12/6/2021

LEARNING OBJECTIVES
 Define the term descriptive epidemiology
DESCRIPTIVE EPIDEMIOLOGY  Discuss types of descriptive epidemiologic studies and
their uses
GLORIA PERET-CLARION, MD
 Describe the process of epidemiologic inference in the
JULIE TANCHANCO-TIU, MD
context of descriptive epidemiology
ANGEL ERICH R. SISON, MD
LOURDES C. MEDALLA, MD
ARNEL V. HERRERA, MD
MACARIO F. REANDELAR JR., MD

EPIDEMIOLOGY Epidemiology differs from clinical medicine in

two important regards:
The distribution of health and disease in groups of
people and the study of the factors that influence 1.Epidemiologists study groups of people, not
this distribution
individuals
 Modern epidemiology also encompasses the
evaluation of diagnostic and therapeutic 2.Epidemiologists study "well" people in addition
modalities & the delivery of health care services to sick people & try to find out the crucial
 Hence, difference between those stricken & those
It is the basic science and fundamental practice spared
of public health

Epidemiology
Descriptive Epidemiology

DESCRIPTIVE ANALYTIC  Provides clues leading to the formation of an

etiologic hypothesis that is consistent with
 Distribution  Determinants
existing knowledge of disease occurrence
 frequency of health  search for causes or
events by person, risk factors  Uncovers patterns of occurrence suggesting
place, & time  response to a study etiologic relationships and can lead to planning
 epidemiologic hypothesis effective prevention and educational programs
variables or  use various  Provides valuable information to enable
characteristics that epidemiologic health care providers and administrators to
can be observed & /or methods efficiently allocate resources
measured

1
 12/6/2021

Uses of Descriptive Epidemiologic

Describing Disease Occurrence
Studies
 What - health issue of
1. Allow for evaluation of trends in health & concern
disease & comparisons among countries &  Who - person
subgroups within countries
 Where - place
2. Provide a basis for planning, provision &
 When - time
evaluation of health services
 Why/how - causes,
3. Identify problems to be studied by analytic
risk factors, modes of
methods & to suggest areas that may be
transmission
fruitful for investigation

Major Descriptive Epidemiologic

Variables
MAJOR DESCRIPTIVE
➢ Person EPIDEMIOLOGIC VARIABLES
➢ Place
I. Person Variables
➢ Time What populations or subgroups do or do not
develop a disease

 Characteristics one is born with

- gender, genetic make-up

 Characteristics modified or acquired w/ time

- immunologic experience
- aging

MAJOR DESCRIPTIVE EPIDEMIOLOGIC Persons may be described according to:

VARIABLES Activities
 Occupation
Person Variables  Recreational activities
 Transitory
 Religious practices
fatigue
nutritional status  Customs

 Behavior
Lifestyle

The four may overlap

2

Persons may be described according to:
Circumstances which
they live in
 Social condition
 Economic status
 Environmental
conditions
PERSON VARIABLES:
1. AGE
 Age is the most important factor to consider
when one is describing the occurrence of
virtually any disease or illness.
 Public health professionals often use age-
specific rates when comparing the disease
burden among populations.
 As age increases, overall mortality increases as
do the incidence of and mortality from many
chronic diseases
 Causes of morbidity and mortality differ
according to stage of life
PERSON VARIABLES:
1. AGE
 Age-specific disease rates usually show
greater variation than rates defined by
almost any other personal attribute.
 Relationship between age of mother and rate
of diabetes, which increases the risk of
complications of pregnancy
 Mothers who give birth when they are older
have higher rates of diabetes than mothers
who give birth at younger ages
 Age differences in birth rates
12/6/2021
MAJOR DESCRIPTIVE EPIDEMIOLOGIC
VARIABLES
Person Variables
Inherited or acquired characteristics:
 Age
 Gender
 Race
 Socioeconomic status
 Marital status
 Ethnicity/Nativity (place of origin)
 Migration
 Religion
PERSON VARIABLES:
1. AGE
 Age-specific disease rates usually show
greater variation than rates defined by
almost any other personal attribute.
 During childhood, among unvaccinated
persons, infectious diseases such as mumps
and varicella occur most commonly
 Teenagers- unintentional injuries, violence
and substance abuse
 Younger adults- unintentional injury
 Older adults- morbidity and mortality from
chronic diseases
Age
 Age is the single most important personal
characteristic. To a large extent, it determines:
- the physiologic activity of the organism
- the level of immunity or resistance
- the potential exposure to a disease agent
 Our behavior & our risk of exposure, differs
markedly at different life stages
Ex. Mouthing behavior of infants
increased sexual activity during adolescence
and young adulthood
3
 12/6/2021

