03 04 Epidemiology Handout

Chap 3: Epidemiology: The Study of Disease, Injury, and
Death in the Community
MLS-CPH Instructors
1
Chap 3: Epidemiology
Objectives
• Identify terms and variables commonly
encountered in epidemiology;
• Discuss the history of epidemiology;
• Display understanding in the three basic types of

epidemiological studies.
• Explain the importance of using rates to describe

the occurrence of disease in a population;
2
• Demonstrate the
process of reporting
births, deaths, and
diseases;
• Compute several
standardized
measurements of
health status;
3
Introduction
Primary Care Physician
• Concerned with the course of disease in an individual
patient
4
DEFINITION:
• Epidemiologist
– is a public health scientist, who is
responsible for carrying out all useful
and effective activities needed for
successful epidemiology practice
GOAL: To limit disease, injury, and death

in a community by intervening
to prevent or limit outbreaks or epidemics
of disease and injury
5
DEFINITION:
• Epidemiology
– study of the distribution and
determinants of health related
states or events in specified
population and the application of this
study to control health problems
– Population medicine
6
• Study
– scientific discipline
• Distribution
– frequency and pattern
• Determinants
– factors that influence the occurrence of
disease and other health-related events
7
• Health-related states or events

– anything that affects the well-being of a population
• Specified population
• Application
8
Brief History of Epidemiology

• “Father of Medicine”
• Suggested the relationship between
the occurrence of disease & the
physical environment (300 B.C.)
Hippocrates
Spiritual Era – Few advances in epidemiology – Epidemics
(Plague, leprosy, smallpox, malaria, syphilis, yellow fever)
•Dr. Benjamin Rush traced the cases

to the docks where ships arrived from
tropical ports (Philadelphia)
•Discovered the yellow fever
Walter Reed mosquito, Aedes aegypti 9
50 years after the yellow fever outbreaks, cholera became

epidemic in London, 1849.
10
A classic example of
epidemiological method…
Dr. John Snow
•Removed pump handle (1849)

•Achieved goal in limiting disease
11
and deaths
After 30 years…
Louis Pasteur
• “Germ theory of disease”
• Principle of pasteurization
Robert Koch
• 1883,
•discovered Vibrio cholerae
& many other bacteria
Early uses for description and investigation of diseases

–Epidemiology, a sophisticated field of science. 12
3 Types of Epidemiology:
• 1. Descriptive epidemiology
• 2. Analytical epidemiology
• 3. Experimental epidemiology
13
Descriptive Epidemiology
– Describes the distribution of health status in
terms of: age, gender, race, geography, time
etc.
– Assessing health status, health
problems, health needs through
collections & surveys
– Disease Surveillance
• what (case definition)
• who (person)
• where (place)
• when (time), and
• how many (count) 14
Analytical Epidemiology
– study of the determinants (causes) of
health-related states or events
– Answers: why and how
– test hypotheses about relationships
between health problems &
possible risk factors, factors that
increase that increase the
probability of disease
15
Experimental Epidemiology
– Evaluate the effects of intervention
– Identify the cause of a disease
– Determine the effectiveness of a
vaccine, therapeutic drug, or surgical
procedure
16
Objective of epidemiological
study:
• To obtain an estimate of an epidemiological measure
without random or systematic error.
The research question should state what we want to

measure.
17
Classes of research questions
1 How many are (becoming) diseased? (occurrence)
2 Why are some diseased? (causal effects, etiology)
3 How can we tell whether someone is diseased?
(diagnostics)
4 What can we do for the diseased? (intervention
effects)
5 How does the diseased fare? (prognosis)
6 How does it feel to have the disease? (patient
experiences)
18
Example: COVID-19 among
students
1 What is the incidence rate of COVID-19 among students? (occurrence)
2 How much does not wearing a mask increase the incidence rate of COVID-19?
(causal effects, etiology)
3 How good is the RT-PCR in diagnosing COVID-19? (diagnostics)
4 How much does handwashing decrease the incidence rate of COVID-19?
(intervention effects)
5 How long do college students with COVID-19 live? (prognosis)
6 How does it feel to be a student with COVID-19? (patient experiences)
19
Concepts of Disease
Occurrence
• The conditions surrounding the
occurrence & the factors favoring the
development of the disease
• Epidemiologic Triangle
20
EPIDEMIOLOGIC TRIANGLE
• 3 components:
21
Components of Epidemiologic Triangle
• HOST – any susceptible organism invaded by

