Descriptive Epidemiology
Dr. Saurabh Kumar
Assistant Professor
Department of Community Medicine
Objectives of Descriptive Epidemiology
To evaluate trends in health and disease and
allow comparisons among countries and
subgroups within countries
To provide a basis for planning, provision and
evaluation of services
To identify problems to be studied by analytic
methods and to test hypotheses related to
those problems
Epidemiology (Schneider)
Descriptive Studies
Relatively inexpensive and less time-consuming than analytic
studies, they describe
Who gets sick and/or who does not
Where rates are highest and lowest
Temporal patterns of disease
Seasonality
Secular trends which are affected by
Changes in diagnostic techniques
Changes in the accuracy of the denominator data
Changes in the age distribution of the population
Changes in survival from improved treatment or disease mutation
Changes in actual disease incidence
Epidemiology (Schneider)
Forecast of Cancer Deaths
Thousands of Deaths
600
510
500
443
400
382
300
200
100
0
41
65
85
118
158
211
268
311
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Years
Forecast of cancer deaths if present trends continue
(Data from the American Cancer Society)
Cancer Death Rates by Site, United States, 1930-87
Figure 5-1. Cancer death rates by site, United States,
1930-1987. Source: American Cancer Society (1991).
Possible Reasons for Changes in Trends
Artifactual
Errors in numerator due to
Changes in the recognition of disease
Changes in the rules and procedures for classification
of causes of death
Changes in the classification code of causes of death
Changes in accuracy of reporting age at death
Errors in the denominator due to error in the
enumeration of the population
Epidemiology (Schneider)
Death Rates
for Individuals
with
Diabetes
Figure 3-27. Drop in
death rates for diabetes
among 55 to 64 year old
men and women, United
States, 1930-1960, due to
changes in ICD coding.
(From US Public Health
Service publication no.
1000, series 3, No. 1.
Washington, DC, US
Government Printing
Office, 1964.)
Possible Reasons for Changes in
Trends (cont.)
Real
Changes in age distribution of the population
Changes in survivorship
Changes in incidence of disease resulting
from
Genetic factors
Environmental factors
Epidemiology (Schneider)
Infant
Mortality
Rates by
Race
Figure 3-3 Infant
mortality rates by
race: United States,
1950-1991. Source:
Reprinted from
National Center for
Health Statistics,
Advance Report of
Final Mortality
Statistics, 1991,
Monthly Vital
Statistics Report, Vol.
42, No. 2, p. 11, 1993.
Case Reports
Case reports report of a single individual
with some atypical findings
Advantages
Limitations
You cannot test for statistical association because
there is no relevant comparison group
Epidemiology (Schneider)
Case Series
A case-series aggregates individual cases in one
report.
Sometimes, the appearance of several similar
cases in a short period heralds an epidemic.
For example, a cluster of homosexual men in Los
Angeles with a similar clinical syndrome alerted the
medical community to the AIDS epidemic in North
America
Epidemiology (Schneider)
Cross-Sectional Studies
Cross sectional studies or prevalence studies measure disease and exposure
simultaneously in a well-defined population
Advantages
Prevalence studies cut across the general population, not simply those seeking
medical care
They are good for identifying the prevalence of common outcomes, such as arthritis,
blood pressure or allergies
Limitations
You cannot determine whether exposure preceded disease
Since you determine prevalent rather than incident cases, results will be influenced
by survival factors
Remember: P = I x D
Factors Influencing Prevalence
Increased by:
Decreased by:
Longer duration of the
disease
Prolongation of life of
patients without cure
Shorter duration of
disease
Increase in new cases
(increase in incidence)
Decrease in new
cases (decrease in
incidence)
High case-fatality
rate from disease
In-migration of cases
Out-migration of healthy
people
In-migration of
susceptible people
Improved diagnostic
facilities
(better reporting)
In-migration of
healthy people
Out-migration of
cases
Improved cure rate
of cases
Prevalence of Congenital
Malformations Across Maternal Age
Prevalence of Cigarette Smoking Among
Successive Birth Cohorts
Comparing Cross-Sectional and
Longitudinal Data
How you organize your data depends on your research question.
Cross Sectional
Data
Cohort or
Longitudinal
45
40
35
30
25
1955
1960
1965
1970
1975
Year of Examination
Data
30 Year Olds in
Successive
Years
Correlational Studies
Correlational studies (ecological studies) use
measures that represent characteristics of entire
populations (areal aggregates) to describe outcomes
in relation to some factor of interest such as age, time,
utilization of services, or exposures
ADVANTAGES
You can generate hypotheses for case-control studies
and environmental studies
You can target high-risk populations, time-periods, or
geographic regions for future studies
Epidemiology (Schneider)
Correlational Studies (cont.)
LIMITATIONS
Because data are for groups, you cannot link disease and
exposure in individuals
Example: Percentage of teenagers taking drivers education and
fatal teenage car accidents study done by National Safety Council
You cannot control for potential confounders
Data represent average exposures rather than individual
exposures, so you cannot determine a dose-response
relationship
Caution must be taken to avoid drawing inappropriate
conclusions, or ecological fallacy
Epidemiology (Schneider)
Breast Cancer Mortality and Dietary Fat Intake
Surveillance
Surveillance can be thought of as watchfulness over
a community.
A more formal definition is the ongoing systematic
collection, collation, analysis, and interpretation of
health data essential to the planning,
implementation, and evaluation of public health
practice, closely integrated with the timely
dissemination of these data to those who need to
know.
Epidemiology (Schneider)
Pros And Cons
Often, the data are already available and thus
inexpensive and efficient to use.
Furthermore, few ethical difficulties exist.
Temporal associations between putative causes
and effects might be unclear.
A dangerous pitfall is that the investigators might
draw causal inferences when none is possible.
Epidemiology (Schneider)
Uses
Trend analysis
Trend analysis is often provided by ongoing
surveillance.
Examples include the emerging epidemic of syphilis
in the Russian Federation, and the international
epidemic of multiple births, prematurity, and low
birthweight caused by assisted reproductive
technologies
Epidemiology (Schneider)
Uses
Planning
A second use is health-care planning. For example,
the introduction of laparoscopy, coupled with bad
press about oral contraceptives and intrauterine
devices, tripled US rates of tubal sterilisation in the
1970s.
Hospitals and ambulatory surgery centres had a
surge in demand for operations, yet less need for
hospital beds.
Epidemiology (Schneider)
Uses
Clues about cause
Observant clinicians noted an association between
high concentrations of oxygen in incubators and
blindness in babies; this finding led to analytical
studies, then a randomised controlled trial,
confirming the association.
Epidemiology (Schneider)
