CHAPTER 2 EPIDEMIOLOGY

At the end of this Activity:

1. Describing the definition, functions, types, concepts and measures of Epidemiology
2. Identifying the level of disease and epidemic patterns
3. Computing and Interpreting the different measures of epidemiology

Epidemiology (CDC.gov)
✓ the study of the distribution and determinants of health-related
states or events in specified populations, and the application of this
study to the control of health problems
✓ often described as the basic science of public health
✓ an integral component of public health, providing the
foundation for directing practical and appropriate public health action
based on this science and causal reasoning

Characteristics of Epidemiology:
scientific discipline with sound methods of scientific inquiry at its foundation
data-driven and relies on a systematic and unbiased approach to the
collection, analysis, and interpretation of data
rely on careful observation and use of valid comparison groups to assess
whether what was observed, such as the number of cases of disease in a
particular area during a particular time period or the frequency of an
exposure among persons with disease, differs from what might be expected
quantitative discipline that relies on a working knowledge of probability, statistics, and sound research
methods
is a method of causal reasoning based on developing and testing hypotheses grounded in such scientific
fields

Related disciplines integrated in Epidemiology:

❖ biostatistics and informatics
❖ biologic, economic, social, and behavioral sciences
❖ physics, and ergonomics to explain health-related behaviors, states, and events

Epidemiology is concerned with the frequency and pattern of health events in a population:
1. Frequency
✓ refers to the number of health events, (example: the number of cases of meningitis or diabetes in a
population), and the relationship of that number to the size of the population
✓ resulting rate allows epidemiologists to compare disease occurrence across different populations

2. Pattern
✓ refers to the occurrence of health-related events by time, place, and person

Time patterns may be:

o annual,
o seasonal,
o weekly,
o daily,
o hourly,
o weekday versus weekend,
o or any other breakdown of time that may influence disease or injury occurrence

Place patterns include:

✓ geographic variation,
✓ urban/rural differences, and
✓ location of work sites or schools
Personal characteristics include:
✓ demographic factors which may be related to risk of illness, injury, or disability such as age, sex, marital
status, and
✓ socioeconomic status, as well as behaviors and environmental exposures

Purposes of Epidemiology in Public Health Practice

Determine the agent, host, and environmental factors that affect health
Determine the relative importance of causes of illness, disability, and death
Identify those segments of the population that have the greatest risk from specific causes of ill health
Evaluate the effectiveness of health programs and services in improving population health ·

Types of disease agents:

❖ biologic,
❖ physical, and
❖ chemical
Types of Epidemiological studies:
I. Observational Studies:
✓ the epidemiologist does not control the circumstances
✓ these studies can be further subdivided into descriptive and analytic.

1. Descriptive epidemiology
✓ collects all data that describe the occurrence of the disease under study
✓ used once a problem has been identified
✓ Relevant information usually includes information about the affected individuals and the place and period
in which the disease occurred
✓ Example: Snow’s search for the cause of the cholera outbreak in London

2. Analytical epidemiology
✓ analyzes a particular disease to determine its probable cause
✓ use different variables to discover possible routes and rates of infection
✓ Nightingale’s work was an example of analytical epidemiology, in which she compared disease in soldiers
and civilians.

2 Methods:
o case control method
▪ the epidemiologist looks for factors that might
have preceded the disease
▪ a group of people who have the disease is
compared with another group of people who are
free of the disease
▪ usually matched by age, sex, socioeconomic
status, and location.
▪ statistics are compared to determine which of
all the possible factors might be responsible
• genetic,
• environmental,
• nutritional, etc
o cohort method
▪ the epidemiologist studies two populations: one
that has had contact with the agent causing a
disease and another that has not (both groups are
called cohort groups)

II. Experimental epidemiology

✓ begins with a hypothesis about a particular disease; experiments to test the hypothesis are then conducted
✓ example is Semmelweis’s use of handwashing of experimental epidemiology

PHARM 325- DEPARTMENT OF PHARMACY | 2nd Semester AY 2023-2024

Clinical trial
✓ testing on humans is
✓ can be used to test a hypothesis regarding the effectiveness of a drug
✓ patients receive the drug (test group) and others (control group) receive a (placebo) a substance that
has no effect
o single blind test, the individuals don’t know whether they are in the test or control group
o double blind test if the treating physicians also don’t know the group identity

Types of Research Studies

Systematic Review
✓ a comprehensive summary of high-quality studies
examining a given topic

Meta-Analysis
✓ a type of systematic review where results from
available high-quality studies are statistically combined
to compute a net overall effect

Randomized Controlled Trial

✓ participants are randomly assigned to receive a given
exposure (such as a new drug or therapy) and then
followed to examine the effects of the exposure on outcomes.

Cohort
✓ one or more population groups (called cohorts) are classified according to their level of exposure to a
given agent/risk factor and followed over time to determine if this exposure is related to the occurrence
of a disease or outcome of interest

Case Control
✓ compares individuals who have a disease or outcome of interest (cases) with those who do not (controls)
✓ Researchers look retrospectively to evaluate how frequently exposure to a risk factor/agent is present in
each group to identify the relationship between the risk factor and the disease or outcome of interest

Cross-Sectional
✓ observes the relationship between a characteristic/risk factor (the exposure) and the prevalence of the
disease or outcome of interest in a specific population at a single point in time.