an agent
• AGENT – the element that must be
present in order for disease to occur
• ENVIRONMENT – includes all factors –
physical, biological, or social – that inhibit or
promote disease transmission
22
HOST FACTORS:
INTRINSIC FACTORS/risk factors
– Influenced by exposure, susceptibility or
response to agents
• Genetic – ex. sickle • Immunologic experience

cell disease •Active – prior to
infection/immunization
• Age •Passive – maternal
• Sex antibodies, gamma
• Ethnic group globulins
• Physiologic – fatigue, • pre-existing disease/
pregnancy, stress intercurrent disease &
human behavior
23
AGENTS OF DISEASE:
A. NUTRITIVE ELEMENTS
* Excess
* Deficiencies
B. CHEMICAL AGENTS
* Poisons
* Allergens
C. PHYSICAL AGENTS
* Heat, Light, Ionizing Radiation
D. INFECTIOUS AGENTS
* Parasites, Protozoa, Bacteria, Fungi, Viruses
24
ENVIRONMENTAL FACTORS
EXTRINSIC FACTORS
- influence existence of the agent, exposure, or
susceptibility to agent
• PHYSICAL – inanimate surroundings
• SOCIOECONOMIC ENVIRONMENT–
– Occupation, urbanization and disruption
• BIOLOGICAL – living things around us
– Intermediate Host: PASSIVE – cockroach, flies, plants, etc.;
ACTIVE – vectors
25
Epidemiologic Data:
• Characteristic data & factors - not constant
• To analyze epidemiologic data

– Organize data according to the variables of :
TIME
PERSON
PLACE
26
VARIABLES:
I. TIME
– refers both to the period of exposure to the
source of infection & the period during
which the illness occurred
II. PERSONS
̶ Characteristics of the individual (exposed &
contacted the infection)
̶ Described in terms of inherent or acquired
characteristics ( age, race, sex, immune status,
marital status)
27
VARIABLES: Persons…
AGE:
• Single most useful variable in describing occurrence &
distribution of disease
• Potential for exposure to a source of infection
• Level of immunity or resistance
• Physiologic activity at the tissue level.
SEX & OCCUPATION :

• Male : higher mortality rate; Female: higher morbidity rate
• Differ in pattern of behavior, activities, travel, occupation,
exposure to infection
• Activities (work, play, & customs)
• Circumstances (social,economic & environmental )
28
VARIABLES:
III. PLACE
– Features, factors or conditions in the
environment where the disease occurred
– Geographic area described in terms of:
• Street , address, city, municipality, province,
region, country
– Urban / Rural Differences
– Socio-economic areas
29
Patterns of Disease Occurrence & Distribution
1. Sporadic Diseases
̶ Intermittent occurrence of a few isolated &
unrelated cases in a given locality
Ex. Rabies (cases scattered throughout the country)
2. Endemic Diseases
– a disease that occur regularly in a population
with the usual number of cases in a given
locality
– Ex. Schistosomiasis in Leyte & Samar, Filariasis
in Sorsogon
Hyperendemic: persistently high level

of occurrence 30
Endemic vs Epidemic
Number of Cases of a Disease
Endemic Epidemic
Time
31
3. Epidemic Diseases
– an unexpectedly large number of cases of
disease in a particular population in relatively
short period of time
– More acute and serious problem
– Ex. Bird Flu
4. Pandemic Diseases
– an outbreak of disease over a wide geographical
area such as a continent
– World-wide occurrence
– influenza pandemic of 1918-1919 killed 25
million people worldwide
32
5. Epizootics
– Disease outbreaks in animal populations
– Ex. Bubonic plague, St. Louis encephalitis (but
later become epidemics)
– epizootiologist
6. Epizoodemic
– Disease outbreaks involving both animals and
humans
33
Phases/Activities in Epidemiology
1. Studies the distribution of disease within populations.
How much of the population is affected? Who among
them are affected? When are they affected? Where
does this occur?
2. Makes comparisons
Characteristics of affected vs. non-affected
3. Makes inferences / conclusions
Analyzes exposed & non-exposed by retrospective &
prospective methods
4. Seeks disease prevention
Develop insights on prevention from observations on
communities
34
Specific Roles in Epidemiological Investigations:
• Surveillance of the occurrence of notifiable

