EPIDEMIOLOGY

By
Prof. Dr Nuzhat Huma
 Natural History of Disease
DEFINITION:
It refers to the course of Disease over time,
unaffected by treatment.

STAGES OF NATURAL Hx OF DISEASE

1. Stage of Susceptibility
2. Stage of Sub-Clinical Disease
3. Stage of Clinical Disease
4. Stage of Disability
 DISEASE

Pre Pathogenesis Pathogenesis

Agent

Host

Environment
 Healthy State

Recovery
Active Worsening of
Disease Disease
Chronic
Introduction of Disease
Disease
Inactive Disability
/Passive Healthy
Disease Carrier
Death

PRIMARY SECONDARY TERTIARY

PREVENTION PREVENTION PREVENTION
 Definition of Epidemiology

Epidemiology is the Study of Distribution,

Determinants and Dynamics of Health
related states and events in specified
population and application of this study to the
control of Health problems
Definition of epidemiology
The word “epidemiology” is derived from the Greek words: epi “upon”, demos
“people” and logos “study”.
Term Explanation
Study Includes: surveillance, observation, hypothesis
testing, analytic research and experiments.
Distribution Refers to analysis of: times, persons, places and
classes of people affected.
Determinants Include factors that influence health: biological,
chemical, physical, social, cultural, economic,
genetic and behavioural.
Health-related states and Refer to: diseases, causes of death, behaviours
events such as use of tobacco, positive health states,
reactions to preventive regimes and provision and
use of health services.
Specified populations Include those with identifiable characteristics, such
as occupational groups.
Application to prevention The aims of public health – to promote, protect, and
and control restore health.
 Other Definitions
 The Science which is concerned with the
factors and conditions, which determine the
occurrence and distribution f Health, Disease,
Disability, Defect and Death in a population
OR
 Study of Distribution, Determinants and
Dynamics of Disease in a Human population
 Important Terms

 Distribution:
The Selection of people in relation to Age,
Sex, Race, Occupational and Social
Characteristics, Place of residence,
Susceptibility, Exposure Status or any other
factor
 Important Terms

 Determinants:
Agent, Host and Environmental Factors.
Determinants include both causes and factors
that influence the risk of Disease
 Epidemiological Determinants

Agent Host Environment

1. Biological 1. Demographic 1. Physical
2. Nutrient 2. Biologic 2. Biological
3. Physical 3. Social 3. Psychosocial
4. Chemical 4. Life Style
5. Mechanical
6. Social
7. Insufficiency
 a) Agent

A disease agent is defined as an element or a

substance, animate or inanimate, the presence
(or absence) of which may initiate or
perpetuate a disease process.
i) Biologic Agent
These are living and include various rickettsiae, fungi,
bacteria, protozoa and metazoan. These agents have
certain properties such as infectivity, pathogenicity and
virulence.
Infectivity – The infectivity of an organism is its
capacity to multiply in or on the tissue of the host.
Virulence – The degree of pathogenicity of an infectious
agent, indicated by case fatality rates and/or its ability to
invade and damage tissues of the host (Benenson 1990)
Pathogenicity – The capability of an infectious agent to
cause disease in a susceptible host.
ii. Physical Agents
Physical agents include exposure to excessive heat, cold,
humidity, pressure, radiation, electricity, sound waves, etc.

iii. Chemical Agent

These cab be of two types:
Endogenous: These are produced inside the body as a result
of some abnormality e.g. excessive urea leading to
ureamina, or excessive bilirubin leading to jaundice or
increased ketone bodies leading to ketoacidosis.
Exogenous: those arising outside the body including dusts,
gases, fumes, metals, allergens, insecticides etc.
iv. Mechanical Agent e.g. chronic friction, associated with the
use of drill machines used by road builders.
b) Host factors

