Overview of Descriptive Studies

Epidemiology
Maria Teresa S. Tolosa, MD, PGDipCE, FPDS || February 2,2017

Content Outline:
I. Introduction
II. Objective of Epidemiology
a. Identify etiology of disease
b. Determine extent of disease
c. Study natural history and progression of
disease
d. Evaluate preventive and therapeutic
measures for a disease
III. Research designs
IV. Descriptive studies
a. Case report
b. Case series
c. Limitations of case reports and case
Series
d. Ecological studies
i. Ecologic fallacy
ii. Pearson’s correlation coefficient
r Figure 2. Epidemiologic Triad
e. Cross-sectional studies
V. References OBJECTIVE OF EPIDEMIOLOGY
1. Identify etiology of disease
LEGEND: 2. Determine extent of disease
‼ 3. Study natural history and progression of disease
4. Evaluate preventive and therapeutic measures for a
Presentation Mentioned in Remember Book disease
the lecture 5. Develop public health policy

OBJECTIVE Identify Etiology of Disease

• Identify the different types of descriptive study design • Epidemiologic Triad – To identify things that cause
disease (Why do we get sick?)
• Know the indication, advantages and limitations of
each descriptive study design

Introduction
• Epidemiology – Study of the distribution and
determinants of health-related states or events
o The application of this study to control
disease and other health problems
• Surveillance and descriptive studies can be used to
study distribution, analytical studies can be used to
study determinants.

Figure 3. Aedes as a vector of disease

Smoking and lung cancer (humans can also be considered

vectors, but not as direct)

Figure 1. Distribution and Determinants of Epidemiology Determine the Extent of Disease

• Can affect individual or communities.

