DESCRIPTIVE

EPIDEMIOLOGY

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Dr.Abdifatah Ahmed Abdullahi
Dr.Kaniini
 CLASSIFICATION OF EPIDEMIOLOGIC METHODS

Descriptive
studies
Observational Case
studies control
Analytical
studies

Epidemiological
studies Randomized
controlled cohort
trials
Experimental or
Interventional
studies

Non-randomized 2
trials
 Observational studies allow nature to take
its own course; the investigator measures
but does not intervene.

 Descriptive analysis is limited to a description

of the occurrence of a disease in a
population.
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 In descriptive epidemiology, it is concerned with
observing the distribution of disease in
human population and identifying the
characteristics with which the disease seems to
be associated

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PROCEDURES IN DESCRIPTIVE STUDIES

1) Defining the population to be studied

2) Defining the disease under study

a) Time

3) Describing the disease by b) Place

c) Person

4) Measurement of disease

5) Comparing with known indices

6) Formulation of an aetiological hypothesis

 STEP 1: DEFINING THE POPULATION
 Descriptive studies are investigations
of population.
 A defined population should not only be in
terms of total no., but also in terms of age, sex,
occupation, etc.

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 The defined population-
i) could be a whole geographic region or a
representative sample
ii)could be a specially selected group- based on age,
sex, occupation, etc
iii) should be large enough so that it is meaningful
iv) should be stable without migration into or out
v)should not be different from other communities 7
STEP 2: DEFINING THE DISEASE
 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

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 STEP 3: DESCRIBING THE DISEASE
Time Place Person

Year, Climatic zones Age Season Birth order

Country, Sex Family size

Month, Region
Week Marital state Height
Urban/Rural
Day, Local community Occupation, Weight
Hour of onset Social status, Blood pressure,
Towns Education Blood cholesterol,
Duration Cities Personal habits
Institutions

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 Single/Point
1) TIME DISTRIBUTION Common
exposure

source Continuous /
multiple
exposure

Short term Person to

person
fluctuations
Arthropod
propagated
vector

Slow Animal
(modern) reservoir
Time
Distribution Seasonal
Periodic trend
fluctuations Cyclic
trend

Long term or 10
secular trends
 EPIDEMIC CURVE
 A graph of time distribution of
epidemic cases is called epidemic curve.

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 A) SHORT TERM FLUCTUATIONS

 An epidemic is the best known short term

fluctuation. It is defined as “ The occurrence in a
community or region of cases of an illness or
other health related events clearly in excess of
normal expectancy”

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 Types-

1)Common source epidemics-

i)Single/Point exposure

ii)Continuous/Multiple exposure

2)Propagated epidemics-

i)Person to person

ii)Arthropod vector
iii)Animal reservoir
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3) Slow(modern) epidemics
 I) COMMON SOURCE EPIDEMICS
1) Single exposure-
 It can occur due to an infectious agent or as a result of
contamination of the environment and develops within
one incubation period.
 The epidemic curve rises and falls rapidly, usually has
one peak
 It tends to be explosive (i.e. clustering of cases within a
short time)
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2) Continuous exposure-
 It is when the exposure from the same source is
prolonged and the epidemic continues over more
than one incubation period.
 The epidemic reaches a sharp peak, but tails off
gradually over a longer period of time.
 Eg: A well of contaminated water or nationally
distributed vaccine(polio vaccine) or food; water
borne cholera.
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II) PROPAGATED EPIDEMICS
 Types- person to person, arthropod, animal
 The epidemic shows gradual rise and tails
off over a much longer period of time
 It is more likely to occur where there is

i) regular supply of new susceptible

individuals- Births, Immigrants

ii) lowering herd immunity 18

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Course of a typical propagated epidemic

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B) PERIODIC FLUCTUATIONS
1) Seasonal trend-
 Seasonal variation is characteristic of many
communicable diseases. Eg: Measles,
upper respiratory tract infections(seasonal
rise during winter), Malaria, etc.
 Non-infectious diseases and conditions
may sometimes exhibit seasonal variation.
Eg: Sunstroke. 21
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2) Cyclic trend-
 Some diseases occur in cycles spread over short
periods of time (days, weeks, months or
years) . Eg: Influenza pandemics are known to
occur at intervals of 7-10yrs due to antigenic
variations.
 Non-infectious conditions may also occur in this
trend. Eg: Automobile accidents in the US are
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more frequent on weekends.
 C) LONG TERM TRENDS
 It refers to changes in the occurrence of disease
over a long period of time.
Eg: Coronary disease, diabetes showing
consistent upward trend and a decline in TB,
polio in developed countries during the past 50
yrs.
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2) PLACE DISTRIBUTION

1) International
variation

2) National
Place
variation
variations
3) Rural-Urban
variation

4) Local distribution 25
A) INTERNATIONAL VARIATION

 Descriptive studies have shown that

the pattern of a disease is not the
same everywhere
 Eg: Cancer of the stomach is very
common in Japan, but unusual in the
US. 26
 B) NATIONAL VARIATION
 There are variations in disease occurrence
within countries.
 Eg: The distribution of endemic goitre,
fluorosis, malaria, nutritional deficiencies
show variations in their distribution.

