DENTISTRY MADE EASY

GENERAL
EPIDEMIOLOGY
-PUBLIC HEALTH DENTISTRY
DESCRIPTIVE EPIDEMIOLOGY
HISTORY
• HIPPOCRATES(460-375BC) – 1ST KNOWN EPIDEMIOLOGIST
• THOMAS SYNDENHAM (1624-1689) – FOUNDER OF EPIDEMIOLOGY
• JOHN SNOW (1813-1858) – FATHER OF EPIDEMIOLOGY
• W.H.FROST (1927) – 1ST PROFESSOR, EPIDEMIOLOGY, US
• MAJOR GREENWOOD - 1ST PROFESSOR, EPIDEMIOLOGY, UK
DEFINITION
• EPI = AMONG; DEMOS= PEOPLE; LOGUS= STUDY
• JOHN M LAST (1988) DEFINES EPIDEMIOLOGY AS “THE STUDY OF THE
DISTRIBUTION AND DETERMINANTS OF HEALTH RELATED STATES OR
EVENTS IN SPECIFIED POPULATION, AND THE APPLICATION OF THIS
STUDY TO THE CONTROL OF HEALTH PROBLEMS”.
AIMS OF EPIDEMIOLOGY
• THE INTERNATIONAL EPIDEMIOLOGICAL ASSOCIATION LISITED THREE
MAIN AIMS OF EPIDEMIOLOGY WHICH WAS PUT FORWARD BY LOWE AND
KOSTRZEWSKI IN 1973 AS FOLLOWS:
1. TO DESCRIBE THE DISTRIBUTION AND SIZE OF DISEASES IN HUMAN
POPULATION.
2. TO IDENTIFY ETIOLOGICAL FACTORS IN THE PATHOGENESIS OF DISEASE.
3. TO PROVIDE DATA ESSENTIAL TO THE PLANNING, IMPLEMENTATION
AND EVALUATION OF SERVICES FOR THE PREVENTION, CONTROL AND
TREATMENT OF DISEASE.
EPIDEMIOLOGICAL METHODS
• EPIDEMIOLOGY AS A SCIENCE IS ORGANIZED INTO THREE DISTINCT
DIVISIONS;
1. DESCRIPTIVE EPIDEMIOLOGY
2. ANALYTICAL EPIDEMIOLOGY
3. EXPERIMENTAL EPIDEMIOLOGY
DESCRIPTIVE EPIDEMIOLOGY
• IT IS THE STUDY WHICH DESCRIBES THE PATTERN OF OCCURRENCE OF A
DISEASE OR A CONDITION RELATIVE TO OTHER CHARACTERISTICS OF A
POPULATION.
• THE VARIOUS STEPS INVOLVED IN A DESCRIPTIVE STUDY ARE-
1. DEFINING THE POPULATION WHICH HAS TO BE STUDIED.
2. DEFINING THE DISEASE UNDER STUDY.
3. DESCRIBING THE DISEASE IN TERMS OF TIME, PLACE AND PERSON.
4. MEASUREMENT OF THE DISEASE.
5. COMPARING WITH KNOWN INDICES.
6. FORMULATING AN ETIOLOGICAL HYPOTHESIS.
1.DEFINING THE POPULATION
• THE DEFINED POPULATION CAN BE THE WHOLE POPULATION IN A
GEOGRAPHIC AREA OR MORE OFTEN REPRESENTATIVE SAMPLE TAKEN
FROM IT.
• NOT ONLY THE TOTAL NUMBER, BUT ALSO ITS COMPOSITION IN TERMS OF
AGE, SEX, OCCUPATION, CULTURAL CHARACTERS ETC.
• THE COMMUNITY CHOSEN SHOULD BE STABLE, WITHOUT MIGRATION
INTO OR OUT OF THE AREA.
2. DEFINING THE DISEASE UNDER STUDY
• THE DISEASE IS DEFINED IN SUCH A WAY THAT HELPS IN IDENTIFYING AND
MEASURING THE DISEASE IN THE DEFINED WAY WITH A DEGREE OF
ACCURACY.
• “OPERATIONAL DEFINITION” : BY WHICH THE DISEASE OR CONDITION CAN
BE IDENTIFIED AND MEASURED IN THE DEFINED POPULATION WITH A
DEGREE OF ACCURACY.
• IF DEFINITION IS NOT VALID, IT CAN BE POWERFUL SOURCE OF ERROR IN
PRESENTATION AND COMPARABILITY OF MEASUREMENTS.
• CASE DEFINITION SHOULD BE ADHERED TO THROUGHOUT THE STUDY.