Age Possible explanations of increasing mortality with

 Affects most health related outcomes
 Should always be considered in any
epidemiologic study if not as the main variable of
interest, at least as a probable confounder.
increasing age
 Cumulative exposure of individual during his
lifetime to environmental insults through diet,
smoking, occupation, & other factors
 Decrease with age in immunological defenses of
human organism
 Increase in frequency of somatic mutations or
chromosomal abnormalities with age which may
result from either cumulative effects of the
environment or decreased efficiency of such
biological mechanism as mitosis

Possible explanations of increasing mortality

PERSON VARIABLES:
with increasing age
2. GENDER
 Hormonal changes throughout a lifetime
 Males generally, have higher all-cause age-
 Exposure to an agent, early in life, that may
specific mortality rates than females from birth
impair the immunologic status of an aging
to age 85 and older.
person
 Morbidity rates are higher in women.
 A nonspecific, genetically determined “wearing
out” of the human organism

Characteristics of persons: Gender Females

 Generally, age-adjusted  Thyrotoxicosis
Mortality rates: M>F  DM
Morbidity rates: M<F  Cholecystitis
 Psychoneurosis
 Possible explanations for sex differentials: Males
- Lifestyle  Ischemic heart
- occupational exposure to hazards disease
- health seeking behaviors  Peptic ulcer
- hormonal profiles  Gout
 Accidents

4
 12/6/2021

PERSON VARIABLES:
PERSON VARIABLES: 4. SOCIOECONOMIC STATUS
3. RACE/ETHNICITY  “descriptive term for a person’s position in
society…”
 Race: people, nation of the same stock
 Ethnic group: marked by the recognition of  One of the most important demographic
common cultural, linguistic, religious, behavioral determinants of disease risk
traits as indicators of contrast to other groups  Often formulated as a composite measure of 3
 Study of migrants: to separate genetics from interrelated dimensions:
environmental factor 1. Person’s income level
 For epidemiological purposes: any group whose 2. Education level
members have lived in proximity & share
customs & values whether by biological or social 3. Type of occupation
mechanisms, is of interest

 Social class is a useful variable linking Social Class

education, occupation, area of residence,
 Its effect on poor health could be mediated
income, lifestyle through health service utilization &
 Time sequence is important to note with SES. environmental condition
“Did health problem cause lower SES or did
lower SES cause health problem?”
 Social class is associated with health across
countries even if people in each social class don’t
share many other characteristics.
 Ranking of population into sub-groups maybe
based on 3 related dimensions: Prestige, Wealth,
Power

Social Class

 Health disparity - differences in the occurrence

of diseases and adverse condition in the Poverty
population
 Health disparity- e.g. cancer health disparities,
defined as “… adverse differences in cancer
incidence and prevalence cancer death Poor
(mortality), cancer survivorship, and burden of Poor service
Poor health
environmental
conditions /
cancer or related health conditions that exist utilization
overcrowding
among specific population groups in the US.”

5
 12/6/2021

PERSON VARIABLES: PERSON VARIABLES:

5. MARITAL STATUS 6. RELIGIOUS AFFILIATION
 Associated with level of mortality for males & females
 Mixture of factors such as genetic,
 In general, ranking in death rates is as follows:
 Divorced environmental, cultural, and behavioral factors
 Widowed  Example:
 Single  Tay-Sachs Disease – degenerative disease of the
 Married brain and nervous system → associated with
genetic mutation present mainly among Jewish
 Possible explanations people of Eastern European descent
 Psychological & physical support provided by spouse
 Cancer – prohibition against smoking and alcohol
 Lifestyle differences
plus sexual behavior
 For females, differences in sexual exposure,
pregnancy, childbearing  2.9% lower in male Mormons

 7.9% lower in female Mormons

MAJOR DESCRIPTIVE EPIDEMIOLOGIC

PERSON VARIABLES: VARIABLES
7. OCCUPATION II. PLACE VARIABLES
 The association of disease with a place implies that
 Percival Pott noted that London chimney the most important causative factors are in the
sweeps had a high rate of scrotal cancer due environment or people of that place
to polycyclic aromatic HC  Example:
 Jackhammer operators – vibratory threshold  Population density (urban vs. rural) can affect
limits how rapidly an airborne disease is transmitted, or
determine risk of exposure to a vector-borne
 Foundry workers - noise disease
 Country of origin or exposure can be important
because diseases may be imported from endemic
areas

Place
What geographic location is most or least common

Factors that may be distributed geographically  A geographic association may be explained in

- Climate terms of characteristics inherent to the place of
- Diet occurrence of a disease
- Cultural practices
- Food preparation & storage method
- Population density
- Exposure to pollutants
- Presence of vectors