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 C) RURAL-URBAN VARIATIONS
 Due to differences in population density, levels of
sanitation, deficiencies of medical care, education and
environment factors, there exists a rural-urban variation
 Chronic bronchitis, cardiovascular diseases, accidents
are more frequent in urban than rural areas.
 Skin and zoonotic diseases and soil transmitted
helminths may be more frequent in rural than urban
areas.
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 D) LOCAL DISTRIBUTIONS
 These variations can be studied with the help of
“spot or shaded” maps.
 If the map showed clustering, it may suggest a
common source of infection.
 Eg: Study of Cholera epidemic.

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 STUDY BY JOHN SNOW, 1854
 Spot map of deaths from cholera in Golden Square area,
This pump was
later suspected
London, 1854 and proved to be
a source of
infection

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 MIGRATION STUDIES
 The use of migrant studies is a way of
distinguishing genetic and environmental
factors.
 Carried out in 2 ways-

1) Study of genetically similar groups but living

under different environmental conditions. Eg:
Twins
2) Study of genetically different groups living
in a similar environment. Eg: Men of
Japanese origin living in USA have higher
rate of coronary heart disease than the 31

Japanese in Japan.
3) PERSON DISTRIBUTION
 The disease can be characterised by defining a
person who develops a disease based on age,
sex, occupation, marital status, social
factors, habits and other host factors.

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 A)
AGE
 Certain diseases are more frequent in certain age
groups than others. Eg: Measles in childhood,
cancer in middle age and atherosclerosis in old age.
 Many chronic and degenerative diseases show a
progressive increase in prevalence with advancing
age.
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 BIMODALITY
 There may be two separate peaks instead of one in
the age incidence curve of a disease.
 This is known as bimodality as seen in Hodgkin’s
lymphoma, breast cancer.
 It indicates that there are two different sets of
causative factors even though the clinical and
pathological manifestations of the disease is the
same in all ages. 34
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 B) SEX
 Variations occur due to-
1) Biologic difference like sex linked genetic
inheritance
2) Cultural and behavioural differences
between the sexes in social settings.
Eg: 4:1 male to female ratio in lung cancer
due to cigarette smoking. 36
C) ETHNICITY
 Differences in racial and ethnic origin.
 Eg: Tuberculosis, sickle cell anemia

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 D) MARITAL STATUS
 In a study, the mortality rates were lower for
married people than unmarried
 It is because according to demographers and
sociologists, marriages are selective with respect
to health of the individual.
 Healthier the individual, the more likely to get
married. 38
 E) OCCUPATION
 Occupation may alter the habit pattern of
employees (Sleep, alcohol, smoking, etc)
 Workers in a particular occupation are exposed
to certain types of risk. Eg: Workers in coal
mines are likely to suffer from silicosis

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F) SOCIAL CLASS

 Health and diseases are NOT equally

distributed in social classes.
 Certain diseases show higher prevalence in
upper class (Diabetes, Coronary heart disease,
hypertension)

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 G) BEHAVIOUR
 Behavioural factors such as smoking, sedentary life,
over-eating, drug abuse lead to certain diseases
(Coronary heart disease, Cancer, etc)
 Factors like mass movement may also lead to
transmission of infectious diseases.

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H) STRESS
 The effects of stress are seen based on the patient’s

response (Susceptibility to disease, Exacerbation of

symptoms, etc)
I) Migration
• Due to migration of people, there is also transmission of
the disease from one place to another.

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 STEP 4: MEASUREMENT OF DISEASE
 Types-

1) Cross sectional studies-

 Prevalence can be obtained.
 It is based on a single examination of a
cross section of population at one point in
time.
 More useful for chronic diseases 43
2) Longitudinal studies-
 Incidence can be obtained.
 The observations are repeated in the same
population over a prolonged period of
time by means of follow up examination.
 Longitudinal is more useful, but it is
time consuming.

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STEP 5: COMPARING WITH KNOWN INDICES

 Comparisons are made with known

indices to arrive at clues to the disease’s etiology

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STEP 6: FORMULATION OF A HYPOTHESIS

 A hypothesis is a supposition, arrived at

from observation or reflection
o An epidemiologic hypothesis should specify-
 The population- characteristics of the people
to whom the hypothesis applies
 Specific cause
 Expected outcome-the disease
 Dose response relationship-The amount of the
cause needed to lead to the stated incidence of
the effect.
 Time response relationship-Time period
between exposure to the cause and
observation of the effect.

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USES OF DESCRIPTIVE EPIDEMIOLOGY
 It provides data regarding the magnitude of
the disease load and types of disease problems
in terms of morbidity and mortality rates and
ratios.
 It provides clue to disease etiology and help in
the formulation of an etiological hypothesis.

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 It provides background data for planning,
organizing and evaluating preventive
service.
 Contribute to research by describing
variations in disease occurrence by time, place
and person.

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THANK YOU

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