EPIDEMIOLOGY

LEARNING OBJECTIVES
The students will be able to:
• define epidemiology
• state the approaches of
epidemiology
 Epidemiology 101
Greek words epi, meaning on or upon, demos, meaning
people, and logos, meaning the study of.

Epidemiology is the study of the distribution and

determinants of health-related states or events in specified
populations, and the application of this study to the control of
health problems
 Terms Used in Epidemiology
o Host: living species (human or animals) capable of
being infected or affected.
o Agent: an animate or inanimate factor that must be
present or lacking for a disease or condition to
occur.
o Environment: everything external to a specific
agent and host.
o Sporadic: presence of occasional cases of the
event unrelated to time or space.
 Terms Used in Epidemiology
o Endemic: constant long-term presence of an event
at about the frequency expected from the past
history of the community.
o Epidemic: presence of the event at a much higher
frequency than expected from the past history of
the community
o Pandemic: presence of an event in epidemic
proportions involving many communities and
countries even in a relatively short period of time.
 Terms Used in Epidemiology
o Biostatistics: is the overall broad term used to identify any
data to delineate health or health-related events.
o Vital statistics: are data that describe birth, adoption, death,
marriage, divorce, separation, annulment patterns, etc.
o Mortality statistics: are data related to the analysis of death
trends.
o Demographic statistics: are data for identifying significant
characteristics, including geographic distribution of people
in a given area & changes in the population over time.
o Mortality data: describe the extent & distribution of illness
in a given community.
 Distribution
Epidemiology is concerned with the frequency and pattern of
health events in a population:

Frequency:
Refers not only to the number of health events such as
the number of cases of meningitis or diabetes in a population,
but also to the relationship of that number to the size of the
population. The resulting rate allows epidemiologists to
compare disease occurrence across different populations.
 Distribution
Pattern:
Refers to the occurrence of health-related events by
time, place, and person. Time patterns may be annual,
seasonal, weekly, daily, hourly, weekday versus weekend, or
any other breakdown of time that may influence disease or
injury occurrence.
Place patterns include geographic variation, urban
/rural differences, and location of work sites or schools.
Personal characteristics include demographic factors which
may be related to risk of illness, injury, or disability such as
age, sex, marital status, and socioeconomic status, as well as
behaviors and environmental exposures.
 Specific Populations
What is the difference between epidemiologists and health-
care providers?
The health care provider is concerned about the health of an
individual.
The epidemiologist is concerned about the collective health of
the people in a community or population.

In other words, the HCP’s “patient” is the individual; the

epidemiologist’s “patient” is the community. Therefore, the
clinician and the epidemiologist have different
responsibilities when faced with a person with illness.
For example, when a patient with diarrheal disease presents,
both are interested in establishing the correct diagnosis.

However, while the clinician usually focuses on treating and

caring for the individual, the epidemiologist focuses on
identifying the exposure or source that caused the illness; the
number of other persons who may have been similarly
exposed; the potential for further spread in the community;
and interventions to prevent additional cases or recurrences.
Nurse Epidemiologist:
As a nurse
epidemiologist, you are tasked
with ensuring that patients
receive optimal care while
reducing the risk of infection.
Additionally, you will focus on
prevention methods, infection
management and direct patient
nursing including but not limited
to serve as a resource & plan
educational programs.
 Data Collection Methods

o Interviews
o Questionnaires and surveys
o Observations
o Documents and records
o Focus groups
o Oral histories
 Types of Collecting Data
Observational Data:
Observational data are captured through observation
of a behavior or activity. It is collected using methods such as
human observation and open-ended surveys.
 Types of Collecting Data

Experimental Data:
Experimental data are collected through active
intervention by the researcher to produce and measure change
or to create difference when a variable is altered.

Control Uncontrolled
Group Group
Tx A Tx B

Results
 Types of Collecting Data

Simulation Data:
Simulation data are generated by imitating or mirror
the operation of a real-world process or system over time
using computer test models.
 Types of Collecting Data

Derived / Compiled Data:

Data collected for health-related purposes typically
come from three sources, individual persons, the environment,
and health-care providers and facilities.
Numbers at a glance: WHO COVID-19
218,946,836 4,539,723
Confirmed cases Confirmed deaths
5,289,724,918
Vaccine doses administered
 Health Indicators
• Crude Birth Rate (CBR) – Overall total reported births
• Incidence Rate (IR) – Reported new cases affecting the population group
• Prevalence Rate (PR) – Determine the sum total of new & old cases of
diseases per percent population
• Crude Death Rate (CDR) – Overall total reported deaths
• Maternal Mortality Rate (MMR) – Maternal deaths due to maternal
causes
• Infant Mortality Rate (IMR) - # of infant deaths (0-12mos) or less than
1 yr old
• Neonatal Mortality Rate (NMR) - # of deaths among neonates (0-
28days or < month)
• Swaroop's Index (SI) – Deaths among individuals in the age grp 50
above
FREQUENCY AND
DISTRIBUTION
AMONG A
POPULATION
 Introduction
• Statistics are used to summarize the data collected

 describe risk

 make comparisons

 identify high-risk groups

 develop hypotheses about the cause(s) of disease

• Most common – frequency measures

 Rates, ratios and proportions

 Frequency Measures

• Ratios –

compares the occurrence of a variable in two different groups

Eg:

