Epidemiology Principles - slide 3

Monday, February 27, 2023 2:01 PM

Objectives of the Module

1. Identify and discuss the phases of an epidemiological investigation (descriptive, analytical, and experimentation).
2. Discuss the development and purpose of hypotheses in research
3. Identify sources of data in epidemiological investigation: population statistics, frequency of health events, mortality and
morbidity data, and casual factors.
4. Describe research designs used in epidemiological studies:
○ Experimental design studies
▪ Community trial studies
▪ Clinical trial studies: controlled (randomized control studies) and non-controlled
○ Observational design studies
▪ Descriptive studies: cross sectional
▪ Ecological studies
▪ Case-control (retrospective)
▪ Cohort studies (prospective)

Phases in Epidemiological investigations

Phase 1: Descriptive Epidemiology

• Involves collecting and analyzing data by person, place and time

○ E.g A number of persons living in your Hall of residence complained of diarrhea, abd. cramps, fever (100 – 102 F)
▪ Get data on Person, place, time (discuss)
▪ Present data
▪ Formulate hypothesis

Phase II: Analytical Epidemiology

1. Test hypotheses suggested from descriptive epidemiology stage

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 2. Concerned with the search for cause and effect

3. Consider any possible influences that may interfere (confounding variables) – a factor that is associated with the risk factors
(exposure) and independently affects the development of the disease

○ Confounding variable can result in:

▪ observation of differences when they do not truly exist
▪ observation of no differences when they do truly exist

Phase III: Experimentation

• The last stage of investigation, the experimentation phase

• Commences after the analytical phase finds that a factor is thought to be related to the disease

• Randomized trial design is used

○ Determines the exposure of the individual to each of the experimental factors including conditions and controls
○ Assigns individuals to groups
▪ Exposed to factors associated with the study
▪ Not exposed to factors associated with the study

Any Phase

• Assist public health administrators in making decisions regarding the allocation of health resources

• Provide information that can be used in the development of education and health programs such as prevention activities

Types of Studies

Descriptive Studies

• Involves the collection of data including:

○ the general characteristics of the distribution of a disease in relation to persons, places, and the time involved.

• Personal variables studied would include:

○ age, sex, race, marital status, occupation, and lifestyle variables

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 • Geographical location
○ countries (tropical or temperate) or within countries (urban or rural)

• Time periods
○ seasonal patterns of disease onset and comparisons between different time periods

Sources of data for descriptive studies

1. Census data
2. Statistical records
3. Clinical records
4. Two basic types of descriptive studies
○ Case reports
○ Case series

Descriptive Studies-Case Report

• Most simple and basic type of design available

• Documentation of data by the health professional
• Relationships between numerous variables that may affect a disease are documented, but not identified as being causal

Descriptive Studies-Case Series

• Similar to the case report

• Documents the number of patients who are affected by the disease
• Can also include things such as surveillance
• Can be useful in identifying the possible emergence of a new disease or an epidemic
• HTLV1 in Jamaica was identified from case series

Advantages and disadvantages

• Descriptive studies are

○ Simple
○ Cost-effective
○ can identify possible fluctuations from known disease cases
○ Assist public health administrators in the efficient allocation of resources, targeting health education programs towards
affected populations

• Disadvantages include the inability to draw causal relationships between factors

Ecological and Cross-Sectional Studies

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 Analytic Studies

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Analytical Epidemiology

• Test hypotheses suggested from descriptive epidemiology stage

• Relational studies obtain information regarding exposure and disease that is specific to the individual

• Study designs used in the analytical approach include

○ Cross-sectional studies
○ Case-control studies
○ Cohort studies
○ Experimental

Experimental and Observational Designs Generally

• Aim to permit a fair, unbiased comparison to be made between a group with, and a group without a risk factor or intervention

• A good research design has the following

○ comparison to be made of a factor/variable within two different groups during a specific time period
○ the differences in the variable within the two groups to be calculated
○ Identifying when the risk factor and disease occurred, and the determination of the sequence of events leading up to the
occurrence

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 Bias

• Def: “Any systematic error in the design, conduct or analysis of a study that results in a mistaken estimate of an exposure’s
effect on the risk of disease”

• Sampling or selection bias – samples are not randomly selected;

• Non-response bias – particular groups may not respond

• Information bias – systematic measurement errors

○ Social desirability
○ Flaws in questionnaire design
○ Recall bias (especially in case control)

• Information bias – objectivity of the investigator

○ Ask – who is behind the study?
○ Why is the information being published

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 Types and Sources of Data

Types of Data Collected by Epidemiologists

• Four main sources of data

1. Population statistics - to determine epidemiological rates

2. Frequency of health events - data that provides more information for research
3. Causal factors or events - exposure to these is used to test hypotheses
4. Linkage data - allows researchers to track individuals within the study over a period of time

Population Statistics

• Major demographic census

• Often carried out by governments
• data includes social, economic, and personal factors

• Vital statistics
• Data related to births, marriages, and deaths
• Birth certificates provide vital statistical information on health
• Differences in number of stillbirths recorded between givens geographic locations
• Can be used to conduct further research into the causes of a stillbirth fluctuation

Causal Factors or Events

• Possible influences of a disease

• Data can be gathered from various sources

○ Mostly medical records that are obtained from physicians or hospitals.

○ Primary records include a number of variables
▪ Sex and age
▪ Lifestyle information (e.g. smoking or drinking history)
▪ Reproductive history
History of disease or accident

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 ▪ History of disease or accident

Linkage data

• Data that permits the epidemiologist to track an individual or group of individuals over a period of time
• Linkage data might be used within a study that determines the effects of extended exposure to a particular pathogenic agent
• In the US - Social Security records used to track a population over multiple decades
○ Framingham heart study

YouTube videos

• http://www.youtube.com/watch?v=sGfIKmKMRdg
• http://www.youtube.com/watch?v=sdFYHSxq_qo

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