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Overview of Descriptive Studies
Study the Natural History and Progression of Disease
Atherosclerosis
• Develop fatty streaks, stenotic block starts to narrow
• Causes coagulation blood factors
Figure 4. Atherosclerosis Progression
Evaluate Preventive and Therapeutic Measures for a
Disease.
• Studying this would help both the individual and
population at large
• Type 2 DM should lose weight, good food, no
smoking, low blood pressure
• Study to evaluate if preventive measures are effective
Figure 5. Type 2 Diabetes
RESEARCH DESIGNS
Figure 6. Research Design
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Research, study, and epidemiologic designs:
• Tells yes or no (dichotomy)
• Is there a comparison group – analytical study
• Cohort study – exposure before disease before
getting outcome
• Case control study – Outcome and you look
back who got the exposure
• Cross sectional – single point in time here and
know
• Check exposure and outcome at the same time
DESCRIPTIVE STUDY
Inquiry into the nature of an unknown phenomenon or the
occurrence of an event. Seeks to know the characteristics of
the phenomenon or event and to categorize it into some
descriptive variables- Fernando Sanchez
• Observational studies which describe patterns of
disease occurrence with respect to variables of
person, place or time
• Initial inquiry into a new topic, event, disease, or
condition
• 2 roles
o Studies that emphasize features of a new
condition
o Those that describe communities or
population
• Individuals: Case reports, case-series reports, before
and after studies, cross-sectional studies, and
surveillance studies
• Populations: ecological studies examine populations
• Do not have a control group
• Cannot establish causality, do not allow inferences to
be drawn from data
• Can suggest hypotheses which can be used in
analytical observational studies
TYPES OF DESCRIPTIVE STUDIES
• Case report
• Case series
• Ecological studies
• Cross-sectional studies
Case Reports
• Detailed report of a single patient (e.g. demographics,
signs & symptoms, treatment, follow-up information)
• Done to document unusual medical occurrences
which may represent first clues to identifying new
diseases or adverse effects of exposures (“You never
say never and never say always because there’s
always room for something new to happen” Dr.
Tolosa)
• Allows for formulation of hypothesis
• Focuses on:
o Unexpected association between diseases
or symptoms
o Unexpected event in the course of observing
or treating a patient
o Findings that shed new light on the possible
pathogenesis of a disease or an adverse
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Overview of Descriptive Studies
effect (e.g. broken heart syndrome – rupture
of chordae tendineae due stress &
psychological distress)
4 interesting cases mentioned:
• 44-year-old patient with a new-onset seizure disorder
after vaccination against Japanese encephalitis: a
case report
• Intratracheal keloid in a 21-month old African-
American child. (Keloid scar formation led to the
blockage of the airway)
• A 51-year old woman crushed by an elephant trunk.
(Woman rushed to the ER with multiple fractures,
internal bleeding & injuries to the face. Author stated
hospitals & emergency physicians should be
equipped and ready for the most bizarre cases to
manage them well.)
• Unani treatment herbal and leech therapy saved the
diabetic foot of a patient from amputation. (Concoction
from herbal sources and leeches placed around
wound of the patient to suck blood and necrotic
tissue.)
Case Series
• Structure and form similar to case reports
• Collection of individual case reports, which may occur
within a fairly short period of time
• May be used as means to identify beginning or
presence of an epidemic: historical importance
• Design may be retrospective or prospective
• Requires a relatively small sample size (10 or more)
• Hypothesis formulation
• Reports frequency of events or outcomes of a
disease, but does not show temporal relationships
between events and outcomes.
• No control group
• May have case selection bias and lacks statistical
validity
• Limited generalization of results because the selection
of study subjects is unrepresentative of total
population
Example:
In 2015 Lubao, Pampanga had 10 to 25 cases of patients who
had scaly hyperpigmented rough and darkened lesions on
neck or extremities and thickening & scaling with presence of
papules & nodules on the hands. Case series done revealed a
deep well contaminated
with arsenic due to a factory that had arsenic as toxic waste.
“Case series may herald something of importance and
significance to the community” Dr. Tolosa
Limitation of case reports and series
• Cannot be used to test for presence of valid statistical
association
• Case report: a risk factor suggested by the
experience of a single person may simply be
coincidental
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• Case series: even if large enough to permit
quantification of the frequency of exposure, it lacks an
appropriate comparison group therefore you cannot
derive to a conclusion
Ecological Studies
• Study where the unit of observation is the population
or a community
• Focuses on comparison of groups rather than
individuals
• Disease rates and exposures are measured in each
series of populations and their correlation is examined
• Find correlation between aggregate (group level)
exposure and outcomes
• Correlation, when present, has both magnitude and
direction (i.e. change in one variable will result in
change in an another)
• Relates frequency where characteristics and
outcomes are the same in a geographic area thus is
useful for suggesting hypothesis
• Cannot be used to draw causal conclusions and are
subject to ecologic fallacy
Ecologic Fallacy
• Assumes that individual members of a group will have
the average characteristic of the group at large.
• Logical error in the interpretation of statistical data in
an ecologic study, whereby inferences about the
nature of specific individuals are based on aggregate
statistics collected for the group to which those
individuals belong.
• Statistics that accurately describe group
characteristics do not necessarily apply to individuals
within that group.
Analysis of Ecologic Data
• Correlation
• Regression analysis
Pearson’s correlation coefficient r
• Test statistic that measures the statistical relationship,
or correlation between two continuous variables
• Gives information about the magnitude of the
association or correlation as well as the direction of
the relationship
• Coefficient values range from +1 to -1
• +1 indicates perfective positive relationship
• -1 indicates perfect negative relationship
• 0 indicates no relationship
• Perfect correlation: If the value is ± 1
o Perfect positive if +1, perfect negative if -1
• High degree: coefficient value lies between ± 0.50
and ± 1, then it is said to be a strong correlation.
• Moderate degree: coefficient value lies between ±
0.30 and ± 0.49, then it is said to be a medium
correlation.
• Low degree: coefficient value lies below + .29, then it
is said to be a small correlation.
• No correlation: coefficient value is zero
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Overview of Descriptive Studies
Figure 7. Pearson’s Correlation Coefficient r
Examples for Analysis of Ecologic Data:
• Correlation between the amount of rainfall and
incidence of dengue:
o An investigation in Thailand, done for use in
disease prevention and control
o Rainfall data (2002-2003) collected from
Ministry of Public Health; correlation between
rainfall and dengue prevalence was
assessed by regression analysis
o Study indicated that dengue prevalence may
depend on rainfall (although other relevant
factors should be looked into according to
the authors)
• Sugar consumption and prostate cancer mortality
Figure 8. Prostate cancer mortality vs. sugar consumption in 71
countries
• Daily meat consumption and colon
incidence in women
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Figure 9. Colon cancer incidence (women) vs. daily meat
consumption (grams)
Cross-Sectional Study
• AKA prevalence study/survey (2019C)
• Measures the prevalence of health outcomes or
determinants of health, or both, in a population at a
point in time
• Information can be used to explore etiology, but
associations must be interpreted with caution
• Bias may arise because of selection into or out of the
study population
• Provides a snapshot of the relationship between
outcome and exposure (2019C)
• Well-suited to the goal of describing variables and
their distribution patterns
• Applicable for diseases that produce little disability
and to the presymptomatic phases of more serious
diseases
• Other applications of cross sectional surveys lie in
planning health care
• Used for examining associations: the choice of which
variables to label as predictors and which as
outcomes depends on the cause-and-effect
hypotheses of the investigators
Advantages
• Quick, cheap and easy to do; least time-consuming
• True prevalence rates are determined
• Multiple exposures and multiples outcomes/diseases
can be studied at a single time
Limitations
• Difficult to establish what is cause and what is effect
o The variables are all measured at a single
point in time
• Impractical for rare diseases, cannot establish causal
cancer relationships, needs a large sample size
• Data are particularly susceptible to distortion through
the introduction of bias into the research during
sampling and interviewing
• No structural distinction between predictors
(exposure) and outcomes
• No attempt to establish a temporal relationship
between predictors and outcomes
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Overview of Descriptive Studies

Figure 10. Design of a cross-sectional study

Example:
Loneliness of left-behind children
• Study in a sample of rural children in China
• Risk factor: being left-behind, “disease present”:
loneliness; data taken at one time from the population
should include (based on design, see Figure above)
o Left-behind, lonely
o Not left-behind, lonely
o Left-behind, not lonely
o Not left-behind, not lonely
• Based on their data, left-behind children were 2.5
times more likely to suffer from loneliness and 6.4
times more likely to be very lonely
• Concluded that left-behind children are at a
significant risk for loneliness

REFERENCES:
• Dr. Tolosa’s Powerpoint
• 2019C
• Recording

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