which make a person susceptible to a disease,

include
Demographic characteristics e.g. age, sex etc
Biological characteristics – such as genetic
factors, blood groups, enzymes, immune status,
blood pressure etc. intercurrent or preexisting
disease
Life style factors – such as habits, life style
whether sedentary or active, smoke etc
c) Environmental factors
These factors are responsible for exposing the
host to the agent. Environment is defined as
the aggregate of all external conditions and
influences affecting the life and development
of an organism. Human behavior or society
c) Environmental factors
The environment can be classified into:
i. Biological Environment – this includes agents of
biological infections, reservoir of infection, disease vectors,
plants and animals
ii. Psycho-social Environment – This includes the social and
political organization of the country, the availability and
accessibility of health services, the general life style of the
people, socio cultural patterns beliefs and values, traditions
and habits, educational level and religion of the people.
iii. Physical Environment – It includes factors like heat, noise,
radiation, air, soil, water, climate etc.
 Important Terms

 Dynamics:
Temporal Distribution, Trends of Disease
causation, Cyclic Patterns or intervals between
exposure to the inciting agents and onset of
disease
 OBJECTIVES OF EPIDEMIOLOGY

 According to the International Epidemiological

Association (IEA), epidemiology has three main
aims:
 To describe the distribution and size of disease
problems in human population.
 To identify etiological factors in pathogenesis of
disease.
 To provide the data essential to the planning ,
implementation and treatment of disease and to
the setting up of priorities among services.
 Ultimate Aim of Epidemiology

a. To eliminate or reduce the health problem

or its consequences.

b. To promote the health and well-being of

the society as a whole.
 Comparison between Epidemiology & C.M

Epidemiology Clinical medicine

Scope Population based Individual oriented
Aim Prevention Treatment & cure
Information Population data, disease Clinical history and
pattern, accessibility & physical examination
availability of services
Diagnosis Studies, surveys and Laboratory and clinical
assessments investigations
Interventions Community health Treatment and
programmes rehabilitation
Evaluation Measuring changes in Follow up of cases
the health status of
population
 Epidemiological Approach

a. Asking questions

b. Making comparisons
 ASKING QUESTIONS
1. Related to health events

 What is the event? (the problem)

 What is its magnitude?
 Where did it happen?
 When did it happen?
 Who are affected?
 Why did it happen?
 ASKING QUESTIONS
2. Related to health action

 What can be done to reduce this problem and its

consequences?
 How can it be prevented in the future?
 What action should be taken by the community? By the
health services? By other sectors? Where and by whom
these activities should be carried out?
 What resources are required? How are the activities to
be organized?
 What difficulties may arise and how might they be
overcome?
 MAKING COMPARISON
 Between Exposed and Unexposed

 Between Diseased and Healthy

By making comparison the Epidemiologist tries

to find out the crucial differences in the Host
and Environmental Factors between those
affected and not affected
 Measurements in Epidemiology
 Measurement of mortality.
 Measurement of morbidity.
 Measurement of disability.
 Measurement of natality.
 Measurement of the presence, absence or
distribution of the characteristic or attributes of
the disease.
 Measurement of medical needs, health care
facilities, utilization of health services and other
health-related events.
 Tools of Measurement

1. Rate

2. Ratio

3. Proportions
 Rate
A rate measures the occurrence of some
particular event (development of disease or
occurrence of death) in a population during
a given time period.

Number of Deaths in one year

Death Rate = ------------------------------------------ X 100
Mid-year population
 A rate comprises of following four elements:
 Numerator
 Denominator
 Time specification
 Multiplier
 Numerator

Numerator refers to the number of times an

event has occurred in a population during a
specified time period. The numerator is not
a component of the denominator in
calculating a ratio.
 Denominator
Numerator has little meaning unless it is
related to the denominator. Appropriate
denominator has to be chosen while
calculating a rate. It may be related to the
1. population e.g.
 Mid-year population,
 Population at risk.
2. Related to the total events.
 IMR, MMR, number of axcedents
 The various categories of rates:
Crude rates
e.g. CBR, CDR
Total no. of live births at a place in a year
CBR= --------------------------- X100
Total mid year population
of same place & same year
 Specific rates:
These are the actual observed rates due to:
 Specific causes (e.g tuberculosis) or
 Occurring in specific group (e.g age or sex group) or
 Specific time period (e.g. annual, monthly or weekly rates)
 Standardized rates
 These are obtained by direct or indirect method of
standardization or adjustment e.g. age & sex standardized
rates.
 VITAL INDEX OR BIRTH DEATH RATIO

