EPI: LE 5 | TRANS 1

5.01 Overview of Descriptive Studies

LEOPOLDO P. SISON, JR, MD, MPH| 02/18/2020

OUTLINE Uses of Descriptive Studies

I. Introduction C. Correlational Studies ● Delineation of syndromes of disease entities
A. Types of Studies D. Ecological Studies ● Establishment of the natural history of the disease
B. Approach E. Cross-Sectional → Example: COVID-19 or Coronavirus disease 2019
II. Descriptive Studies Studies ▪ Incubation period, who are affected and where they come
A. Case Report III. Review Questions from
B. Case Series IV. References ● Classification of disease, clinical manifestations, etc.
● Magnitude of occurrence and pattern
Remember Lecturer Book Previous Trans
→ Especially for ecological studies
  
A. CASE REPORT
LEARNING OBJECTIVES ● Detailed report of a single patient (e.g. demographics, signs
At the end of the session, the students will be able: & symptoms, treatment, follow-up information)
● To explain the various types of descriptive study designs ● Done to document unusual or unexpected medical
● To understand the uses of different descriptive study designs occurrences which may represent first clues to identifying new
I. INTRODUCTION diseases or adverse effects of exposures
→ “You never say never and never say always because there’s
A. TYPES OF STUDIES always room for something new to happen.” – Dr. Tolosa
● Experimental [22A Trans]
→ Study factor is manipulated by the investigator ● Allows for formulation of hypothesis
→ “Variables are exposed to risk factors”  ● Focuses on:
→ E.g. Laboratory vs. Real world → Unexpected association between diseases or symptoms
● Observational → Unexpected event in the course of observing or treating a
patient
→ No manipulation of study factor by the investigator
→ Findings that shed new light on the possible pathogenesis of
→ “Observe only”  a disease or an adverse effect
→ E.g. Descriptive vs. Analytic, Retrospective vs. Prospective ▪ Ex: Broken Heart Syndrome – rupture of chordae
● Qualitative vs. Quantitative tendineae due to stress & psychological distress
→ Epidemiologic studies are more quantitative → Unique or rare features of a disease
→ Unique therapeutic approaches
B. APPROACH → A positional or quantitative variation of the anatomical
● Observational structures
→ Descriptive ▪ Ex: Dextrocardia, Situs Inversus
▪ For hypothesis generation 
− Case Report Strengths and Limitations
− Case Series ● No statistical analysis or comparative group
− Ecological Study (for aggregate samples) ● It provides the first report of unexpected event, hypotheses for
− Cross-sectional Studies testing and definition of issue for further study, but the results
→ Analytical are rarely generalized
▪ For hypothesis generation and testing  Case: Cutaneous Larva Migrans
− Case Control
− Cohort ● 19/F, married with cats and dogs in household
− Cross-sectional Studies ● Contact with damp rags
● Experimental → Presented with erythematous pruritic skin lesions erupted on
→ For hypothesis testing  her right mid-lateral leg
▪ Clinical Trials (RCT) ● A serpiginous (lesion having a wavy margin) skin eruption
− Therapeutic Trial caused by burrowing larvae of animal hookworms, usually dog
▪ Field Trial and cat hookworm
− Prevention purposes ● Treatment: Albendazole 400mg tablet
▪ Community Trial ● One tablet once a day for 7 days
− Intervention purposes Other Examples
−