No. of male children attending a immunization clinic

No. of female children attending a immunization clinic

 Frequency Measures

• Proportions:

A proportion is a ratio which indicates the relation in

magnitude of a part of the whole

Eg:

No. Of male children attending the immunization clinic

Total number of children attending the immunization clinic

 Frequency Measures

• Rates:

 Type of frequency measure used with two-category

variables

 Measure the occurrence of an event in a population over

time

 Reflect groupings of people based on time, place and

person.
 Frequency Measures

• Comprises the following – numerator, denominator, time

specification and multiplier.

• Usually expressed as per 1000 or 1, 00,000 according to

convenience or convention to avoid fractions.
 Frequency Measures

• a ratio to compare two independent groups

• a proportion to compare one group with a larger one to

which it belongs

• a rate to measure an event in a population over time

Categories of rates:

 Crude rates

 Specific rates

 Standardized rates
 Mortality rates

• Mortality rates measure the frequency of occurrence of death

in a defined population during a specified interval

• Difference in the risk of dying from a disease

• Can serve as measures of disease severity

• Serve as surrogates for incidence rates when the disease being

studied is severe and lethal one.
 Mortality rates

• Essential components of death rates:

• A population group exposed to the risk of death

• A time period

• The number of deaths occurring in the population during that

time period
 Types of mortality rates

Crude Death Rate:

Number of deaths in an area in a year per 1000 population

counted at midyear

Total No. of Deaths from all causes in 1 year X 1000

No. of persons in the population at mid year
 Mortality rates

Specific mortality rates:

• To calculate the rate specifically for a group eg. Age, sex,

ethnic groups

Age specific mortality rate :

No. of deaths among children < 10 years in one year X 1000

No. of children in the population < 10 years of age at mid year

 Mortality rates

• Eg:

Annual mortality rate from leukemia

in children < 10 years of age

= No. of deaths from leukemia in one year in children < 10 years

No. of children in the population < 10 years at mid year

 Mortality rates
Case Fatality Rates:

• What percentage of people who have a certain disease die

within a certain time after their disease was diagnosed

• It is the measure of disease severity

No. of individuals dying during a specified

period of time after disease onset or diagnosis X 100

No. of individuals with the specified disease at that particular

time
 Mortality rates

Proportional Mortality Rate:

• Represents the no. of deaths due to particular cause per 100/

1000 total deaths

• Expressed as percentage

No. of deaths from a specific cause X 100

Total No. of deaths in the population

Example:

Assume a population of 1,00,000 of whom, 20 are sick with the

disease X and in that year 18 die from the disease X and total
deaths from all causes is 36.

Crude Death rate = 36 per 1 lakh population

Case fatality rate = 18/20 X 100 = 90%

Proportional mortality rate = 18/36 x 100= 50%

 Relevance of mortality rates in public health

• Single indicator which can signal a broad range of health

problems

• Clearly an index of the severity of a disease from both clinical

and public health stand points

• Also be used as an index of the risk the disease

 Relevance of mortality rates in public health

Are good reflection of incidence rates under 2 conditions:

• When the case fatality rate is high

• When the duration of disease is short

Eg: Ca. Pancreas is a highly lethal disease and death generally

occurs within months of diagnosis. Hence mortality rates from
ca pancreas can be taken as the incidence of the disease.
Limitations of mortality data:

• Incomplete reporting of deaths

• Lack of accuracy - inaccuracies in the recording of age and

cause of death

• Lack of uniformity

• Choosing a single cause of death

• Diseases with low fatality

 Comparing mortality in different population
• Important for the evaluation of community health status

• Used to compare two or more populations or one population in

different time periods

• populations may differ in regard to many characteristics & so

comparisons of crude rates can be misleading

• Differences in determinants can distort comparisons between

populations
 Advantages Disadvantages

Crude Death Rate  Actual summary rates  Since populations

vary in composition (e.g.,
 Readily calculable age), differences in
crude rates difficult to
interpret