disease
• Coordinates with other members of the health
team during the disease outbreak
• Participates in case findings & collection of
laboratory specimens
• Isolate cases of communicable diseases
• Performs & teaches household members
method, concurrent & terminal disinfection
35
Specific Roles in Epidemiological Investigations:
• Gives health teachings to prevent further spread

of disease to individual & families
• Follow up cases & contacts
• Organizes, coordinates & conducts community
education campaign
• Refers cases when necessary
• Coordinates with other concerned community
agencies
• Accomplishes & keeps records & reports &
submits to proper office/ agency
36
Break…
37
VITAL STATISTICS
38
VITAL STATISTICS:
• Statistics – systematic approach of obtaining, organizing &
analyzing numerical facts so that conclusion may be drawn from
them.
• Vital Statistics – systematic study of vital events such as births,

illnesses, marriages, divorce, separation & deaths.
• Statistics of morbidity & mortality indicate the health of a

community & the success or failure of health work.
39
• Statistics on population (age, sex & distribution) =

NSO/PSA
• Births & Deaths are registered in the Office of the Local
Civil Registrar of the municipality or city.
– CITY = City Health Department
40
Use of Vital Statistics:

• Indices (point out) of the health & illness status of a
community
• Serves as basis for planning, implementing, monitoring
& evaluating community health programs & services.
41
Sources of Standardized Data

• Philippine Census
– conducted every 10 years, enumeration of population
• Statistical Abstract of the Philippines
– statistics on social, political, & economic organization
• Vital Statistics
– statistical summaries of records of major life events
42
Sources of Standardized Data

• Morbidity & Mortality Weekly Reports (MMWR)
– lists cases of notifiable diseases in the Philippines.
• National Health Surveys
– health interviews of people
– clinical tests, measurement, and physical
examinations
– survey of places where people receive medical care
• FHSIS – Field Health Services & Information
System
• https://www.doh.gov.ph/sites/default/files/publicatio
ns/FHSIS_Annual_2018_Final.pdf
43
Objectives of FHSIS:
• Provide summary of data on health services
delivery = barangay, municipality, city, district,
provincial, regional, and national
• Provide data that can be used for program
monitoring & evaluation purposes.
• Provide standardized data base w/c can be
access for more in depth studies.
• Ensure that the data reported to FHSIS are
useful & accurate.
• Minimize the recording & reporting burden at
the service delivery level to allow more time for
patient care & promotive activity. 44
RATES, RATIOS and
PROPORTIONS:
• Ratio – comparison between any two values or variable
(usually in the form of “:1”)
45
3151:189
46
16.7:1
RATES, RATIOS and
PROPORTIONS:
• Proportion – comparison of a part to the whole
47
• Rate – the number of events that occur in a given

population in a given period of time
– Person experiencing the event (NUMERATOR)
– total population exposed to the risk of same event
(DENOMINATOR)
– allow comparison of outbreaks that occur at
different times or in different places
49
General Types of Rate:

– Crude or General Rate
• Refers to total living population presumed to be exposed to
the risk
– Specific Rate
• Refers to specific population , limits population, definitely
exposed to risk
• Made specific : age, sex, education, occupation, marital
status, race etc…
50
3 Important Kinds of Rates

• Natality (birth) rate
– a measure of the natural growth or increase
of a population.
• Morbidity (disease) rate

– a measure of the persons who became ill or
are ill at a given time
• Mortality (fatality) rate

– A measure of mortality from all causes w/c
51
result in a decrease of population
Crude Birth Rate:
Total # of live births registered in a

given calendar year
CBR = X 1000
Estimated population as of July 1
of same year
This entry gives the average annual number of

births during a year per 1,000 persons in the
population at midyear.
52
Example
• 4,130,665 babies were born in the US during 2009,
when the U.S. population was 307,006,550. Determine
the crude birth rate.
53
General Fertility Rate

