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Clinical
epidemiology
 Key messages

Clinical epidemiology is the application of

epidemiological principles and methods to the practice
of medicine
With rising health-care costs, clinical practice has
become a common subject of epidemiological research

Evidence-based guidelines have improved clinical

outcomes.

effective treatments are not fully used, and

ineffective or costly and unnecessary treatments are
still being prescribed
 Clinical epidemiology is the application of
epidemiological principles and methods to the practice of
clinical medicine.
 It usually involves a study conducted in a clinical setting,
most often by clinicians, with patients as the subjects of
study.
 The discipline refines methods developed in epidemiology
and integrates them with the science of clinical medicine.
 The aim of clinical epidemiology is to aid decision-making
about identified cases of disease.
 Clinical epidemiology – which includes the methods used
by clinicians to audit the processes and outcomes of their
work – is a basic medical science
 The central concerns of clinical
epidemiology are:
• definitions of normality and abnormality
• accuracy of diagnostic tests
• natural history and prognosis of disease
• effectiveness of treatment and
• prevention in clinical practice.
Definitions of normality and abnormality

 The first priority in any clinical

consultation is to determine whether
the patient’s symptoms, signs or
diagnostic test results are normal or
abnormal.
 This is necessary before any further
investigations or treatment. It would be
easy if a clear distinction could always
be made between measurements of
normal and abnormal people
 Measurements of health-related variables
can be expressed as frequency
distributions in the population of patients.
 Occasionally the frequency distributions
for abnormal and normal measurements
are quite different, but more often there
is only one distribution and the so-called
abnormal people are at the tail
 There are three ways of distinguishing :
 normal as common
 abnormal as associated with disease
 abnormal as treatable.
 Normal as common

 This definition classifies values that occur

frequently as normal and those that occur
infrequently as abnormal
 We assume that an arbitrary cut-off point
on the frequency distribution (often two
standard deviations above or below the
mean) is the limit of normality and
consider all values beyond this point
abnormal.
 This is called an operational definition of
abnormality, 2.5% of the population as
abnormal
 An alternative approach, which does not
assume a statistically normal distribution,
is to use percentiles: we can consider that
the 95th percentile point is the dividing
line between normal and abnormal, thus
classifying 5% of the population as
abnormal
Abnormality associated with disease
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