Dr.

Eman Khammas Al-Aadi

Head of Community Medicine Department
 DESCRIPTIVE EPIDEMIOLOGY
PERSON, PLACE and TIME

Three groups of variables are commonly used in

descriptive epidemiology. These are:

A. Characteristics describing the persons affected

such as age, sex, marital status,  education,
occupation, habits, genetics and ethnic groups.
B. Characteristics describing the place where
persons were found affected. The distribution of
the disease may have
1. International,
2. National (limited to one country), 
3. Continental, 
4. Or local: only part of a country or urban-
rural pattern?
 C. Characteristics describing the time in which
.persons were found affected

Does the distribution follows

1. secular trend (over many years and decades),

2. seasonal trend (within the same year),
3. recurrent pattern.
4. Occurrence of disease after special events, e.g., raining.
?
variables related to (person, place and time) are not
necessarily have causal association with the disease being
.examined. they are simply used in description
An association of a particular disease with a given place
might be due to the type of people inhabiting that place (e.g.,
SCD).sickle cell disease
Also, an association of disease with a characteristic of person
might be due to environmental factors peculiar to that place of
residence rather than the person characteristic itself (e.g.
Schistosomiasis or asthma or occupational diseases like
. mesothelioma
 The descriptive associations are helpful in hypothesis
formulation.

Hypothesis: A proposed explanation of a relationship

that has to be accepted or refuted and tested by further
research

Testing of hypothesis needs other methods (analytical

.methods)
 Epidemiological study cycle
Descriptive studies

Data aggregation and 

analysis

Analysis of Model
results and building
further studies &formulation
of hypothesis

 Analytical studies to test

      hypothesis
Examples on descriptive epidemiology
A. Distribution of disease with age:

the distribution of disease is very variable with age. Actually,

age is an important confounding variable and must be
considered and controlled .

The variation of disease distribution with age may be

explained as follows:
1. Accuracy of diagnosis. Disease is less likely to be
ascertained in extreme age groups. This leads to
under estimation of certain causes of death in the
very  young and the very elderly people. In some
instances, basic population data are lacking on such
extreme age groups
Variation in intensity and duration of exposure to risk .2
.factors
3. Variation in immunity and susceptibility.
The type of epidemiological parameter used, (incidence, .4
.prevalence or  mortality)
e.g ( in a disease with constant incidence with age and
negligible mortality and incomplete recovery, the age specific
prevalence increases with age because cases once
developed tend to accumulate over time thus raising the
prevalence.
5. Bimodality:
In some instances the distribution of disease frequency with
age  may  have more than one peak (bimodal) as in case of
the incidence of lymphomas and tuberculosis, this bimodality
may suggest the heterogeneity of data and the
possibility that we are dealing with two disease entities rather
than with one disease.
Example (Tuberculosis )
the first peak in the incidence  rate of tuberculosis in young
children is definitely primary (exogenous) tuberculosis. On
the other hand, the peak late in life is mainly secondary
(endogenous) tuberculosis.
Ageing or biological clock. Some times, people become .6
very aging and lose the ability to carry out even simple tasks,
.yet they have no apparent disease
B. Distribution of disease with marital status:

In many studies it was reported that death rates and suicidal

rates are higher among non-married people (single, widowed
and divorced) than they are in married people. This is true for
both males and females. Such variation might be difficult to
explain but two explanations are possible:

a. Marriage stabilizes life and reduces the risk of exposure

to hazardous behavior. Married people may feel more
responsible not only for their lives but for the care and life
of their spouses and children. They may avoid certain
risky behaviors. Some recent studies contradict this
hypothesis
b. People who are unmarried are actually not healthy to
start with and they prefer not to marry. The higher risk of
death and suicide among them is related to their poor
health to start with rather than marital status (being
unmarried).
C. Interpretation of association of disease
distribution with place

The following criteria are essential to demonstrate an

association of disease distribution with place:
High frequency rates of the disease are observed in all .1
.ethnic groups living in that place
2.Similar people who inhabit other places do not show high
frequency rates of the disease.
Healthy people entering the place become affected by the .3
.disease at a rate similar to that of the indigenous population
4. People who leave the place and move to other places do
not experience high frequency rates of the disease.
5. Species other than man may show similar pattern of the
disease.
:When these criteria are fulfilled, it is possible to imply that
Either the inhabitants of that particular place posses
characteristics of importance to the etiology of the disease.
Or that the physical, chemical, biological or social
environment of that place contain etiological factors of the
disease. More intensive research is required to identify such
factors.
4. Interpretation of disease variation with time
Secular changes:

Distribution of disease with time may follow long term changes

(secular changes or trends). The changes occur over years or
decades
1.The rise indicates real increase in the incidence of the
disease in response to
a. Massive exposure to disease agents,
b. Change in life style of the people .      
a. Failure of adaptation to social change.

2.The rise is artificial due to

a. Improved diagnosis of disease.
 b. Improved recording of cases.
c. Change in classification of disease.
 d. Ageing of the population/ change in population at risk
5. Seasonal changes

A change of disease frequency within the year reflects:

1. Change in population immunity (susceptibility),
2. Change in environmental situation in favor of disease
agent development or multiplication and in its
transmission to new hosts .
3. Introduction of additional causal factors
4. Combination of these factors