1865)
» described the association between childbed fever and
physician’s unclean hands
 32 years before causal agent was discovered
Jan
Risser,
PhD
Spring, 1999 Will
Risser,
Brief History of Epidemiology
Classical Nutritional Epidemiology
– James Lind (1716-1794)
» conducted an experiment which showed that scurvy could
be treated and prevented with limes, lemons, and oranges
 ascorbic acid was discovered 175 years later
– Joseph Goldberger (1874-1927)
» identified that pellagra was not infectious but nutritional
in origin and could be prevented by increasing the amount
of animal products in the diet and substituting oatmeal for
corn grits
 niacin was discovered 10 years later
Jan
Risser,
PhD
Spring, 1999 Will
Risser,
Brief History of Epidemiology
Epidemiology of Chronic Diseases
 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]

Jan
Risser,
PhD
Spring, 1999 Will
Risser,
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.

mortality stepped care 9.0/100 referred care 9.7/100

final blood pressure 84.1 in stepped care 89.1 in referred care
Jan
Risser,
PhD
Spring, 1999 Will
Risser,
Brief History of Epidemiology
Epidemiology of Chronic Diseases
 Physician Health Study
– randomized, placebo-controlled, double-blind clinical trial
– conducted entirely through the mail
– 22,071 male physicians enrolled to study the effects of aspirin on
cardiovascular disease and the effects of beta-carotene on cancer
– randomly assigned to one of four groups
aspirin beta carotene
active active
active placebo
placebo active
placebo placebo
Jan
Risser,
PhD
Spring, 1999 Will
Risser,
ROOTS OF MODERN EPIDEMIOLOGY
1. ACUTE DISEASE INVESTIGATION
----- Emphasis on empirical systematic
investigation, biology, and
environment/host manipulation

2. MEDICINE
----- All early epidemiologists were
physicians.
ROOTS OF MODERN EPIDEMIOLOGY
3. STATISTICS
----- Emphasis on the scientific method,
quantification and measurement,
and hypothesis testing. In 1960s, many
epidemiologists were statisticians.
4. SOCIAL SCIENCES
----- Investigation of human behavior in
relation to disease, and methods of
data collection (surveys, etc.)
ROOTS OF MODERN EPIDEMIOLOGY
5. COMPUTER SCIENCES
----- Emergence of “chronic” disease
epidemiology required the ability to
handle large amounts of data and to
perform complex analyses.

6. MANAGERIAL SCIENCES
----- Management principles for acquisition
of grants, research collaboration, and
management of clinical trials.
ROOTS OF MODERN EPIDEMIOLOGY

7. GENOMICS
----- 2001 marked first publication of
draft sequences of the human genome.
Intensive investigations being
conducted to identify “disease
susceptibility genes” “gene-
environment” interactions, and “gene-
gene” interactions.
 Classical versus Modern
Applications
 Classical: descriptive, observational, field,
analytical, experimental, applied,
healthcare, primary care, hospital, CD,
NCD, environmental, occupational,
psycho-social, etc
 Modern: risk-factor, molecular, genetic,
life-course, CVD, nutritional, cancer,
disaster, etc