DESCRIPTIVE EPIDEMIOLOGY

 Presented by
Madhushree Das
M.Sc. Nursing Part I
Epidemiology is the study of the distribution and determinants of health-related states or
events (including disease), and the application of this study to the control of diseases and other
health problems……John M Last, 1988.

Epidemiology is derived from the word epidemic (epi=among; demos=people; logos=study)

 AIMS OF EPIDEMIOLOGY:

 To describe the distribution & magnitude of health & disease

problems in human populations.
 To identify etiological factors (Risk Factors) in the pathogenesis of
disease.
 To provide the data essential to the planning, implementation &
evaluation of services for the prevention, control & treatment of
disease & to the setting up to priorities among those services.
 Descriptive epidemiology describes the distribution of disease,
death and other health outcomes in the population according to
person, place and time, providing a picture of how things are or
have been-the who, where
and when of disease pattern.
TYPES OF EPIDEMIOLOGICAL STUDIES
 DESCRIPTIVE EPIDEMIOLOGY

 It provides a way of organizing and analyzing data on health and disease in

order to understand variations in disease frequency geographically and over
time and how disease varies among people based on a host of personal
characteristics (person, place and time).

 When is the disease occurring? …….Time distribution

 Where is it occurring? .........Place distribution
 Who is getting the disease? .........Person distribution
 Aims of descriptive epidemiology:

 Permit evaluation of trends in health and disease

 Provide a basis for planning, provision and evaluation of health
services
 Identify problems to be studied by analytical method and
suggest areas that may be fruitful for investigation
Steps in descriptive studies:

 Defining the population to be studied.

 Defining the disease under the study
 Describing the diseases by….Time
Place
Person
 Measurement of disease
 Comparing with known indices
 Formulating of etiological hypothesis
1. Defining the population to be studied:

 Epidemiologists have been labelled as men in search of a denominator.



 Describing the study population:

 Total number
 Age composition,
 Sex composition,
 Occupations,
 Socioeconomic status,
 Literacy profile,
 Social customs,
 Habits,
 Specific lifestyles,
 Knowledge of health facilities available and their utilization.
2. Defining the disease under study:

 The epidemiologist defines the disease which can be measured and identified
in the defined population with a degree of accuracy.
 This is different from the clinician’s definition of a disease.
3. Describing the disease by a) Time b) Place c)
Person:

 The time: year, season, month, week, day.

 The place: country, cities, towns, urban/rural.
 The persons: who are affected with the disease: age, sex, occupation,
education, personal habits, height, weight, BP etc.
Time distribution:

 I. Short term fluctuations (hours, days, week)



 The occurrence of cases of an illness or other related events in a region or a

community clearly in excess of the normal expectancy.
 Day of week and time of day: For occurrence of road traffic accidents,
occupational disease/exposures displaying data by day of the week or time of
the day may be more informative. Pattern of these occurrences may suggest
hypothesis and possible explanation.
I. Short term fluctuations (hours, days, week)
=Epidemics:
The occurrence of cases of an illness or other related events in a region or a
community clearly in excess of the normal expectancy .
Common source single exposure epidemic:
These are also known as point source epidemics. The exposure to the disease agent is brief
and essentially simultaneous, the resultant cases all develop within one incubation period
of the disease (for example epidemic of food poisoning) Bhopal gas tragedy in India and
Minamata disease in Japan.
Common source-continuous or repeated exposure:
Sometime the exposure from the same source may be prolonged-continuous, repeated
or intermittent-not necessarily at the same time or place. E.g. prostitute may be a
common source in gonorrhea outbreak, but since she will infect her clients over a period
of time. There may be no explosive rise in the number of cases. A well of contaminated
water or a nationally distributed brand of vaccine (e.g. Polio vaccine).
Propagated epidemics

A propagated epidemic is most often of infectious origin and result

from person to person transmission of an infectious agent. (e.g.
epidemics of hepatitis A and polio).The epidemic usually shows a
gradual rise and tails of over a much longer period of time.
Transmission continuous until the number of susceptible is depleted
or susceptible individuals are no longer exposed to infected persons
or intermediary vectors.
II. Periodic fluctuations:

 A. Seasonal trend:


 Seasonal variation is a well-known characteristic of many communicable

diseases, e.g. measles, varicella, cerebro-spinal meningitis, upper respiratory
infection, malaria etc.

 B. Cyclic trend:
 Some disease occur in cycles spread over short periods of time which may be
days, weeks, months or years. E.g. Measles in every 2-3 yrs., Influenza once in
7 to 10 yrs. Accidents more on weekends.
III. Long term or secular trends:

 The term secular trend implies changes in occurrence of disease.(i.e. A

progressive increase or decrease)over a long period of time, generally several
years or decades.
 Examples include coronary heart disease, lung cancer and diabetes which
have shown a consistent upward trend in the developed countries during the
past 50 years or so, followed by a decline of such diseases as tuberculosis,
typhoid fever, diphtheria and polio.
Importance of time trends in descriptive
epidemiology:

 To know diseases which are increasing or decreasing & emerging health

problems.
 Can frame effective measures to control the disease.
 Formulate etiological hypothesis.
 Provide guideline to health administrator in matters of prevention or control
of disease.
Place distribution:
4.Measurement of disease:

 It is mandatory to have a clear picture of the amount of disease in the

population. The information should be available in term of morbidity, mortality.
Measurement of mortality is straight forwarded. Morbidity has two aspects-
incidence and prevalence. Incidence can be obtained from longitudinal study
and prevalence from cross sectional studies.
 Incidence: The number of new cases occurring in a defined population during
a specified period of time.
 Prevalence: The term disease prevalence refers specifically to all current
cases (old and new) existing in given point in time, or over a period of time in a
given population.
Cross sectional study: it is the simplest form of an observational study.it is
based on a single examination of a cross-section of population at one point of
time-the result of which can be projected on the whole population provided
the sampling has been done correctly. Cross sectional study is also known as
prevalence study.

Uses of cross-sectional study:

1.determine the prevalence of disease.
2.Identify positive causative factors in disease.
3.Study shows association between variables but they do not establish cause
and effect relationship.
4.Use to formulate hypothesis.
Longitudinal Studies: There is an increasing emphasis on the value of
longitudinal study in which observation are repeated in the same
population over a prolonged period of time by means of follow up
examinations.

Uses of longitudinal studies:

1.Useful to study natural history of disease.
2.Helps to find out incidence rate.
3.Helps to identify risk factors of disease.
5.Comparing with known indices:

 The essence of epidemiology is to make comparison and ask

questions. By making comparison between different population and
subgroups of the same population, it is possible to arise clues to
disease etiology. We can also identify or define groups who are at
increased risk for certain diseases.
6.Formulation of a hypothesis:

 By studying the distribution of disease, and utilizing the techniques of

descriptive epidemiology, it is often possible to formulate hypothesis
relating to disease etiology.
 For example: Cigarette smoking causes lung cancer-is an incomplete
hypothesis.
 An improved formation: The smoking of 30-40 cigarettes per day
causes lung cancer in 10 per cent of smoker after 20 years of exposure.
Uses of Descriptive Epidemiology:

 Helps to know magnitude of disease in community. e.g. morbidity

&mortality rates.
 Helps to know the distribution of the disease. time, place, person
 Helps to formulate an etiological hypothesis.
 Helps to plan, organize &implement curative and preventive services.
 Helps in doing research.