Descriptive Epidemiology

Dr. Jatin Chhaya

 Research Methods
(1) Observational studies (2) Experimental studies

(a) Descriptive studies

Case studies and Case series (a) Randomized
controlled trial
(b) Analytical studies
(b) Field trials
(i) Ecological or correlational
(ii) Cross sectional or
prevalence (c) Community trial
(iii) Case-Control
(iv) Cohort or Follow up study
Descriptive Epidemiology
Includes activities related to
characterizing the distribution of
diseases within a population
In Descriptive Epidemiology:
 Who? – person - Demographic
 Where? – place - Geographical
 When? – time - Temporal
to formulate
• Concerns anrelated
activities etiological
to identifying
hypothesis.
possible causes for the occurrence of
Procedures:
Defining the population of the community
Defining the disease under study
Describing the distribution disease with
reference to time, place and person
Measurement of disease
Making comparison with known indices
Formulation of etiological hypothesis.
Defining the population under study:
The population must also be defined in terms of area
(place) and time.
For example, if we want to study the problem of
measles in a primary health center area, during a given
year, the population under study is all under fives, the
area is the entire jurisdiction of PHC and the time is
the particular year.
Thus, the study population (defined population)
becomes the population at risk, i.e. it becomes the
denominator and helps in calculating the rates, i.e. in
measuring the disease frequency.
Defining the disease under study:
That means the disease which is taken up for study
has to be defined in such a way that the
epidemiologist should not only be able to identify
those with disease from those without the disease, but
also be able to measure it with accuracy. This is called
‘Operational definition’.
For example, leprosy is defined as a case with
hypopigmented patch/patches with partial or total loss
of sensation, with thickening of nerves and
demonstration of acid-fast bacilli in the skin smear
examination.
Describing the distribution of the disease with
reference to time, place and person.
TIME DISTRIBUTION
This means describing the time of occurrence/ onset
of the disease with reference to year, month, week,
day, hour of onset, season, atmospheric temperature,
climate etc.
This study often gives a clue about the etiology of the
disease or the predisposing factors, so that preventive
measures can be adopted.
There are three kinds of time trends or fluctuations:
1. Short-term fluctuations.
2. Periodic fluctuations.
3. Long-term fluctuations.
TIME DISTRIBUTION
Short-term Fluctuations
 This means sudden occurrence of a disease in a given area, and
lasting for a short period, e.g. an epidemic disease.
 There are two types of epidemics:
Common source epidemics
Propagated epidemic
 Common source epidemics: This is an epidemic occurring from a
common source, either by single exposure or by repeated
exposure. Accordingly, there are two subtypes.

 Common source single exposure epidemic (Point source

epidemic): This means all the cases develop almost
simultaneously following single exposure. For example, food
poisoning, Bhopal gas tragedy, fire accident in an industry.