• More specific
• Births are related to the segment of the
population deemed capable of giving birth.
# of registered livebirths in a
year
GFR = X 1000
Midyear population of
women 15-44 years of age
54
Example
• During 2009, there were 61,948,144 women aged 15 to
44 in the US. There were 4,130,665 live births. What is
the general fertility rate?
55
Morbidity (Disease) Rate:
# of cases of residents with illness

in an area in a calendar year
Morbidity rate = X 1000
Population in the area
in the same year
56
3 Important Types of
Morbidity Rates
• Incidence Rate
– Measures the frequency of occurrence of the
phenomenon during a given period of time
– New cases only
– The speed of new cases of a disease in the
population
• Prevalence Rate
– Measures the proportion of the population w/c exhibits
a particular disease at a particular time
– Deals with the total # number of cases (new & old)
• Attack Rate
– A more accurate measure of the risk of exposure
– Risk during an outbreak
57
Usually expressed for the entire epidemic period, from
the first to the last case
59
3 Important Types of Morbidity Rates

# of new cases of a disease
in a certain time period
IR = X 1000
Estimated population as of
July of same year
# of new and old cases of a disease
PR = in a certain time period
X 1000
Total # of person examined
at a given time
# of persons acquiring a disease

registered in a given year
AR = X 1000
# of exposed to same disease in
the same year
60
Example
Calculate the incidence rate per 1,0000 of COVID-19

cases in Region XI if the estimated population is
5,146,930.
Example
• A study starts with 4,875 health people. Over the next 2
years, 75 develop the disease. What is the incidence
rate of disease over the study period?
62
Example
Calculate the prevalence rate per 100,000 of COVID-19 cases

in Region XI if the estimated population is 5,146,930.
Example
• Fifty-nine people ate roast beef suspected of causing a
Salmonella outbreak. Thirty-four people fell ill; 25
remained well. What is the attack rate?
64
Crude Death Rate:
Total # of deaths (all causes)

registered in a given calendar year
CDR = X 1000
Estimated population as of July
1 of same year (midyear
population)
65
Example
66
Different Mortality Rates:
Infant Mortality Rate

= measures the risk of dying during the 1st year
Total # of deaths under 1 year of age

IMR = X 1000
Total # of registered live births of
same calendar year
67
Different Mortality Rates:

Maternal Mortality Rate
• risk of dying from causes related to pregnancy,
childbirth & puerperium
• Index of obstetrical care needed & received by
community.
Total # of deaths from maternal

causes registered for a given year
MMR =
X 1000
Total # of live births registered
of same year
68
• Fetal Death Rate = pregnancy wastage

Total # of fetal deaths registered in a
given calendar year
FDR = X 1000
Total # of live births registered of
same year
• Neonatal Death Rate = risk of dying the 1 st

month of life. A
good index of the effect of prenatal care & obstetrical management of newborn.
# of deaths under 28 days of age

NDR = X 1000
# of live births registered of same
year 69
Example
• During 1 year, there were 134 fetal deaths with 20
weeks or more gestation and 10,000 live births.
Calculate the fetal death rate.
70
SPECIFIC DEATH RATE:

• Describes more accurately the risk of exposure of certain
classes or groups to a particular diseases.
• Specific rates render more comparable & thus reveal the
problem of public health.
Deaths in a specific class/group
Specific Death Rate =
X 1000
in same specified class/group of
said year
# of Deaths from specific cause

registered in a given year
Cause Specific Death Rate = X 1000
of the same year 71
Example
• The number of deaths among the 25-34 year old age
group population (39,872,598) due to HIV infection was
1,588 during 2003. What is the cause-specific death
rate due to HIV?
72
# of Death in a particular age

group registered in a given
calendar year
X 1000
Age Specific Death Rate =
1 in same age group of same
year
# of Death of a certain sex

registered in a given calendar
year
Sex Specific Death Rate = X 1000
1 in same sex for same year
73
Example
Proportionate Mortality Ratio
• describes the proportion of deaths in a specified

population over a period of time attributable to different
causes
# of registered deaths from specific

cause or age for a given calendar year
PM = X 100
# of registration deaths from all
causes, all ages in same year
75
PROBLEM WITH PMR:
76
Example
• In a certain community, there were 66 deaths due to
coronary heart disease during a year and 200 deaths
due to all causes in that year. Calculate the PMR.
77
Case Fatality Ratio