Case Series
✓ a summary of a small group of individuals' experience with a similar disease or outcome of interest

Case Reports
✓ a summary of one individual's
experience with the disease or
outcome of interest.

Animal Research Studies

✓ conducted using animal subjects.

Test-tube lab research

✓ conducted in a controlled laboratory
setting

PHARM 325- DEPARTMENT OF PHARMACY | 2nd Semester AY 2023-2024

The table beside identifies the advantage and
disadvantages of the different study designs and
the basis of classification (Strom,2006)

Classification of Infectious Diseases

a. One scheme groups infectious
diseases according to the body
systems they affect.
b. Infectious diseases may also be
classified based on the taxonomic
groups of their causative agents.
c. Every disease (not only infectious
disease) can also be classified
according to its longevity and
severity.

▪ Acute Disease- If a disease develops rapidly

but lasts only a short time
▪ Chronic Disease- Develops slowly (usually
with less severe symptoms) and are continual or recurrent
▪ Subacute Diseases- have durations and severities that lie somewhere between acute and chronic
▪ Latent Diseases- when the pathogen remains inactive for a long period of time before becoming active
▪ Communicable - When an infectious disease comes from another infected host, either directly or indirectly
▪ Contagious Disease- if a communicable disease is easily transmitted between hosts
▪ Noncommunicable Disease- Arise outside of hosts or from normal microbiota. They are not spread from one
host to another and diseased patients are not a source of contamination for others.

Level of disease
endemic level of the disease (baseline)
✓ the amount of a particular disease that is usually present in a community
✓ not necessarily the desired level, which may in fact be zero, but rather is the observed level
✓ In the absence of intervention and assuming that the level is not high enough to deplete the pool of
susceptible persons, the disease may continue to occur at this level indefinitely;
✓ expected level of the disease

Sporadic
✓ disease that occurs infrequently and Outbreak
irregularly ✓ carries the same definition of epidemic;
often used for a more limited geographic
Endemic area
✓ constant presence and/or usual prevalence
of a disease in a population within a Cluster
geographic area ✓ an aggregation of cases grouped in place
and time that are suspected to be greater
Hyperendemic than the number expected, even though the
✓ persistent, high levels of disease occurrence expected number may not be known

Epidemic Pandemic
✓ sudden increase, in the number of cases of a ✓ epidemic that has spread over several
disease above normally expected number in countries or continents, usually affecting a
the population in that area large number of people

Epidemics
✓ occur when an agent and susceptible hosts are present in adequate numbers, and the agent can be
effectively conveyed from a source to the susceptible hosts

PHARM 325- DEPARTMENT OF PHARMACY | 2nd Semester AY 2023-2024

 ✓ may result from:
• A recent increase in amount or virulence of the agent,
• The recent introduction of the agent into a setting where it has not
been before,
• An enhanced mode of transmission so that more susceptible
persons are exposed,
• A change in the susceptibility of the host response to the agent,
and/or
• Factors that increase host exposure or involve introduction through
new portals of entry
Rate Prevalence rate
✓ measure of the frequency with which an ✓ the proportion of the population that has a
event occurs in a defined population over a health condition at a point in time
specified period of time ✓ reflects the presence of disease in a
✓ useful for comparing disease frequency in population
different locations, at different times, or
among different groups of persons with Case-fatality rate
potentially different sized populations; ✓ the proportion of persons with the disease
✓ a measure of risk who die from it
Morbidity
Incidence rate ✓ any departure, subjective or objective, from
✓ this measure conveys a sense of the speed a state of physiological or psychological well-
with which disease occurs in a population, being
and seems to imply that this pattern has ✓ in practice, encompasses disease, injury,
occurred and will continue to occur for the and disability
foreseeable future
✓ reflect the occurrence of new disease in a Natality measures
population ✓ population-based measures of birth
✓ these measures are used primarily by persons
Attack rate working in the field of maternal and child
✓ the proportion of the population that health
develops illness during an outbreak Mortality rate
✓ alternative and more accurate phrase this ✓ measure of the frequency of occurrence of
rate is incidence proportion death in a defined population during a
specified interval.

This table can be used for deriving the formula for the different morbidity and natality measures (CDC,gov)
Risk

PHARM 325- DEPARTMENT OF PHARMACY | 2nd Semester AY 2023-2024

 ✓ probability that an individual will be affected by, or die from, an illness or injury within a stated time or age
span.
Rate
✓ number of cases occurring during a specific period; always dependent on the size of the population
during that period.
Ratio
✓ value obtained by dividing one quantity by another
✓ often compares two rates.
Proportion
✓ the comparison of a part to the whole as the number of cases divided by the total population
✓ does not have a time dimension, It can be expressed as a decimal, a fraction, or a percentage.

***Measures of public health impact place the association between an exposure and a disease in a public health
context. Two such measures are the attributable proportion and vaccine efficacy

REFERENCE:
https://www.cdc.gov/training/publichealth101/e-learning/epidemiology/

PHARM 325- DEPARTMENT OF PHARMACY | 2nd Semester AY 2023-2024