It is defined as the number of live births per 100 deaths at a place

for a certain time period.
V.I =
No. of lives births for a specified period in a specified place x 100
No. of deaths recorded during the same period at the same place
If the vital index is equal to 100 it means that
neither the population is increasing nor is it
decreasing. If the vital index is above 100 it
means the population is growing and if it is
below 100 it means it is decreasing.
 Measures of Mortality

Mortality rates frequently form the basis for

epidemiological investigations.
limitations of mortality rates
1. Under-reporting, many deaths especially those
that take place at home or in the rural areas are
not reported.
2. Incorrect diagnosis the exact cause of death
may not be correctly ascertained.
a) Crude death rate =
No of deaths in a year from all causes x 1000 or
Total mid year population

b) Cause specific death rate =

No of deaths in a year for a specific cause x 100,000
Total mid year population
c) Infant mortality rate =
No. of deaths in a year among children less than 1 year old x 1000
Total live births over the year

d) Case fatality rate=

No. of deaths from a disease in a specified period x 100
No. of diagnosed cases of the disease in the same period
e) Proportional mortality rate=
No. of deaths in a year from a specific cause x 100
Total no. of deaths during the year

f) Maternal mortality ratio=

Total no. of female deaths due to complications of
pregnancy, child birth or within 42 days of delivery
from puerperal causes in an area during a given year X 100
Total No. of live births in the same area and year
g) Maternal mortality rate=
Total no. of female deaths due to complications of
pregnancy, child birth or within 42 days of delivery or
from puerperal causes in an are during given year
Total No. of women in child bearing age (15-45years) in
the same year same place X 1000

h) Perinatal mortality rate=

Number of late foetal deaths (28 weeks gestation or
more) still births and early neonatal deaths under one
week in a year in a defined population
Number of live and still births X 1000
 SUMMARY STATISTICS

For comparison between different populations

summary statistics are employed. They can
help in the comparison of populations with
different age structures.
 STANDARDIZED RATES

An age standardized death rate or age adjusted rate is

a summary measure of the death rate that a population
would have if it had a standard age structure. For
example age, race socio-economic status etc.
 Adjusted or Standardized Rates:
If we want to compare the death rates of two
populations with different age- composition, the
crude death rate is not an ideal tool. This is
because, rates are only comparable if the
populations upon which they are based are
comparable. Age adjustment or age
standardization is done, which removes the
confounding effect of different age structure and
yields a single standardized or adjusted rate, by
which the mortality experience can be compared
directly
 Table 1
Calculation of age-specific death rates for city X
Age Mid-year Deaths in the year Age-specific death
population rates

0 4,000 60 15.0
1-4 4,500 20 4.4
5-14 4,000 12 3.0
15-19 5,000 15 3.0
20-24 4,000 16 4.0
25-34 8,000 25 3.1
35-44 9,000 48 5.3
45-54 8,000 100 12.5
55-64 7,000 150 21.4
53,500 446
Crude death rate per 1000=8.3
 Table 2
Calculation of the standardize death rate for city
X
Age Standard Age-specific Expected deaths
population death rates