II. DESCRIPTIVE STUDIES
● A descriptive study does not explain associations or
relationships, but seeks knowledge for better understanding
of the nature of the subject of the study to serve as basis for
some future actions, including formulation of hypothesis of
relationship
→ It is an inquiry into the nature of an unknown phenomenon
or the occurrence of an event
→ It seeks to know the characteristics of the phenomenon or
event and to categorize it into some descriptive variables
● The aim of a descriptive study is to infer findings from a
sample from a reference population
● “Everything starts with descriptive studies” 
LE 2 TRANS 1 TG: Alvarez A, Alvarez P, Anonas, Apugan TH: Arboleda
● 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
● 51-year-old woman crushed by an elephant trunk.
→ Woman rushed to the ER with multiple fractures, internal
bleeding, and injuries to the face
→ Author states hospitals and 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
the wound of the patient to suck blood and necrotic tissue.
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 B. CASE SERIES → If you spent more hours studying, your GPA is also expected
● Similar in structure and form as case reports, but describes a to increase
group or set of cases, instead of a single patient
→ Case series – is an objective report of a clinical characteristic
or outcome from a group of clinical subjects with the same
or similar manifestations
→ Description
▪ A brief objective report of clinical characteristic or
outcome from a group of clinical subjects
→ Study question
▪ Report new disease or health related problem
● May be retrospective or prospective  Figure 1. GPA and Hours of Studying Correlation
→ In prospective studies, individuals are followed over time and Negative Relationship
data about them is collected as their characteristics or
circumstances change ● Increase in the values of one variable is associated with
▪ Birth cohort studies are a good example of prospective decrease in the second variable
studies ● E.g. GPA (Variable 1) and alcohol intake (Variable 2)
→ In retrospective studies, individuals are sampled and → Increase in alcohol intake will show decrease in your GPA
information is collected about their past
● Usually requires a relatively small sample size
→ Usually 2 or more 
▪ 10 or more according to the Powerpoint
● Reports the frequency of events or outcomes of a disease, but
does not show temporal relationships between events and
outcomes
→ Temporal relationship – “Which causes which” 
Strengths and Limitations

● Control or comparison group is not included Figure 2. GPA and Alcohol Consumption Correlation
● Generalization of the results is limited because the selection of No Relationship / Non-relationship
study subjects is unrepresentative
● There is no relationship between the two variables
● This study design has case selection bias and lacks
● E.g. Socioeconomic status and honesty
statistical validity
→ Case selection bias – depends upon the investigator of
which case to study or to include in his case series
Case: Pneumocystis carinii pneumonia (PCP)

● 5 cases of Pneumocystis carinii pneumonia (1980-1981)

among young, healthy, homosexuals in LA
→ Hypothesis regarding risk factors for development of AIDS
▪ Guide: Look at the characteristics of the subjects/patients
Figure 3. Honesty and Social Economic Status Correlation
(age, sex, where they came from, etc.) 
Curvilinear Relationship
Case: Angiosarcoma of the Liver
● Type of relationship between two variables whereas one
● 3 patients with angiosarcoma of the liver in males working in a
variable increases, so does the other variable, but only up to a
vinyl chloride plant
certain point, after which, as one variable continues to increase,
→ Hypothesis: Occupational exposure to vinyl chloride is
the other decreases
associated with hepatic angiosarcoma
● E.g. Physical performance increases at sport competition at
C. CORRELATIONAL STUDIES moderate level but then decreases with higher the anxiety
NOTE: This section was not discussed by Dr. Sison, but was
included in 2022 transes.
● When the goal of research is to test a hypothesis about the
relationship between variables
→ There is no manipulation of variables
▪ Data is plotted accordingly into a graph
● Often difficult to interpret since it is seldom possible to examine
directly the various potential explanations for findings
Positive Relationship
Figure 4. Sports Performance and Anxiety Correlation
● Increase in the values of one variable is associated with D. ECOLOGICAL STUDIES
increase in the second variable ● Relates the frequency with which some characteristic and some
● E.g. GPA (Variable 1) and hours studying (Variable 2) outcome of interest occur in the same geographic area
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 → Useful for formulation of hypothesis
→ Describe the magnitude and direction of correlations (i.e.
a change in one variable is noted with a change in another
variable)
▪ Seeks to find correlation between aggregate exposure
A B
and outcomes—correlations, if present, has both
magnitude and direction
▪ Measures disease rates, exposures, and relations
● The unit of observation is the population or community
→ Focuses on the comparison of groups rather than individuals
● Limitation: Cannot be used to draw causal conclusions and is
subject to ecological fallacy
● Longitudinal ecological studies C D
→ Use on-going surveillance or frequent cross-sectional
studies to measure trends in disease rates over many years
in a defined population Figure 5. Scatterplots / Scattergrams showing linear associations. The best fit
Ecological Fallacy line is obtained to generate the graph. There is no best fit line in box D.