Specific Rates  Homogenous  Cumbersome to

subgroups compare many
subgroups of two or
 Detailed rates useful more populations
for
epidemiologic and public
health purposes
 Comparing mortality in different population

Two criteria:

• Rates should relate the number of events to

the population at risk

• Because many health outcomes vary by

age, the effect of the population’s age
distribution must be taken into account
 Standardization of rates
• Set of techniques used to remove as far as possible the effects
of differences in age or other confounding variables when
comparing two or more variables

• Age and sex are two of the most common variables used for
standardization - called standardized rates

• Involves taking weighted averages of the stratum-specific

outcome measures
 Standardization of rates

• A standard is a set of weights that is used in taking weighted

average

Eg: if the only stratification variable is age, a standard might be

the amount of person-time or number of persons in a standard
population that fall into each of the age categories
 Standardization of rates

2 types :

 Direct standardization

 Indirect standardization
 Direct standardization

• To compare health outcomes among populations that may have

different age distributions

• Used when age specific rates of disease are known for the
populations being compared.

• A standard population is used in order to eliminate the effects

of any differences in age between the two or more populations
being compared
Standard population
 Defined as one for which the numbers in each age and sex
group are known.
 "Artificial populations" with fictitious age structures

 uniform basis for the calculation of comparable measures for

the respective reference population
Age Population No. Of Age Age Populati No. Of Age
group A deaths specific groups on B deaths specific
s in each death in each death
age rate age rate
group group
B1 A1 B2 A2

CDR = A1/B1 CDR =A2/B2

Age Std Age Expected Age Std Age Expected

groups populati specific deaths groups populati specific deaths
on death on death
rates rates
C1 D1 C1 D2

ADR1 = D1/C1 ADR2 = D2/C1

 Example 1:
Population A Population B

No. of deaths 862 1130

Total population 900000 800000

Crude mortality rate 96 142

(per 1,00,000
population)
 Example 1:
Population A Population B

No. of deaths 862 1130

Total population 900000 800000

Crude mortality rate 96 142

(per 1,00,000
population)
 Standard population

Age Population

30-49 900000

50-69 500000

>70 300000
• Age adjusted rates:

No. of expected deaths X 100000

Total standard population

• Population A = 1986 /1700000= 11 7 per 100000

population

• Population B = 2122/1700000= 125 per 100000 population

 Formulas

CRUDE BIRTH RATE (CBR)

CBR = Overall total reported births X 1000

Population

INCIDENCE RATE (IR)

IR = New cases of disease X 100

Population
 Formulas

PREVALENCE RATE (PR)

PR = New cases + old cases X 100

Population

CRUDE DEATH RATE (CDR)

CDR = Overall total deaths X 1000

Population
 Formulas

MATERNAL MORTALITY RATE (MMR)

MMR = # of maternal deaths X 1000

total # of livebirths

INFANT MORTALITY RATE (IMR)

IMR = # of infant deaths X 1000

TLB
 Formulas

NEONATAL MORTALITY RATE (NMR)

NMR = # of neonatal deaths X 1000

total # of livebirths

SWAROOP’S INDEX (SI)

SI = # of deaths (individual > 50yrs old) X 100

Total Deaths
Standards of Community Health
Nursing Practice
 Standards of Community Health
Nursing Practice
• Theory: The Nurse apples theoretical concepts as basis fror
decisions in practice.
• Data collection: The nurse collects data that are
comprehensive and accurate.
• Diagnosis: The Nurse analyzes data collected about the
community, family and individual to arrive at a diagnosis.
• Planning: At each level of prevention the Nurse develops
plans that specify nursing actions unique to the clients’
needs.
• Intervention: The Nurse, guided by the plan, intervenes to
promote, maintain or restore health, to prevent illness & to
effect rehabilitation.
 Standards of Community Health
Nursing Practice
• Evaluation: The nurse evaluates responses of the
community, family and individual to interventions in order
to determine the progress toward goal achievement &
eventually to revise the database.
• Quality assurance & Professional Development: The
Nurse participates in peer review & other means of
evaluation to assure the quality of nursing practice. He/she
assumes responsibility for his/her professional
development and contributes to the professional
development of others.
 Standards of Community Health
Nursing Practice
• Interdisciplinary collaboration: The Nurse collaborates
with other health care providers and professionals and
community representatives in assessing, planning,
implementing and evaluating community health programs.
• Research: The Nurse contributes to theory and practice in
community health through research.
 One could gain knowledge and skills
("knowing how") without ever learning the
theory ("knowing that").
In short, experience is a prerequisite
for becoming an expert.
 C.I.

You
Nurses encounter this all the time!!
 Thank You!!
Shukrane!!
Salamat Po!!
Arigato`!!
Muchas Gracias!!
Merci!!
Danke!!