0 2,400 15.0 36
1-4 9,600 4.4 42.24
5-14 19,000 3.0 57
15-19 9,000 3.0 27
20-24 8,000 4.0 32
25-34 14,000 3.1 43.4
35-44 12,000 5.3 63.6
45-54 11,000 12.5 137.5
55-64 8,000 21.4 171.2
93,000 609.94
Standardized death rate per 1000 = 609.94 x 1000 = 6.56
93,000
a. Direct Standardization:
A standard population is selected. “A standard
population is one for which the numbers in each age and
sex group are known”
i. Standard population is created by combining two
populations.
ii. For each age group, an expected number of deaths or
events in the standard population is obtained.
iii. These are added together for all the age groups to give
the total expected deaths.
iv. The final operation is to divide the expected total
number of deaths by the total of the standard population.
Which yields the standardized or age adjusted rate.
The direct method of standardization is
feasible only if the actual specific rates in
subgroups of the observed population are
available, along with the number of
individuals in each subgroup.
 Table 3
Proportion of heavy smokers in cases and controls
(lung cancer)

Age Total Cases Controls

subjects No. Heavy smokers No. heavy smokers
40-49 500 400 200 50% 100 50 50%
50-59 500 100 10 10% 400 40 10%
Total 1,000 500 210 42% 500 90 18%
 Table 4
Age-adjusted proportions

Age Subjects Expected number of heavy smokers

Cases Controls
40-49 500 500x50 = 250 500x50 = 250
100 100
50-59 500 500x10 =50 500x10 =50
100 100
Total 1000 300 300

Standardized 300 X 100 = 30 300

X 100 = 30
Rates 1000 1000
A HYPOTHETICAL EXAMPLE OF DIRECT AGE ADJUSTMENT:
I. COMPARISON OF TOTAL DEATH RATES IN A POPULATION AT TWO
DIFFERENT TIMES

EARLY PERIOD LATER PERIOD

Population Number Death rate Population Number of Death rate
of deaths per 100,000 deaths per 100,000
900,00 862 96 900,000 1,130 126
A HYPOTHETICAL EXAMPLE OF DIRECT AGE ADJUSTMENT:
II. COMPARISON OF AGE-SPECIFIC DEATH RATES IN TWO DIFFERENT
TIME PERIODS
EARLY PERIOD LATER PERIOD
Age group (yr) Population No. of Death rates Population No. of Deaths rates
deaths per 100,000 deaths per 100,000
All ages 900,000 862 96 900,000 1,130 126
30-49 500,000 60 12 300,000 30 10
50-69 300,000 396 132 400,000 400 100
70+ 100,000 406 406 200,000 700 350
A Hypothetical Example of Direct Age Adjustment
III. Carrying Out an Age Adjustment Using the Total of the Two Populations as the
Standard
Age group Standard “Early” Age- Expected No. of “Later” Age- Expected No.
(yr) Population specific Mortality Deaths Using specific of deaths
Rates per 100,000 “Early” Rates Mortality Rates Using “Later”
per 100,000 Rates

All ages 1,800,000

30-49 800,000 12 96 10 80
50-69 700,000 132 924 100 700
70+ 300,000 406 1,218 350 1,050

Total number of deaths

expected in the 2,238 1,830
standard population:
2,238 1,830
Age-adjusted rates: “Early” = = 124.3 “Later”= = 101.7
1,800,000 1,800,000
IV. An example of direct age adjustment: comparison of age-adjusted Mortality rates in Mexico
and in the United States, 1995-1997
Age Group (yr) Standard Age-specific Mexico Expected No. of Age-specific Expected No. of
Population Mortality Rates per Deaths Using United States Deaths Using
100,000 Mexico Rates Mortality United States
Rates per Rates
100,000

