ANALYTICAL EPIDEMIOLOGY

.PART 1

Dr. Eman Khammas Al-sadi

Chief of Community Department
DEFINITION OF BASIC TERMS
:Risk
A probability that an individual will become
ill or die within a specified period of time or
.age. It is used to denote incidence rate
:RISK FACTORS

Modifiable & non modifiable

a. Risk marker. An attribute or an exposure that is associated
.with an increased risk of disease or other specific outcome
Like troponin marker for MI diagnosis, Coronary Arteries thickness by
MRI studies
b. Determinant.‫حم ددات‬
An attribute or exposure that increases the risk of
.disease or other specific outcome
c. Modifiable risk factor: A determinant that can be modified by
an intervention thereby reducing the risk of disease or other
specific outcome.

:it risk factors can be modifiable & non modifiable factors

 :Relative risk
is a measure of strength of association between an
exposure and an outcome .Itis value is an indicator of
the significance of the exposure in the etiology of the
outcome.

The relative risk is calculated by

Incidence rate among exposed

Relative risk (RR) = ---------------------------------------------------------
Incidence rate among non exposed
The value of the relative risk depends on the difference in the
incidence rates of the disease in the two groups (exposed group
.and non exposed group)
The greater the value of the relative risk is, the stronger the
.association is and the more likely that the association is causal
:Attributable risk (AR)
It refers to the fraction of the incidence rate of the disease that can
be attributed to the exposure to the risk factor. or (How many
times factor exposure would increase the incidence rate of a
.group)
:It is calculated by the following formula
Attributable risk AR= IR among exposed – IR among non exposed
The significance of the attributable risk is that:
o it gives an idea about the expected gain in health and
life or the expected reduction in incidence rate if the
risk factor is eliminated.
The expected reduction can be expressed as percentage
out of the incidence rate among the exposed as follows
Association :

A statistical (quantitative) dependence between two or

more variables. Variables are said to be associated if
they tend to occur together more frequently than could
be explained by chance. The degree of association is
.determined by statistical tests

Types of statistical association

a. Non causal when the apparent association is due to
confounding process, i.e., a third factor is related both to
the risk factor (the cause) and the outcome or effect (the
disease).
b. Causal which is either direct (A B)
or indirect (A B C)
Causal association
A statistical association is likely to be causal if the
following criteria are fulfilled:
A. Epidemiological criteria by (Austin Bradford Hill )) 9
1.Strength of association. effect size
2. Dose-response relationship.
3. Time sequence.
4. Experimental evidence. "Occasionally it is possible to appeal to experimental
evidence"
5. Consistency. Consistent findings observed by different persons in different
places with different samples.
6.Specificity: Causation is likely if there is a very specific population at a
specific site and disease with no other likely explanation
7.Coherence. Coherence between epidemiological and laboratory findings
increases the likelihood of an effect. However, Hill noted that "... lack of such
[laboratory] evidence cannot nullify the epidemiological effect on associations".
8. Biological plausibility. A plausible mechanism between cause and effect is
helpful
9.Analogy: The use of analogies or similarities between the observed
association and any other associations
.B.Biological criteria (Koch's Postulates)
1. Agent is regularly found in lesions of cases
2. Agent is isolated in pure culture in artificial media
3. Agent causes similar disease in experimental
animals
4. Agent is recovered from diseased animals
ANALYTICAL STUDIES
 , Analytical studies

1. the researcher attempts to explore how and why a disease

process is maintained in a given population or place.
2. we always use comparative or control groups and we test
hypotheses so that they are accepted or not.
3. Hypotheses are accepted when we have adequate evidence
to support them.
4. When the evidence is inadequate, hypotheses are not
accepted and further studies may be required.
e.g.
it might be suggested that parental smoking increases the risk of
acute respiratory infection among children aged under five years.
To test this hypothesis, two types of analytical epidemiological
studies may be used:
 Case - Control studies

Definition
A study that compares patients who have a disease or
outcome of interest (cases) with patients who do not have
the disease or outcome (controls), and looks back
retrospectively to compare how frequently the exposure to a
risk factor is present in each group to determine the
relationship between the risk factor and the disease.
:In case-control studies
1. The (exposure and outcome) or disease have
occurred before the start of the study.
2.The study proceeds backwards from outcome to cause.
3.Controls are used to support or refute any inference.
4. Two groups of persons are studied, the first consists of
subjects who have the disease under study at the time
of the beginning of the study (cases). The
second group consists of subjects who are free from
the disease under study (controls).
5. Both cases and controls are preferably matched for
age and sex. Some times they are matched for other
variables but overmatching is to be avoided.
:The basic steps are
1. Selection of cases and controls .    
2. Matching for known confounding variables (at least age
and sex).
3. Measurement of past exposure in both groups.
4. Analysis and interpretation.
,To illustrate the study design
we identify a number of children who are suffering from acute
respiratory infection (say pneumonia) Suppose the number is
240.An equal or more number of children matched for age and
sex but are free from acute respiratory infection at the time of
.the study is also selected (controls).suppose 380 child