3. DESCRIBING THE DISEASE
• THE OCCURRENCE AND DISTRIBUTION OF DISEASE IS DESCRIBED BY TIME,
PLACE, AND PERSON AND IDENTIFYING THOSE CHARACTERISTICS
ASSOCIATED WITH PRESENCE OR ABSENCE OF DISEASE IN INDIVIDUALS.
• CHARACTERISTICS EXAMINED :
4. MEASUREMENT OF DISEASE
• “DISEASE LOAD”
• THE MEASUREMENT OF DISEASE IS DONE IN TERMS OF MORTALITY AND MORBIDITY
INDICATORS.
• THE MORBIDITY CAN BE EXPRESSED IN TERMS OF TWO UNITS- “INCIDENCE” AND
“PREVALENCE”.
• DESCRIPTIVE EPIDEMIOLOGY EITHER USES A CROSS- SECTIONAL OR LONGITUDINAL
STUDY.
A. CROSS-SECTIONAL STUDIES : -ARE ALSO CALLED AS “PREVALENCE STUDIES” AS THEY
MEASURES THE PREVALENCE OF DISEASE. -MORE USEFUL FOR CHRONIC THAN SHORT
LIVED DISEASES.
B. LONGITUDINAL STUDIES : OBSERVATIONS ARE REPEATED IN THE SAME POPULATION
OVER A LONG PERIOD OF TIME. THEY ARE EXTREMELY USEFUL : 1. FOR STUDYING THE
NATURAL HISTORY OF THE DISEASE AND ITS OUTCOME. 2. FOR IDENTIFYING THE RISK
FACTORS ASSOCIATED WITH THE DISEASE AND 3. FOR CALCULATING THE INCIDENCE
RATE OF THE DISEASE.
5. COMPARING WITH KNOWN INDICES
• THE ESSENCE OF EPIDEMIOLOGY IS MAKE COMPARISONS AND ASK
QUESTIONS.
• TO ARRIVE AT CLUES TO DISEASE ETIOLOGY.
• ALSO HELPS IN DEFINING THE GROUPS WHO ARE AT INCREASED RISK FOR
CERTAIN DISEASES.
6. FORMULATION OF HYPOTHESIS
• A HYPOTHESIS IS A SUPPOSITION, ARRIVED FROM OBSERVATION AND
REFLECTION.
• USING THE TECHNIQUES OF DESCRIPTIVE EPIDEMIOLOGY, IT IS POSSIBLE
TO FORMULATE HYPOTHESIS RELATING TO DISEASE ETIOLOGY.
• IT CAN BE ACCEPTED OR REJECTED USING THE TECHNIQUES OF
ANALYTICAL EPIDEMIOLOGY.
• AN EPIDEMIOLOGICAL HYPOTHESIS SHOULD SPECIFY :
1. THE POPULATION – CHARACTERISTICS OF PERSONS TO WHOM HYPOTHESIS
APPLIES.
2. SPECIFIC CAUSE BEING CONSIDERED.
3. EXPECTED OUTCOME – THE DISEASE.
4. THE DOSE - RESPONSE RELATIONSHIP – THE AMOUNT NEEDED TO LEAD TO STATED
INCIDENCE OF THE EFFECT.
5. THE TIME – RESPONSE RELATIONSHIP – THE TIME PERIOD THAT WILL ELAPSE
BETWEEN EXPOSURE TO THE CAUSE AND OBSERVATION OF THE EFFECT.
EG : CIGARETTE SMOKING CAUSES CANCER – IS INCOMPLETE HYPOTHESIS.
CORRECT : THE SMOKING OF 30-40 CIGARETTES PER DAY CAUSES LUNG CANCER IN 10%
OF SMOKERS AFTER 20 YEARS OF EXPOSURE.
USES OF DESCRIPTIVE EPIDEMIOLOGY
1. USEFUL IN PROVIDING DATA WITH REGARD TO THE TYPES OF DISEASE PROBLEMS
AND THEIR MAGNITUDE IN COMMUNITY. (MORTALITY AND MORBIDITY RATES
AND RATIOS)
2. PROVIDES INFORMATION ON THE ETIOLOGY OF THE DISEASE AND HELPS IN
FORMULATING AN ETIOLOGICAL HYPOTHESIS.
3. PROVIDES BACKGROUND DATA REQUIRED FOR THE PLANNING, ORGANIZING,
AND EVALUATING PREVENTIVE AND CURATIVE SERVICES.
4. LEADS THE PATH FOR FURTHER RESEARCH WITH REGARD TO A PARTICULAR
DISEASE PROBLEM.
THANK YOU