All ages 100,000

<1 2,400 1,693.2 41 737.8 18
1-4 9,600 112.5 11 38.5 4
5-14 19,000 36.2 7 21.7 4
15-24 17,000 102.9 17 90.3 15
25-44 26,000 209.6 55 176.4 46
45-65 19,000 841.1 160 702.3 133
65+ 7,000 4,967.4 348 5,062.6 354
Total number of deaths expected in the standard population
639 574
Age-adjusted rates:
639 6.39
Mexico = =
100,000 1,000
574 5.74
United states = =
100,000 1,000
From Analysis Group, Pan American Health Organization Special Program for Health Analysis: Standardization: A Classic
Epidemiological Method for the Comparison of Rates.
b. Indirect age Standardizations:
i. Standardized Mortality Ratio:
The simplest and most useful form of
standardization is the standardized mortality
ratio (SMR). In England, it is the basis for
the allocation of government money to the
health regions of the country.
 “Standard mortality ration is a ratio (usually
expressed as a percentage) of the total number
of deaths that occur in the study group to the
number of deaths that would have been
expected to occur if that study group had
experienced the death rates of a standard
population (or other reference population)”.
 In other word, SMR compares the mortality in
a study group (e.g. an occupational group)
with the mortality that the occupational group
would have had if they had experienced the
national mortality rates.
SMR=
Observed Deaths X 100
Expected Deaths
If the ratio had value greater than 100, then the
occupation would appear to carry greater
mortality risks than that of the whole
population. If the ratio had value less than 100
the occupation would appear to carry less
mortality risks than that of the whole
population.
Suppose that the mortality experience of coal workers
was 129%, which meant that their mortality was 29%
more than that experienced by the national
population.
 Table 5
Calculation of the SMR for coal workers

Age National Coal worker Observed Expected

population death population deaths deaths
rates per 1000
25-34 30 300 . 9.0
35-44 5.0 400 . 2.0
45-54 8.0 200 . 1.6
55-64 25.0 100 . 2.5
1.000 9 15.1
SMR = 9/15x100=60
* It is not necessary to know these values. Only the total for the whole
age-range is required
 Result Evaluation
 An SMR of 100 indicates that the observed
number of deaths is the same as the
expected number of deaths.
 An SMR greater than 100 indicates that the
observed number of deaths exceeds the
expected number,
 An SMR less than 100 indicates that the
observed number of deaths is less than the
expected number. 5
Advantages:
the SMR has the advantage over the direct
method of age adjustment in that it permits
adjustment for age and other factors where age
specific rates are not available.
ii. Other Standardization Techniques:
 Life table
 Regression techniques
 Multivariate analysis
 Ratio

It expresses a relation between two random

quantities. The numerator is not a
component of denominator e.g. sex-ratio,
doctor-population ratio, child-woman ratio
etc.
 Proportions
 A Proportion is a ratio which indicates the relation in
magnitude of a part to the whole.
 The Numerator is always included in the denominator
 The proportion is usually expressed as Percentage. For
Example.,

The Number of Children with Scabies at a Certain Time

-------------------------------------------------------------------- X 100
Total Number of Children in the Village at the Same Time
 Measurement of Morbidity
Morbidity has been defined as "any
departure, subjective or objective, from a
state of physiological well-being e.g.,
sickness, illness, disability etc.
 Three aspects of morbidity are:
 Frequency
 Duration
 Severity
Why Morbidity Data is Important
* .Describes the magnitude and disease load in
community.

* .Provides more comprehensive and accurate

data for basic research.

* .Provides data for etiological factors and thus

helpful in disease prevention.

* .Needed for disease monitoring and control

activities
 INICDENCE
It is the number of new cases occurring in
a defined population during a specified
period of time. It is given by the formula:

Number of new cases of specified disease

during a given period
--------------------------------------------- X 1000
Population at risk during that period
 Example of Incidence
For example, if there had been 500 new cases
of an illness in a population of 30,000 in a
year, the incidence rate would be:

500
-------- X 1000 = 16.7 per thousand per year
30,000
 Special Incidence rates

1. Attack rate

2. Secondary Attack Rate

 Attack Rate
Attack rate is an incidence rate usually
expressed as percent.