6

MAJOR DESCRIPTIVE EPIDEMIOLOGIC
VARIABLES
Place Variables
Type of Comparisons
1. International comparisons of disease frequency
2. Geographic (within country) variations
3. Urban/rural differences
4. Localized occurrence of disease
Characteristics of Place:
Type of Comparisons
1. International comparisons
 USCIA reported the ranked life expectancy
was 66.1 years (2008 estimate).
 The 3 countries with the highest life
expectancy in 2008 were Andorra (83.5 yrs),
Macau (83.3 yrs), and Japan (82.1 yrs).
 The 3 with lowest life expectancies were
Zambia (38.6 yrs), Angola (37.9 yrs), and
Swaziland (32.0 yrs).
Characteristics of Place:
Type of Comparisons
2. National (Within Country)
 Regional differences in factors such as climate,
latitude, and environmental pollution affect the
prevalence and incidence of diseases.
12/6/2021
Characteristics of Place:
Type of Comparisons
1. International comparisons
 Both infectious and chronic diseases show
great variation from one country to another
(WHO).
 Some of these differences maybe attributed to
climate change, cultural factors, national
dietary habits, and access to health care.
Characteristics of Place:
Type of Comparisons – Int’l comparisons
 Considerations for its validity
 Accuracy of diagnosis
 Completeness of reporting
 Classification
 Data processing
Characteristics of Place:
Type of Comparisons – Within country
 Political boundaries
 Denominators are provided
 Natural boundaries
 Characterized by some particular
environment or climatic condition
 Differences in genetic makeup, social
customs, economic activities, access to care
7

Characteristics of Place:
Type of Comparisons
3. Urban-Rural Differences
 Urban morbidity & mortality are those that are
more likely to be spread by person-to-person
contact, crowding, & inner-city poverty or
associated with urban pollution
 Rural areas more affected by environmental &
cultural factors that reinforce unhealthful
behaviors
Characteristics of Place:
Type of Comparisons
 Basis for distribution of cases:
 Place of residence
 Place of work
 Place visited/route of travel
 Birthplace
 Healthy persons entering the area become ill
with a frequency similar to the indigenous
inhabitants
 Inhabitants who have left the area do not show
high rates
 Species other than man inhabiting the same area
show similar manifestations
12/6/2021
Characteristics of Place:
Type of Comparisons
4. Localized Patterns of Disease
 May depend on specific environmental
conditions that may exist in a particular
geographic area
 Ecologic environment: endemic diseases
 Physical elements: eg. Water & air, ionizing
radiation: goiter
 Sociocultural: lung cancer in areas with
shipyards
Criteria suggesting association to a place
 High frequency rates are observed in all ethnic
groups inhabiting the area
 High frequency rates are not observed in persons
of similar ethnic groups inhabiting other areas
Reasons for variation in place
 Clustering of racial, ethnic, or religious
groups with unique behaviors or lifestyles
 Gene-environment interaction, e.g. high
prevalence of sickle cell anemia in areas
of Africa which are highly endemic for
malaria
 Influence of climate or environment
8
 12/6/2021

MAJOR DESCRIPTIVE EPIDEMIOLOGIC Characteristics of Time:

VARIABLES 1. Secular time trends
III. TIME
 Observation of the changes in disease frequency  Refer to gradual changes in the frequency of a
over time disease over long time periods, as seen in
 Time may be calendar time or milestones changes in the rates of chronic diseases &
caused by changes in environmental factors or
 Changes in disease frequency may occur:
host susceptibility
 Over long periods of time (secular changes)
 Sources of data
 Repetitively/seasonality (cyclical changes)
 Death registration
 Within a short period of time (epidemic)
 Disease notification
 Clustering
❖Usually displayed in a 2-dimensional graph  Disease registries

Characteristics of Time:
Secular time trends Reasons for apparent secular changes in
Reasons for apparent secular changes in disease frequency
disease frequency
Changes in
Changes in:  population demography where trend is observed
 the completeness of the source of data  the environment
 diagnostic ability of physicians & other  the natural history of the disease
contributing relevant data
Improvement or deterioration of the prognosis
 practice in data collection over time
 prognosis over time

Characteristics of Time:
Characteristics of Time:
2. Cyclic Fluctuations
Cyclic Fluctuations
1. Increases & decreases in the frequency 2. Seasonal variations – diseases that are
of diseases & health conditions over a strongly influenced by environmental factors
period of years or within a year may show seasonal variation
Example:  Role of vectors
 Birth rates (seasonal trend)  Recreational or occupational activities
 Depression 3. Variations of biological & sociological
 Influenza determinants
 Mortality for heart diseases  Frequency of suicide by day of the week
 Accidents  Onset of myocardial infarction