• Index of a killing power of a disease
• The risk of dying from a disease in a
time period (the duration of the disease)
number of deaths from the disease
CFR = X 100
number of people with the
disease
CFR = 0 to 1, or percent
78
Example
• 45 cases of zika virus infection occurred in Cebu and
22 of these died. Calculate the CFR.
79
Death-to-case Ratio
• similar with CFR but different in terms of formulation
80
81
Calculate the death-to-case ratio in Region XI.

Vaccine effectiveness/efficacy
• measure the proportionate reduction in cases among
vaccinated persons
• utilized during clinical trials
83
Reporting Births, Deaths, & Diseases
Doctors
Centers for Disease

Clinics Local Health National Control and
Department Health
Prevention (CDC)
Department
Hospitals
85
Chap 3: Epidemiology: The Study of Disease, Injury, and
Death in the Community
MLS-CPH Instructors
Learning Objectives:
• classify diseases
• explain models of communicable and non-
communicable diseases
• discuss approaches to disease prevention and control
• provide examples of preventive measures for
communicable and non-communicable diseases
Classification of Diseases and Health

Problems
• Diseases and health problems can be classified in
several meaningful ways.
– Communicable vs. non-communicable diseases
– Acute vs. chronic diseases and illnesses
Communicable vs. non-communicable

diseases
• Communicable diseases
– caused by pathogenic agents which can be transmitted from
an infected host to a non-infected but susceptible host.
• Non-communicable diseases
– cannot be transmitted from a diseased host to a susceptible
one.
Acute vs. chronic diseases and illnesses
• Acute diseases
• Duration (3 months or less)
• Peak severity of symptoms occur & subsides within 3
months or sooner
• Chronic diseases
• Duration (longer than 3 months)
• Recovery is slow and often incomplete
Communicable Diseases
• The communicable disease
model includes three basic
elements.
– disease agent, the host, and
the environment.
• Chain of Infection
– model that conceptualizes the
transmission of a
communicable disease from
its source to a new susceptible
host.
Chain of Infection
Non-communicable Diseases
• Non-communicable disease can best be
visualized by the multi-causation
disease model (Difficult to discern
cause).
– Contributing factors:
• Genetics
• Environmental
• Behavior
Non-communicable Diseases
• PHIL. = 4 major non-communicable
diseases (chronic diseases or lifestyle
related diseases):
– Cardiovascular diseases (CVD)
– Cancer
– Chronic Obstructive Pulmonary Disease
(COPD)
– Diabetes Mellitus
Non-communicable Diseases:
• Rank high among the nation’s leading causes of
death
– Heart disease
• Number 1 killer of Americans
– Stroke
• 3rd leading cause of death
• Blood supply to brain is interrupted
– Cancer
• 2nd cause of death
• Common cancer sites: breast, prostate but
can occur in other sites
• Other non-communicable diseases:

– COPD (4th leading cause of death)
– Diabetes-type II (7th leading cause of death)
– Chronic liver disease and cirrhosis (10th leading cause)
• Phil. = urbanization & lifestyle changes