Number of new cases of a specified

disease during a specified time interval
----------------------------------------------------- X 100
Total population at risk during the
same interval
 Secondary Attack Rate

It is defined as the number of exposed

persons developing the disease with in the
range of the incubation period following
exposure to a Primary Case
 Uses of Incidence Rate
It is useful for taking action,

1. Control Disease
2. For Research into etiology and pathogenesis,
distribution of disease and efficacy of
therapeutic and preventive measures
 Prevalence

Relationship between incidence and prevalence: I

Incidence

Baseline Increased
Prevalence Prevalence

Relationship between incidence and prevalence: II

 PREVALENCE

Refers to all current cases (old and new)

existing at a given point in time and over a
period of time in a given population.
 Types of Prevalence

 Point Prevalence

 Period Prevalence
 Point Prevalence
It is given by the formula:
Number of all current cases of a specified
disease existing at a given point in time
------------------------------------------------- X 100
Estimated population at the same point
in time
Point denotes the time taken to examine the
population sample
 Period Prevalence

Number of existing cases, old and new,

of a specified disease during a given
period of time interval
----------------------------------------------- X 100
Estimated mid-interval population at risk
 Case 1
Case 2

Case 3
Case 4
Total No of
Patients
Case 5 admitted
Case 6 during this 1
year = 100
Case 7

Case 8

Case 9

Case 10

1Jan,2004 28 Dec,2004
 What is the point prevalence of Hepatitis B on
1st January 2004.
 What is period prevalence of Hepatitis B
during the year 2004 (Jan to Dec).
 Relation between Incidence and
Prevalence
 Prevalence = Incidence x Duration of the
Disease
INCIDENCE

PREVALENCE

RECOVERY DEATH
 Variations in Incidence and
Prevalence
 Since Incidence depends on the occurrence of
new cases of a disease, a DECREASE in
Incidence may be due to
 Enhanced Resistance to the disease
 A change in Disease Etiology
 An effective prevention program that reduces
exposure to a known risk factor for the disease.
 A DECREASE in Prevalence may be due to
 A decrease in Incidence
 A shorter duration of the disease due to either
improved treatment methods leading to more rapid
recovery or an increase in virulence leading to
more rapid death.
Examples of Point and period prevalence
and cumulative incidence in interview studies
of asthma
Interview Question Type of measure
“Do you currently have Point prevalence
asthma?”
“Have you had asthma Period prevalence
during the last [n] years?”
“have you ever had Cumulative incidence
asthma?”
 Uses of Prevalence
1. It helps to estimate the magnitude of Health/
Disease problems in the community and
identify potential high risk population.

2. It is especially useful for administrative and

planning purposes, e.g.,
Hospital Beds, Manpower Needs,
Rehabilitation Facilities
 Factors influencing prevalence
Increased by: Decreased by:
Longer duration of the Shorter duration of the
disease disease

Prolongation of life of High case-fatality rate

patients without cure from disease

Increase in new cases Decrease in new cases

(increase in incidence) (decrease in incidence)

Out-migration of health In-migration of healthy

people people

In-migration of susceptible Out-migration of cases

people

Improved diagnostic facilities Improved cure rate of

(better reporting) cases
Comparison of incidence and prevalence
Incidence
Measures the number of new cases, episodes or
events occurring over a period of time usually
one year
Provides best measure of whether a condition is
increasing , decreasing or static
Useful for evaluating the effectiveness of
health programmes (a measure used in
surveillance programmes.
Good method for ascertianing how the
population is making use of the health care
services
Can provide information about disease having a
short duration e.g. measles
For chronic conditions like leprosy and TB the
incidence per year is much lower than their
prevalence
Prevalence
Measures the total number of existing cases,
episodes or events occurring at one point in
time (new and old cases)
More complicated measure to describe
magnitude of a health condition
Combination of the previous incidence of a
condition and its duration
Does not provide evidence of causality
Can provide information about chronic disease
like leprosy
In countries with poor diagnostic facilities,
disease prevalence can be obtained by cross
sectional surveys
 Class Exercise

A prevalence survey conducted from January 1

through December 31, 2003, identified 1,000
cases of schizophrenia in a city of 2 million
persons, the incidence rate of schizophrenia in
this population is 5/100,000 persons each year.
What percent of the 1,000 cases were newly
diagnosed in 2003?
CLASS A: INAPPARENT INFECTION FREQUENT
Example: tubercle bacillus

0 Percentage of infections 100 Distribution of clinical

severity for three
classes of infections
CLASS B: CLINICAL DISEASE FREQUENT; FEW DEATHS (not draw to scale).
Example: Measles virus (Adapted from
Mausner JS, Kramer S:
Epidemiology
0 Percentage of infections 100 An introductory Text.
Philadelphia,
CLASS B: INFECTIONS USUALLY FATAL
WB Saunders,
Example: Rabies virus
1985, p 265.)