 Common Source Repeated/ Continuous Exposure Epidemic

In this type, epidemic disease occurs from a common
source, but the exposure occurs continuously or
intermittently or repeatedly and not necessarily
simultaneously.
Therefore, the epidemic is not explosive. For example, A
professional sex worker as a source of gonorrhea, infecting
When this data is represented in the form of a
curve in a graph, it is called ‘Epidemic curve.’
Salient features of point source epidemic curve
are :
 There is sudden rise and sudden fall
 There are no secondary curves
Large number of cases occur with a narrow interval
of time
All cases have the same incubation period
Exposure is almost simultaneous and brief
Short-term Fluctuations - Propagated Epidemic:
In this type, the epidemic does not originate from a
common source like food or water, but spreads from
person to person, until all the susceptible are affected.
Thus, there is gradual rise and gradual fall of the curve.
Example: Epidemic of meningitis, measles, etc.
TIME DISTRIBUTION
Periodic Fluctuations:
This means occurrence of a disease in a community
during a definite period, either in a particular season or
periodically in a cyclic form. Accordingly, there are two
types: Seasonal trend and cyclic trend.
Periodic Fluctuations:
Seasonal Trend
Some diseases occur in a definite season.
Measles and chickenpox in the early spring season
Upper respiratory infection in the winter season
Diarrheal diseases during summer months.
The seasonal trend of the disease is because of the
favorable environmental factors such as humidity,
rainfall, atmospheric temperature, over crowding,
etc.
Periodic Fluctuations:
Cyclic Trend
This means tendency of a disease to occur cyclically once
in several days, weeks, months or years.
Examples: Epidemic of measles once in 2 to 3 years,
rubella once in 6 to 9 years, influenza once in 7 to 10
years.
Accidents more on weekends.
Thus, the knowledge on periodic fluctuations helps to
protect the community
TIME DISTRIBUTION
Long-term Fluctuations (Secular Trend):
This means changes in the occurrence of the disease over
a long period of time, several years or decades.
For example, coronary heart disease, diabetes, lung
cancer have shown an upward trend in the developed
countries during the last 50 years, followed by a
downward trend of diseases like leprosy, tuberculosis,
typhoid, amoebiasis, etc.
Thus, studying the time distribution of a disease helps the
epidemiologist not only to formulate an etiological
hypothesis but also to implement prevention and control
measures.
PLACE DISTRIBUTION
This means the pattern of occurrence of a disease in
different places. This helps to compare the disease
occurrence from one country to another country, and
within the same country from one state to another
state, from rural to urban areas and local areas.
International Variations
For example, cancer of stomach is common in Japan,
unusual in US.
Ca cervix common in India, less in UK, US, etc.
Breast cancer low in Japan, high in Western
Countries, etc.
This helps the epidemiologist to identify the causative
factors and thereby prevention. Other examples are
yellow fever in South America, sleeping sickness in
Africa.
National Variations
For example, goiter is more in subhimalayan region,
lathyrism in Madhya Predesh, leprosy in Tamil Nadu
and Andhra Pradesh, filariasis in coastal areas, etc.
Thus, diseases show variations in the same country.
This also helps the epidemiologist to find out the
favourable factor for the disease, thereby appropriate
health care services can be provided.
Rural-Urban Variations
The prevalence of non-communicable diseases such as
diabetes, hypertension, cancer, mental diseases are more
in urban areas than rural areas.
On the other hand, zoonotic diseases and soil borne
diseases are more in rural areas than urban areas. These
variations help the epidemiologist to identify the risk
factors and the risk-groups, so that care can be taken.
Local Distribution of the Disease (in an Area)
This is studied by representing the number of cases in the
area-map, in the form of spots, depending upon the area to
which they belong. This is called ‘Geographic spot map’
or ‘Shaded map’
Such a map at a glance shows area of high frequency and
area of low frequency. Area of high frequency (Cluster of
spots) gives a clue to the epidemiologist about the
common source of infection.
It was by such a study that John Snow of England in 1854
was able to focus attention that a common water pump in
the Broad street of London was the source of infection of
cholera epidemic. Thus, he was also able to hypothesize
that cholera was a water borne disease, much before the
organisms were isolated by Robert Koch.
PERSON DISTRIBUTION
This means describing the distribution of a disease in
the community with reference to the host characters of
the persons affected, such as age, sex, occupation,
literacy level, marital status, social class, behavior,
and such other factors.
Age
 Certain diseases occur more frequently in certain age group.
For example, measles and diphtheria among preschool
children, cancer in the middle age, atherosclerosis among
elderly.
 But there are certain diseases like Hodgkin’s disease and
leukemia, which has increased incidence in two age groups.
For example, Hodgkin’s disease is more between 15 to 35
years and between 70 to 90 years. Such a tendency of a disease
to show two separate peaks, is called ‘Bimodality
phenomenon.’ Tuberculosis has ‘Trimodality distribution’: a
small peak in early childhood, an extensive peak in adult age
and a moderate peak in old age
Sex
 Certain diseases are more common among men. For example,
lung cancer, TB, coronary heart disease and some are more
Marital Status
 This often becomes a risk factor. Cancer cervix is rare in nuns compared to
married women. Similarly, mortality rates are high among unmarried than
among married persons. This is because married people lead a secured and
protected life.
Occupation
 Persons working in particular occupations are exposed to particular types of
risks. Example, Tetanus, Ankylostomiasis are common among agriculturist
workers, Pneumoconiosis are common among industrial workers.
Social Class
 Diseases like hypertension, diabetes, coronary artery diseases are common
among people of higher socioeconomic class and diseases like malnutrition,
rheumatic heart disease and communicable diseases are common among
people of lower socioeconomic class. Thus, social factors like poverty,
illiteracy, ignorance, poor standard of living, overcrowding, etc. play a very
important role in the development of the diseases in the community
Behavior
Human life-style or behavior such as smoking,
alcoholism, over eating, multiple sexual partnership,
drug-abuse, etc. influence the development of the
disease. Thus, study of these risk factors help the
epidemiologist to formulate an etiological hypothesis.
Stress
Stress increases the susceptibility of an individual to
the disease and often exacerbates the symptoms.
Migration
Movement of the people from rural to urban areas has
resulted in the spread of diseases from one place to
another. Migration of the people is a challenge for the
prevention and control of the disease.
(3) Measurement of Disease
This means estimating the ‘Disease load’ or magnitude of
the problem in terms of morbidity, mortality, disability,
etc.
Mortality is measured directly in terms of death rates.
Morbidity is expressed in terms of incidence
(Longitudinal study) and prevalence (Cross-sectional
study) rates.
(4) Making Comparison with Known Indices:
The observations are compared with different groups.
This helps to find out the etiological factors and also
helps to identify the ‘Risk’ group, so that preventive
measures can be adopted.
(5) Formulation of Etiological Hypothesis
By studying the distribution of a disease in the
community, with reference to time, place and person,
the epidemiologist can formulate an etiological
hypothesis (supposition).
The hypothesis must be correct and complete.
For example, ‘Chronic alcoholism causes cirrhosis of
liver’—is an incomplete hypothesis. Better statement
would be ‘Drinking 200 to 300 ml of alcohol per day
causes cirrhosis of liver among 20 percent of
drunkards after 25 years of exposure’.
Uses of Descriptive Epidemiology

It helps to know the extent/magnitude of the

disease in the community, in terms of morbidity
and mortality rates.
It helps to know the distribution of the disease
with reference to time, place and person.
It helps to identify the risk group.
It helps to formulate an etiological hypothesis.
It helps to plan, organize and implement curative
and preventive services.
It helps in doing research.
Thanks.. & MCQs
1) Studying distribution of disease or health related
characteristics in human population and identifying
the characteristics with which disease seem to
associated is: [MH 2002]

(a) Descriptive epidemiology

(b) Experimental epidemiology
(c) Analytical epidemiology
(d) Ecological epidemiology
2) All are Observational studies except?
a) Case control study
b) Cohort study
c) Cross sectional study
d) Randomize control trail
3) Case-control study is a type of ?
(a) Descriptive epidemiological study
(b) Analytical study
(c) Longitudinal study
(d) Experimental epidemiological study
4)Which is not an analytical study?
(a) Case control study
(b) Cohort study
(c) Ecological studies
(d) Field trials
5) Descriptive study define distribution of disease
according to:
a) Time
b) Place
c) Person
d) All of above
Thank you..