9

Characteristics of Time:
3. Point epidemics
 May indicate the response of a group of
people circumscribed in place to a common
source of infection, contamination of other
etiologic factor to which they were exposed
almost simultaneously
 Sharp increases in disease frequency w/in
hours, days, or weeks
 Could be due to almost simultaneous
exposure to a single source (point source)
 Presented as a curve or histogram
 Temporal clustering
- denotes health events that are related in
time such as
- post vaccination reactions such as syncope
- development of puerperal psychosis (a few
days after a mother gives birth)
 Spatial clustering
- indicates cases of disease (often
uncommon diseases) that occur in a specific
geographic region. E.g., cancer cluster
Combination of person, place & time
(Migrant population studies)
Determines whether high rates of certain
diseases noted in certain countries are intrinsic to
the inhabitants of that country
12/6/2021
Characteristics of Time:
4. Clustering
 Clustering in time
The interval between the precipitating event &
onset
of illness can be measured with precision
 Case clustering: unusual aggregation of health
events grouped together in time and place at the
time of their diagnosis
 Example:
- London cholera epidemic (1850’s)
- Legionnaire’s outbreak (late 1970’s)
Characteristics of Time:
5. Cohort Effects
 Cohort is defined as a population group, or a
subset distinguished by a common
characteristic that is followed over a period of
time
 Cohort effect: the influence of membership in
a particular cohort
 The common characteristic may be that the
group experienced an exposure associated w/
a specific setting (occupational cohort or a
school cohort)
Migrant population studies
 Demonstrates that certain places do possess
characteristics of significance in the etiology of
certain diseases independent of the people
who inhabit those places
10

Migrant population studies
 Assess significance from the points of view of
risk of a particular disease of the years spent in
the homeland prior to migration relative to those
spent in the host country
Methods of describing disease
occurrence:
 Statistical measures
- Measures of disease frequency
- Measures of central tendency / dispersion /
location
 Figures
- tables : serve as the basis for charts & graphs
- charts : bar, pie charts
- graphs : line graphs, histograms
 Spot maps
 After we organize the data, we can look at
epidemiologic variables to:
 Identify characteristics that might be
important, &
 Form hypotheses about the source, causative
agent, & mode of transmission of illness
12/6/2021
Variations over time:
 True increases or decreases
- actual changes in the frequency of the
disease in that population
 Changes in the sensitivity & specificity of the
surveillance system
 Mistakes made in collecting or organizing the
data
 Changes in the perceptions of the public or the
health care community about the importance
of diagnosing & reporting that particular
disease
Summary
 Epidemiologic variables are characteristics that
can be observed and/or measured
 Epidemiologic variables may be characteristics
of time, place, or person
 Tables, charts are good tools for organizing
epidemiologic data. They make it possible to
identify, explore, understand, & present data
distributions, trends, & relationships.
EPIDEMIOLOGIC INFERENCES FROM
DESCRIPTIVE DATA
1. Provide a basis for generating hypotheses, thus
studies of this type connect intimately with the
process of epidemiologic inference.
2. The process of inference in descriptive
epidemiology refers to drawing conclusions
about the nature of exposures and health
outcomes and formulating hypotheses to be
tested in analytic research.
11
 12/6/2021

EPIDEMIOLOGIC INFERENCES FROM

DESCRIPTIVE DATA
Progression in scientific process
Casual observation

Hypothesis formation

Controlled observation

Experimental studies

TYPES OF DESCRIPTIVE 1. CASE REPORTS

EPIDEMIOLOGIC STUDIES
 Accounts of a single occurrence of noteworthy
health-related incident or small collection of
1. CASE REPORTS
such events
2. CASE SERIES
 e.g., CDC published 3 case reports of women
3. CROSS-SECTIONAL STUDIES (e.g. A survey of who developed adverse reactions (Acute Renal
population) Failure) to injections of cosmetic soft-tissue
fillers, which are substances used to improve the
❖Case Report and Case Series are among the appearance of bodily areas such as lips and
most basic types of descriptive studies buttocks

2. CASE SERIES 3. CROSS-SECTIONAL STUDIES

 Larger collection of cases of disease, often
grouped consecutively and listing common
features such as the characteristics of affected
patients
 Examines the relationship between diseases (or
other health-related characteristics) and other
variables of interest as they exist in a defined
population or in a representative sample at one
particular time

 Type of prevalence study in which exposures and

distributions of disease are determined at the
same time, although it is not imperative for the
study to include both exposure and disease

12
 12/6/2021

CROSS-SECTIONAL STUDIES
 Make a one time assessment of the prevalence
of disease in a study group that in most situation
has been sampled randomly from the parent
population of interest
 Maybe used to formulate hypotheses that can be
followed up in analytic studies

Reference:
 http://samples.jbpub.com/9780763754433/Chapter4.p
Thank you! df

Good day!!!

13