0 Percentage of infections 100

Inapparent Mild Moderate Severe (nonfatal) Fatal

 CELL RESPONSE HOST RESPONSE

Lysis of Cell Fatal

Discernable Clinically Severe Disease Clinical

Cell Transformation or
Effect Cell Dysfunction
Disease
Moderate Severity/Mild Illness

Incomplete Viral Infection without

Below Maturation Clinical Illness
Subclinical
Visual Disease
Change

Exposure without Exposure without

Cell Entry Infection
 Example of Subclinical/Clinical Ratio for Viral
Infections (Inapparent/Apparent Ratio)
VIRUS CLINICAL AGE AT ESTIMATED CLINCAL CASES
FEATURES INFECTION AT RATIO
Polio Paralysis Child +/- 1000:1 0.1% - 1%

Epstein-Barr Mononucleosis 1-5 Yrs >100:1 1%

6-15 Yrs 10:1 - 100:1 1% - 10%
16-25 Yrs 2:1 - 3:1 50% - 75%
Hepatitis A Jaundice <5 Yrs 20:1 5%
5-9 Yrs 11:1 10%
10-15 Yrs 7:1 14%
Adult 1.5:1 80-95%

Rubella Rash 5-20 Yrs 2:1 50%

Influenza Fever, Cough Young Adult 1.5:1 60%

Measles Rash, Fever 5-20% 1:99 >99%

Rabies CNS Symptoms Any Age <1:10000 >>>>99%

Epidemiology and public health

Public health, broadly speaking, refers to

collective actions to improve population
health. Epidemiology, one of the tools for
Improving public health, is used in
several ways.
 USES OF EPIDEMIOLOGY

 To study historically the rise and fall

of disease in the population.
 Community diagnosis

 Planning and evaluation

 Evaluation of individual’s risks and
chances
 Syndrome identification

 Completing the natural history of

disease
 Searching for causes and risk factors
 Natural history of disease
Epidemiology is also concerned with the
course and outcome (natural history) of
diseases in individuals and groups
 Natural History

Death

Subclinical Clinical
Good health changes
changes

Recovery
 Health status of populations
Epidemiology is often used to describe the
health status of population groups. Knowledge
of the disease burden in populations is
essential for health authorities, who seek to use
limited resources to the best possible effect by
identifying priority health programmes for
prevention and care.
In some specialist areas, such as environmental
and occupational epidemiology, the emphasis
is on studies of populations with particular
types of environmental exposure.
 Describing the health status of populations

Good Health

ill
Time
Health

Proportion with ill health,

change over time,
and with age
 Causation of disease
Although some diseases are caused solely by
genetic factors, most result from an interaction
between genetic and environmental factors.
Diabetes, for example, has both genetic and
environmental components.
We define environment broadly to include any
biological, chemical, physical, psychological,
economic or cultural factors that can affect
health. Personal behaviours affect this
interplay, and epidemiology is used to study
their influence and the effects of preventive
interventions through health promotion
 Causation
Genetic factors

Good health Poor health

Environmental factors
(including behaviours)
 Evaluating interventions
Archie Cochrane convinced epidemiologists to
evaluate the effectiveness and efficiency of
health services. This means determining things
such as the appropriate length of stay in
hospital for specific conditions, the value of
treating high blood pressure, the efficiency of
sanitation measures to control diarrhoeal
diseases and the impact of reducing lead
additives in petrol.
 Evaluating interventions

Treatment
Medical care

Good health Ill health

Health promotion
Preventive measures
Public health services
Thank You