Descriptive

Epidemiology
By SUMALA .G
INTRODUCTION :
● Epidemiology is derived from the word epidemic (epi = among;demos = people; logos =
study)
● The Greek physician Hippocrates has been called the ‘Father of Epidemiology’

DEFINITION :
● According to John M. Last (1988)
● The study of the distribution and determinants of health-related states and events in
populations, and the application of this study to control health problems.
AIMS OF EPIDEMIOLOGY :

1. To describe the distribution and size of disease problems in human

populations.

2. To identify etiological factors.

3. To provide the data essential to the planning, implementation,

evaluation of services for the prevention, control, treatment, and to
the setting up priorities among those services.
TOOLS OF EPIDEMIOLOGY :

RATES RATIOS PROPORTIONS

METHODS OF EPIDEMIOLOGY :

I. Descriptive epidemiology.

II. Analytical epidemiology.

III. Experimental epidemiology.

DESCRIPTIVE EPIDEMIOLOGY :

● Descriptive studies are usually the 1st phase

of epidemiological investigation.

● These studies are concerned with the

distribution of diseases or health-related
characteristics in human populations and
identifying the characteristics with which
the disease in question seems to be
associated.

M
AS
K
Steps in descriptive studies :

1. Defining the population to be studied

2. Defining the disease under study

3. Describing the disease by — time, place, and person

4. Measurement of disease

5. Comparing with known indices

6. Formulation of an aetiological hypothesis

1. Defining the Population to be Studied :

● First step is to define the population in terms of number, age, sex,

occupation, cultural characters .
● “ Defined population” can be the whole population in a geographic
area, or specifically selected group .
● wherever a group of people can be fairly accurately counted and
should be stable without migration.
● The defined population provides a denominator for calculating rates.
2. Defining the Disease Under Study :

● Epidemiologist needs a definition that is both precise and valid to

enable him to identify those who have the disease from those

who do not.

● He looks out for an “operational definition” that is a definition by

which the disease condition can be identified and measured in

the defined population.’

3. Describing the Disease :

Describing the disease by :

3a. Time Distribution
3b. Place Distribution
3c. Person Distribution
 3a. Time Distribution :

SHORT TERM PERIODIC LONG-TERM

FLUCTUATIONS FLUCTUATIONS FLUCTUATIONS
1. Short-term fluctuations :

e.g. epidemic.

A. Common source epidemics.

1. Single exposure or point source epidemics, e.g. food poisoning.

2. Continuous or multiple exposure, e.g. water from a contaminated well.

B. Propagated epidemics: It is most often of infectious origin and results from

person to person transmission of an infectious agent.

For example: epidemics of hepatitis A and polio.

2. Periodic fluctuations :

A. Seasonal trend : It is well known for many communicable diseases

e.g: measles and varicella.

B. Cyclic trend : Some disease occur in cycles spread over short periods of time

which may be days, weeks, months, years.

Measles in the pre- vaccination era appeared in cycles with major peaks every

2 to 3 years and rubella every 6 to 9 years.

3. Long-term or secular trends:

● The term secular trend implies changes in the occurrence of disease

(progressive increase or decrease) over a long period of time, generally

several years or decades.

● For example : coronary heart disease, lung cancer and diabetes have

shown a consistent upward trend in the past 50 years or so, followed by a

decline of such diseases as tuberculosis, typhoid, diphtheria and polio .

● Interpretation of time trends helps in seeking emerging health problems

and effectiveness of measures to control old ones.

3b. Place Distribution :

1. International variations

2. National variations

3. Rural-urban differences

4. Local distributions

5. Migration studies
 International comparisons may
examine mortality and morbidity
in relation to socioeconomic
factors, dietary differences and
International the differences in culture and
1. variations :
behaviour. For example, cancer of
stomach is very common in Japan
and unusual in USA. Cancers of
oral cavity and uterine cervix are
exceedingly common in India as
compared to industrialized
countries.
 Distributions of endemic goitre,
fluorosis, leprosy, malaria have
National shown variations in their
2. variations
distribution in India. Such
information is needed to
demarcate the affected areas and
for providing appropriate health
care services.
 Chronic bronchitis, lung cancer,
cardiovascular diseases are usually
more common in urban than in
3. Rural-urban rural areas. Infant mortality rate,
maternal mortality rate are higher
differences
in rural than urban areas.
Variations are due to differences
in medical care, social class levels
of sanitation, educational and
environmental factors.
 •Inner and outer city variations in
disease frequency are well known.
•These variations are best studied with
the aid of ‘spot maps’ or ‘shaded maps’.
•These maps show at a glance areas of
high or low frequency the boundaries
4. Local and patterns of disease distribution.
distributions •For example : if the map shows
‘clustering’ of cases, it may suggest a
common source of infection or a
common risk factor shared by all the
cases.
 a. Comparison of disease and death rates for
migrants with those of their kin who have
stayed at home. This permits study of
genetically similar groups but living under
different environment. If the disease and death
rates in migrants are similar to the country of
adoption, the likely explanation could be
Migration change in the environment.
5. Studies b. Comparison of migrants with local population
of the host country provides information on
genetically different groups living in similar
environment.

