Nies and

Nies and McEwen: Chapter 4:
ATI: Chapter 3
Epidemiology
Objectives --Epidemiology
• Objective 1. Define and discuss the following terms; compare and contrast the following methods and
concepts of epidemiology related to community health
1. descriptive epidemiology
2. analytic epidemiology
• Objective 2. Define the following epidemiological concepts, including their identifying factors and
interconnection in epidemiology and the disease process:
• 1. epidemiological triangle
• a. agent
• b. host
• c. environment
• Objective 3. Define and differentiate, and be able to calculate, as well as discuss the implication of the
following epidemiological rates:
• 1. attack rate
• 2. incidence rate
• 3. prevalence rate
• 4. age-adjusted rate
• 5. proportionate mortality rate
• Objective 4. Define and discuss the concepts of risk and risk factors as the two terms relate to the
epidemiological process

• Objective 5. Define, discuss, and differentiate the concepts of screening and surveillance as they relate to
the epidemiological process

• Objective 6. Define, discuss, and differentiate between the concepts of cross-sectional studies and
retrospective studies.




• Objective 1. Define and discuss the following
terms; compare and contrast the following
methods and concepts of epidemiology
related to community health
• descriptive epidemiology uses person, place, and time
variables to describe disease patterns.
• analytic epidemiology analyzes complex relationships among
determinants of diseases. The focus is on disease etiology.


• Objective 2: Define the following
epidemiological concepts, including their
identifying factors and interconnection in
epidemiology and the disease process:
• 1. the epidemiological triangle
• a. agent
• b. host
• c. environment


Objective 2
Agent Factors
• Nutritive elements
• Chemical agents
• Physical agents
• Infectious agents

Objective 2
Host Factors
• Genetics
• Age
• Sex
• Ethnic group
• Physiological state
• Prior immunological experience
• Inter-current or preexisting disease
• Human behavior

Influence, exposure, susceptibility, or response to agent
Objective 2
Environmental Factors
• Physical environment
• Biological environment
• Socioeconomic environment

Influence Existence of the Agent, Exposure, or Susceptibility to Agent
Objective 2
The Epidemiological Triangle

Objective 2
• Objective 3. Define and differentiate, and be
able to calculate, as well as discuss the
implication of the following epidemiological
rates:
• 1. attack rate
• 2. incidence rate
• 3. prevalence rate
• 4. age-adjusted rate
• 5. proportionate mortality rate


Incidence of
Rocky Mountain Spotted Fever
In The United States
“Epidemiological Rates”
• Rates are arithmetic expressions that help
practitioners consider a count of an event
relative to the size of the population from which
it is extracted

Rate: Numerator/Denominator =
Number of health events in a specified period/Population in same area in same specified period × k

Objective 3
Attack Rate
• An attack rate is a special incidence rate that
documents the number of new cases of a
disease in those exposed to a disease.

Objective 3
Incidence Rate
• Incidence rates
– New cases

– Number of New Cases in a Given Time Period
– Population at Risk During Same Time Period

– Example: In a total population of 4000, where 250 individuals already have the disease, 75 new cases
are reported.
– 75 75
4000 – 250 3750

X 1000
= = 0.02 x 1000 = 20 per 1000 per time period
Objective 3
Prevalence Rate
• Prevalence rates
– All cases

– Number of Existing Cases
– Total Population

– Example: In a population of 4000 , 250 individuals have a particular
disease.
– 250
– 4000


X 1000
= 0.0625 X 1000 = 62.5 per 1000
Objective 3
Age-Adjusted Rate
• Age-adjustment or standardized rates reduce
bias due to unequivalent age distribution of
the populations being compared.
Objective 3
Proportionate Mortality rate
• The proportionate mortality rate (PMR)
represents the percentage of deaths resulting
from a specific cause relative to deaths from
all causes.

