Study Designs

Descriptive Studies

Dr Anjali N Shete
GMCH Aurangabad
 Study Design Sequence
Hypothesis formation

Descriptive
Case reports Case series
epidemiology

Analytic Animal Lab

epidemiology study study

Clinical
Hypothesis testing
trials

Cohort Case- Cross-

control sectional
 Descriptive Studies Develop
hypothesis
Increasing Knowledge of

Investigate it’s
Disease/Exposure

Case-control Studies relationship to

outcomes

Define it’s meaning

Cohort Studies with exposures

Test link
Clinical trials experimentally
 Introduction

• A descriptive study can be defined as one in which only

one group of subjects is studied , without any comparison
group, for describing the outcome in terms of its frequency
and its distribution according to selected variables related
to person, place and time.

• It gives a tentative guess (hypothesis) about possible role

of certain factors in the outcome of interest, but does not
confirm the role because of absence of a comparison
group.
 Characteristics
• No comparison group.

• The main objective is to describe:

 Incidence or prevalence of disease

 Describe the natural history of disease
 Describe the distribution of the disease according
to variables related to person, place and time.

• Makes suggestion or hypothesis about certain “cause

and effect” relationship which can be further tested
by analytical studies.
• First phase of an epidemiological investigation.

• These are concerned with observing the distribution of

the disease or health-related characteristics in human
population and identifying the characteristics with
which the disease in question seems to be associated.
 Descriptive studies answer 3 basic
questions

• When is the disease occurring? Time

distribution

• Where is it occurring?
Place distribution

• Who is getting the disease?

Person distribution
 Steps

1. Defining the population to be studied

2. Defining the disease under study
3. Describing the disease by
• Time
• Place
• Person
4. Measurement of disease
5. Comparing with known indices
6. Formulation of etiological hypothesis
1. Defining the Population to be Studied

Descriptive study is the study of populations not individuals

 Defining the population to be studied
• Define population base in terms of
• Age
• Gender
• Occupation
• Cultural characters etc

• Defined population can also be specially selected group

• Age and Sex groups
• Occupational Groups
• School children
• Small communities
 Defining the population to be studied
• Defined population needs to be large enough

• The community should be stable

• Clear on who belong or does not

• Community should not be different from others in the

region

• Health facility should be close enough

Framingham Heart Study: All above criteria were followed

 Why do we need “defined population?”

• To provide denominators for calculation of rates.

• Rates are required for measurement of

frequency of the disease and study of
distribution and determinants.

Epidemiologist: People in search for a denominator

2. Defining the disease under study
 Defining the disease under study

• Needs of clinician and epidemiologist may diverge

• Precise and valid definition is required by

epidemiologist

• Operational definition by which a disease or condition

can be identified and measured in defined population
with a degree of accuracy
 Measles

Clinical Case definition: An illness characterized by

following:

(1) Generalized rash lasting ≥ to 3 days

(2) Temperature ≥ 1010 F

(3) Cough, Coryza or Conjunctivitis

 Epidemiologist definition

• Suspected case: Any febrile illness accompanied by

rash

• Probable case: A case that meets clinical case

definition, has noncontributory or no serologic or
virologic testing and is not epidemiologically linked to a
confirmed case.

• Confirmed case: a case that is laboratory confirmed or

that meets the clinical case definition and is
epidemiologically linked to a confirmed case
3. Describing the disease
 Describing the disease

• Time distribution
– When is the disease occurring?

• Place distribution
– Where is it occurring?

• Person distribution
– Who is getting the disease?
Time Place Person
Year, Season Climatic zones Age Birth Order
Month, Week Country, region Sex Family size
Day, Hour of onset Urban/Rural Marital state Height
Duration Local Community Occupation Weight
Towns Social status Blood Pressure
Cities Education Blood Cholesterol
Institutions Personal Habits
 Time distribution
• The disease pattern may be described by its time of
occurrence ie. By week, month, year, day of week, hour
of onset etc.

• This explains weather the disease is seasonal,

weather it shows periodic increase or decrease,
weather it follows a consistent time trend.

• Epidemiologist have identified three different trends

or fluctuations
– Short term fluctuation
– Periodic Fluctuation
– Long term or secular trends
 Short term fluctuations
• Epidemic is the best known short term fluctuation.
 Types of epidemics

A. Common-source epidemics
A. Single exposure or ‘point- source’ epidemics
B. Continuous or multiple exposure epidemics

B. Propagated epidemics
A. Person to person
B. Arthropod vector
C. Animal reservoir

C. Slow or modern epidemics

 Periodic fluctuations

• Seasonal trend
Eg. Measles, Varicella, Cerebro-spinal meningitis,
Upper respiratory infections, malaria etc.

Sunstroke, Hay fever, Snakebite.

• Cyclic trend
Measles, Influenza pandemics, Automobile accidents
 Long term or secular trends

• Secular means progressive increase or decrease over a

long period of time

• Consistent tendency to change in a particular direction or

a definite movement in one direction

• Eg CHD, Lung Cancer, DM: upward trend

• Tuberculosis, typhoid fever, diptheria, polio: downward

trend
 Steps

1. Defining the population to be studied

2. Defining the disease under study
3. Describing the disease by
• Time
• Place
• Person
4. Measurement of disease
5. Comparing with known indices
6. Formulation of etiological hypothesis
 Place Distribution
(Geographical comparisons)

• Geographical pathology is important dimensions

of descriptive epidemiology

• International Variations
• National Variations
• Rural- urban variations
• Local distributions
 International Variation

• Pattern of disease is not same everywhere.

• Ca stomach
• Oral Cancer and Ca Cervix
• Breast Cancer
 National variations

• Endemic goitre
• Lathyrism
• Fluorosis
• Leprosy
• Malaria
• Nutritional deficiency
 Rural-urban variation

• Chronic bronchitis • Hand, skin and zoonotic

disease
• Accidents
• Soil transmitted
• Lung cancer
helminths
• Cardiovascular disease
• Death rates: Infant
• Mental illness and drug mortality, maternal
dependence mortality
 Local distributions

• Best studied by spot maps or shaded maps

• “Clustering of cases”: common source

• John Snow: Cholera

 Migration studies

• Comparison of disease and death rates of migrants with

those of their kin who stayed at home

• Comparison of migrants with local population of the

host country
 Person distribution

• Age • Occupation
• Sex • Social Class
• Ethnicity • Behavior
• Marital Status • Stress
• Migration
4. Measurement of disease
 Measurement of disease

• Disease load in terms of

– Mortality
– Morbidity
• Incidence: longitudinal studies
• Prevalence: Cross-sectional studies

– Disability
5. Comparing with known indices
 Comparing with known indices

• Making comparisons and asking questions

• Making comparison between different
population
• Making comparison in subgroups of same
population
• We can arrive at clues to disease etiology
• We can also identify or define groups who are at
increased risk for certain disease
 Formulation of a hypothesis

• A hypothesis is a supposition arrived at from observation

• It can be accepted or rejected using techniques of

analytical epidemiology
 An hypothesis should specify the
following

• The population

• The specific cause being considered

• The expected outcome

• The dose-relationship

• The time-response relationship

 Cigarette smoking causes lung cancer

Smoking of 30-40 cigarettes per day causes lung

cancer in 10 percent of smokers after 20 years exposure
 Uses of descriptive epidemiology
• Provide data: magnitude of disease problems in
community in terms of morbidity and mortality rates and
ratios

• Provide clues to disease etiology and help in formulation

of etiological hypothesis

• Provide background for planning, organizing and

evaluating preventive and curative services

• Contribute to research by describing variation of

disease occurrence by time, place and person
Thank You