• If migration rates of disease and death are

similar to the country of origin, the likely
explanation could be the genetic factors.
 3c. Person Distribution :

1 2 3 4 5 6 7 8

Age Bimodality Gender Ethnicity Occupation Socioeconomic Marital status Behavior

Eg : Measles- childhood Eg : Dental caries Eg : Oral cancer. Eg: tuberculosis Measure & Association of Many diseases Eg : typhoid,cholera
cancer - middle age Females have less identification disease with exhibit associations and diarrhoeal
atherosclerosis - old incidence than socioeconomic with marital status. disorders.
age males status
 Spotlight on mobile

• It is related to disease than

any other single host factor.

• Certain diseases are more

frequent in certain age groups
1. AGE : than in others.

• For example, measles in

childhood, cancer in middle
age and atherosclerosis in
old age.
 • Is the occurrence of two separate
peaks in the age incidence of a disease.

• It indicates that the material is not

homogeneous-that the entity under
examination might probably be divided
into two .

2. BIMODALITY: • Bimodality even suggests the existence

of casual differences other than that on
which classification of diseases is based.

• An example of a disease exhibiting

“bimodality” is Dental caries, which is
usually found in children as pit and
fissure and in the older age group as root
caries.
 • Chronic diseases such as diabetes,
hypothyroidism, obesity are common in
females .

• whereas lung cancer and coronary

3. GENDER : heart disease are more common in males.

•The differences may be due to

biological differences between the
gender and also due to cultural and
behavioural differences.
 • Differences in disease occurrence have
been noted in population subgroups of
different racial and ethnic origin.

• e.g. tuberculosis, cancer, sickle cell

4. ETHNICITY : anaemia.

•These differences whether they are

related to genetic or environmental
factors, have been a stimulus to further
study.
 • As a measure of socioeconomic status

• For identification of risks associated with

exposure to agents peculiar to certain
occupations.

• To identify groups whose general patterns

of life vary because of the different
5. OCCUPATION : demands made by their occupation.

• Occupation may alter the habit pattern of

employees like sleep, alcohol, smoking.
Persons working in particular occupation
are exposed to particular types of risks. For
example, coal miners are likely to suffer
from silicosis, those in sedentary
occupation face the risk of heart disease.
 •Individuals in upper social classes
have a longer life expectancy and
better health and nutritional status
than those in lower social classes.
6. SOCIOECONOMIC •Certain diseases like cardiovascular
STATUS : diseases, hypertension and diabetes
have shown a higher prevalence in
upper classes compared to lower
classes.
 Married persons are generally more
secure and protected and this
7. MARITAL STATUS : contributes to lower mortality rates
among married persons.
 Behavior is looked upon as a risk
factor in modern day diseases
such as cancer, obesity,
8. BEHAVIOR : cardiovascular diseases, etc. For
example, cigarette smoking,
sedentary life, overeating and
drug abuse.
4. Measurement of Disease :

● This information should be available in

terms of mortality, morbidity, disability and
so on; and should preferably be available
for different subgroups of the population.
● Measurement of morbidity has 2 aspects—
incidence and prevalence.
● Incidence can be obtained from
“longitudinal” studies and prevalence from
“cross-sectional studies.”

M
AS
K
Cross-sectional studies :
● It is the simplest form of observational study.

● It is based on a single examination of a cross-section of population at one

point of time the results of which can be projected on the whole

population provided the sampling has been done correctly.

● This study is also known as “prevalence study”. These studies are more

usually for chronic than short- lived diseases.

● These studies are useful to:

• Know the distribution of a disease rather than aetiology.

• Suggest causal hypothesis, which can be tested by analytical study.

 • Time sequence cannot be
Cross-sectional studies : deduced.

• Little information about the

Disadvantages
natural history of the disease
and rate of incidence.
Longitudinal studies :
● In case of longitudinal studies, observations are repeated in the same population over

a prolonged period of time by means of follow-up examinations.

● These studies are useful to:

1. Study natural history of disease and its future outcome.

2. Identifying risk factors of the disease.

3. For finding out incidence rate.

Longitudinal studies disadvantage :

● Difficult to organize and more time consuming.
5. Comparing with Known Indices :

By making comparisons between different populations, and

subgroups of same population, it is possible to arrive at clues to
disease aetiology and also identify groups who are at increased
risk for certain diseases.
 6. Formulation of a Hypothesis :

By studying the distribution of disease and utilizing the

techniques of descriptive epidemiology, it is possible to formulate
hypothesis relating to disease aetiology. A hypothesis can be
accepted or rejected, using the techniques of analytical
epidemiology.

An epidemiological hypothesis should specify—the population,

specific cause, expected outcome, dose-response relationship,
and time-response relationship.

For example, the smoking of 30–40 cigarettes/day causes lung

cancer in 10% of smokers after 20 years of exposure.
Uses of descriptive
epidemiology

1. Provide data regarding the

magnitude of disease and type of
disease in the community.

2. Provide clues to disease aetiology.

3. Provide data for planning,

organizing, evaluating preventive
and curative services.

4. Contribute to research.
Thank you!

SUMALA