● Logical error in interpretation of statistical data, whereby Example: Correlations between meteorological parameters
inferences about the nature of specific individuals are based and prostate cancer
solely upon aggregate statistics collected for the group to which
those individuals belong
● Fallacy assumes that individual members of a group have the
average characteristics of the group at large
→ Question posed: Are these factors really affecting people?
● Statistics that accurately describe group characteristics do not
necessarily apply to individuals within the group
→ E.g. Falsely assumes that every individual´s IQ is high, since
the class average is high
Analysis of Ecological Data
● Pearson's Correlation Coefficient (r) 
→ Evaluate the linear relationships between two continuous
variables
→ Provides information about the magnitude (r2) and direction
(r) of the relationship  Figure 6. Relationship between heating degree days and prostate cancer
▪ Observations are collected, then Pearson's coefficient is incidence
computed to specify the nature of the relationship ● The colder the temperature, and the drier the climate in a
between the variables country, the higher the incidence of prostate cancer.
→ Use of interval variables and ratio
→ Values range from +1 to -1
Table 1. Pearson’s Correlation Coefficient Values
Pearson’s Correlation
Indication
Coefficient (r)
+1 Perfect positive relationship
-1 Perfect negative relationship
0 No relationship
Table 2. Degrees of Correlation
Pearson’s
Degree of Indication
Correlation
Correlation
Coefficient (r)
±1 Perfect correlation
Figure 7. Showing correlation denoted between temperature and incidence of
±0.50 - ±1 High Strong Correlation prostate cancer and amount of land used to grow crops and incidence of
Medium prostate cancer
±0.30 - ±0.49 Moderate
Correlation
● Furthermore, in counties with high average annual snowfall
< ±0.29 Low Small Correlation (>75 cm/yr), the amount of land used to grow crops (a proxy for
b No correlation pesticide use) was positively correlated with the incidence of
→ Measures the degree of correlation of two continuous prostate cancer
variables in an interval scale → Data analysis is done through correlation and regression
Table 3. Pearson’s Correlation Coefficient analysis
Interval Degree of Correlation ● Question generated: Do the people who have prostate cancer
0.00 – 0.25 Little or no relationship in this survey really live in those areas? They might only be
0.26 – 0.50 Fair degree of relationship there because the place has specialty hospitals 
0.51 – 0.75 Moderate to good relationship → Shows that studies like this are for hypothesis generation.
There is a need to go for higher research design to know the
> 0.75 Good to excellent relationship
association 