– Brought considerable change on the health status of Filipinos.
• Globalization & social changes
– Influenced the spread of non-communicable /lifestyle
degenerative diseases
– Increase risk exposure
Prevention, Intervention, Control,
and Eradication of Diseases
• Prevention
– taking action to prevent or delay the onset of illness or
injury before pathogenesis occur.
• Intervention
– taking action to control a disease in progress.
• Control
– means containment of a disease
– can include both prevention and intervention measures.
• Eradication
– uprooting or total elimination of a disease from the
human population.
Prioritizing Prevention and Control
Efforts:
• 1. Leading causes of death
– most common way people prioritize health
problems.
– The U. S. spends 66.5% of its health care budget
on the four leading causes of death.
• 2. Years of Potential Life Lost (YPLL)
– measurement that emphasizes the importance of
those diseases that kill people of all ages
• 3. Economic cost to society
– Evaluate the impact of a particular disease or health
problem
– Example:
• Cost of treatment
• Loss of productivity
Levels of Prevention
• Primary prevention
– Prevent or forestall (delay)the occurrence
• Vaccines
• Diet
• Exercise
• Non-risky behaviors
• Secondary prevention
– early diagnosis and prompt treatment of a disease
before the disease becomes advanced and
disability becomes severe.
• Diabetes: blindness, amputation, dialysis
• Health screenings
• Tertiary prevention
– Retrain, re-educate, rehabilitate patient who has the
disability
• Stroke patients
Prevention of Communicable
Diseases
• Do primary, secondary and tertiary prevention of
communicable diseases
– Primary
• Pasteurization
• Antibiotics/antivirals
• Disinfectants
– Secondary
• Isolation
• Surveillance
• Quarantine
• Drug treatment
– Tertiary
• Control for the individual
– Convalescence
Application of preventive measures for

the control of a communicable disease
• HOW?
– Know the chain of infection – prevention

or control measures can be used at
each link
– Practice Standard Precautions (barriers,

hand washing, disposal of “sharps”)
Prevention of non-communicable
diseases
• Primary prevention
– Adequate food supplies (healthy foods)
– Housing
– Education opportunities
– Efficient community services
• Secondary prevention
– Mass screenings for chronic diseases
– Personal screenings
• Tertiary prevention
– Adequate emergency medical personnel
– Adequate services
– Adequate facilities
Application of Preventive Measures

for Non-Communicable Disease
• Community role:
– Recognize the importance
– Supportive environment
• Smoking cessation/restricting smoking
• Gym facilities
• Safe neighborhoods
• Individual role:
– Modifiable risk factors – vices (CHANGE)
– Non-modifiable risk factors - genetics

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03 04 Epidemiology Handout

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Chap 3: Epidemiology: The Study of Disease, Injury, and

Death in the Community

• Discuss the history of epidemiology;

• Display understanding in the three basic types of

• Explain the importance of using rates to describe

GOAL: To limit disease, injury, and death

• Health-related states or events

Brief History of Epidemiology

•Dr. Benjamin Rush traced the cases

50 years after the yellow fever outbreaks, cholera became

Dr. John Snow

•Removed pump handle (1849)

Early uses for description and investigation of diseases

The research question should state what we want to

Components of Epidemiologic Triangle

• HOST – any susceptible organism invaded by

• Genetic – ex. sickle • Immunologic experience

• To analyze epidemiologic data

SEX & OCCUPATION :

Patterns of Disease Occurrence & Distribution

Hyperendemic: persistently high level

Number of Cases of a Disease

Patterns of Disease Occurrence & Distribution

Patterns of Disease Occurrence & Distribution

Specific Roles in Epidemiological Investigations:

• Surveillance of the occurrence of notifiable

Specific Roles in Epidemiological Investigations:

• Gives health teachings to prevent further spread

• Vital Statistics – systematic study of vital events such as births,

• Statistics of morbidity & mortality indicate the health of a

• Statistics on population (age, sex & distribution) =

Use of Vital Statistics:

Sources of Standardized Data

Sources of Standardized Data

• Rate – the number of events that occur in a given

General Types of Rate:

3 Important Kinds of Rates

• Morbidity (disease) rate

• Mortality (fatality) rate

Crude Birth Rate:

Total # of live births registered in a

This entry gives the average annual number of

General Fertility Rate

Morbidity (Disease) Rate:

# of cases of residents with illness

3 Important Types of Morbidity Rates

# of persons acquiring a disease

Calculate the incidence rate per 1,0000 of COVID-19

Calculate the prevalence rate per 100,000 of COVID-19 cases

Crude Death Rate:

Total # of deaths (all causes)

Different Mortality Rates:

Infant Mortality Rate

Total # of deaths under 1 year of age

Different Mortality Rates:

Total # of deaths from maternal

• Fetal Death Rate = pregnancy wastage

• Neonatal Death Rate = risk of dying the 1 st

# of deaths under 28 days of age

SPECIFIC DEATH RATE:

# of Deaths from specific cause

# of Death in a particular age

# of Death of a certain sex