Objective 3
Comparing Rates
• The occupational health nurse notes that
during the past year 4 of 628 factory
employees have developed asbestososis. He
checks with MMWR, and notes that the
incidence rate of asbestososis in the general
population is 5 per 1000.
• Is the rate for the factory higher or lower than
for the general population?
5 / 1000 = 0.005 4 / 628 = 0.0064

0.005 X 1000 = 5 per 1000 0.0064 X 1000 = 6.4 per 1000
Incidence in General Population Incidence in Factory
Objective 3
• Objective 4. Define and discuss the concepts
of risk and risk factors as the two terms relate
to the epidemiological process


Objective 4
RISK FACTORS
• a. Identification of risk factors is closely associated with
chronic disease reduction.
• b. Risk factors are variables that have been shown to increase
the rate of disease in persons who have them or have been
exposed to them.
• c. Identification of risk factors is critical to development of
prevention interventions.
• d. Risk is the likelihood that healthy persons exposed to a
factor will acquire a specific disease.
• e. Risk factor refers to the specific exposure factor. Risk
factors may be fixed characteristics –non-modifiable-- (i.e.,
age, sex, genetics), or modifiable--lifestyle factors (dietary
habits, exercise regimens), or external to the individual (i.e.,
cigarette smoking, stress, noise).


Objective 4
• Objective 5. Define, discuss, and differentiate
the concepts of screening and surveillance as
they relate to the epidemiological process

Screening
• The purpose of screening programs is to identify risk factors and diseases
in their earliest stages. Screening is usually classified as a secondary
prevention activity because disease is discovered after a pathological
change has occurred.
• Guidelines for screening programs include:
• 1. Adequate and appropriate follow-up should be planned for those who test positive.
• 2. Early diagnosis of the disease should be beneficial.
• 3. Acceptable and medically sound treatment should be available.
• 4. Procedures for ensuring confidentiality should be in place.
• 5. Tests must be cost effective and acceptable to the client.
• 6. Costs of program, follow-up, and resulting medical care should have a bearing on
the decision to screen.
• 7. Screening tests should ideally have high sensitivity (the ability of a test to detect
those with the disease) and specificity (the extent to which a test can identify those
without the disease)

Objective 5
Surveillance
• Surveillance allows ongoing collection of
information by monitoring changes in disease
frequency and trends in occurrence of risk
factors.
• The nurse evaluates trends in morbidity by
identifying new cases and calculating
incidence rates.

Objective 5
• Objective 6. Define, discuss, and differentiate
between the concepts of cross-sectional
studies and retrospective studies.

Cross-Sectional Studies
• Cross-sectional studies (also known as
prevalence or correlational studies) examine
relationships between potential causal factors
and disease at a point in time.

Objective 6
Retrospective Studies
• Retrospective (case control) studies compare a
group of individuals known to have a disease
with a similar group of individuals who do not
have the disease to determine whether the
diseased group differs from the non-diseased
group in its exposure to a specific factor or
characteristic. Data collection extends back in
time to determine previous exposure or risk
factors.

Objective 6
Objectives ~ Epidemiology
• Objective 1. Define and discuss the following terms; compare and contrast the following methods and concepts of
epidemiology related to community health
1. descriptive epidemiology
2. analytic epidemiology
• Objective 2. Define the following epidemiological concepts, including their identifying factors and interconnection in
epidemiology and the disease process:
• 1. epidemiological triangle
• a. agent
• b. host
• c. environment
• Objective 3. Define and differentiate, and be able to calculate, as well as discuss the implication of the following
epidemiological rates:
• 1. attack rate
• 2. incidence rate
• 3. prevalence rate
• 4. age-adjusted rate
• 5. proportionate mortality rate
• Objective 4. Define and discuss the concepts of risk and risk factors as the two terms relate to the epidemiological process

• Objective 5. Define, discuss, and differentiate the concepts of screening and surveillance as they relate to the
epidemiological process

• Objective 6. Define, discuss, and differentiate between the concepts of cross-sectional studies and retrospective studies.