E. CROSS-SECTIONAL STUDIES
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● In a cross-sectional study, the variables are all measured at
a single point in time, with no structural distinction between
predictors (exposure) and outcomes
→ Therefore, there is no attempt to establish a temporal
relationship
● It may involve the measurement of current exposure and/or
historic exposure
→ Example: COVID-19
▪ Cross-sectional analytical study
− Distribution of people, prevalence
− Associations, odds-ratio, relative risk
▪ Cross-sectional descriptive study
− No associations made
− 2x2 table, compute for specificity and sensitivity
● The design is valuable for providing descriptive information
about prevalence – it is well suited to the goal of describing
variables and their distribution patterns
→ How many of the population really have the disease?
→ Survey of the people who have the disease 
● This design may also be used for examining associations,
although the choice of which variables to label as predictors
and which as outcomes depends on the cause-and-effect
hypotheses of the investigators
→ Example: Which is the risk factor and which is the outcome,
diabetes or hypertension?
▪ Depends on the researchers, must be backed up by
related literature 
● Morbidity and mortality studies are cross-sectional studies
Table 4. Morbidity and Mortality Studies
Morbidity Studies Mortality Studies
Prevalence Studies Mortality Surveys
Case series in health centers, Analysis of official mortality
clinics, and hospitals statistics and hospital records
● Cross sectional studies measure existing disease and current
exposure levels
● The study analyzes data collected on a group of subjects at
one time rather than over a period of time
→ If it is over a period of time, it is a case control study 
General Steps in Doing a Cross-Sectional Study
1. Select a sample from the population
2. Collect data using standardized data collection method (e.g.
questionnaire)
3. Analyze the collected data
Figure 8. Schematic diagram for cross sectional studies
● Identify the risk factors and diseases, not which came first 
Strengths and Limitations
● Quick and easy
● True rates are determined (the prevalence)
● Can study multiple exposure and multiple diseases
● Impractical for rare diseases
→ E.g. Doing a cross-sectional study for hypertension, a
prevalent illness, is more practical than doing a cross-
sectional study for penile cancer wherein only 1 out of 1000
men have it. It will be difficult to find respondents.
EPI Overview of Descriptive Studies
● Not useful for establishing casual relationships
→ It does not allow us to answer the question, which came first
(which caused which)
● Data are particularly susceptible to distortion through the
introduction of bias into the research during sampling
questionnaire and interviewing
→ Prevarication bias 
▪ Occurs when a study subject over- or under-estimates
outcome because of knowledge of the kind of treatment
they had received [Hiebert and Nordin, 2006]
▪ Subject may subconsciously feel the need to provide
answers pleasing to the interviewer, or may feel that there
is some secondary gain from consciously misreporting
their clinical status [Hiebert and Nordin, 2006]
● Needs a large sample size
I. REVIEW QUESTIONS
For numbers 1 to 5, choose the appropriate RESEARCH
STUDY DESIGN from the choices below for the given
situations. Choices may be used more than once or not at all:
A. Case Study
B. Case Series
C. Cross- Sectional Study
D. Ecological Study
1. In 1981, a previously healthy homosexual man presented with
serous fluid build-up in his lungs and recurrent episodes of
Pneumonia. He was eventually diagnosed to have rare
Pneumocystis carinii pneumonia, a fungal infection not
commonly seen in immunocompetent individuals.
2. Also in 1981, a group of young men having sex with other men
(MSM) in their second and third decades of life from New York
City were suffering from Kaposi’s sarcoma, an aggressive rare
form of skin cancer. All men shared similar high-risk lifestyle and
comparable clinical presentations.
3. Now in 2018, people having Pneumocystis carinii (i.e.,
taxonomic reclassification as Pneumocystis jiroveci) pneumonia
have been more common; thus there is a need for a study of the
true prevalence rate of the said disease.
4. A province found to have high consumption of fat also had a high
prevalence rate of cancer. Which uses the population of a
specified geographic area as the subject?
5. Which of the following research designs could study the
association of multiple exposures and multiple outcomes at the
same time?
6. The correlation between consumption of carbohydrates
and prevalence of diabetes mellitus (DM) was calculated to
have a Pearson’s r value of 0.88 with a p-value of 0.01. How
should these VALUES be INTERPRETED?
A. Carbohydrate consumption and DM have an excellent
correlation that is statistically significant
B. Carbohydrate consumption and DM have an excellent
correlation that is not statistically significant
C. Carbohydrate consumption and DM have little or no
correlation that is statistically significant
D. Carbohydrate consumption and DM have little or no
correlation that is not statistically significant
7. Which of the following can be a CASE REPORT?
A. Investigating the efficacy of Moringa oleifera
(malunggay) cream in resolving bacterial skin infections
as compared to mupirocin cream
B. Adverse events of glutathione capsules in five adult
women residing in an urban community
C. The onset of generalized acneiform eruption on a
teenage male given oral corticosteroids for optic neuritis
D. All of the above
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8. Which of the following does NOT belong to the category of
ANALYTICAL STUDIES?
A. Cross-sectional study
B. Ecological study
C. Case control study
D. Non-concurrent cohort study

1A 2B 3C 4D 5C 6A 7C 8B
II. REFERENCES
Dr. Sison’s Lecture and Powerpoint
2022A and 2022C Trans
2021B Trans
Hiebert R, and Nordin M. (2006). Methodological aspects of outcomes research.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454552/.

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