BASIC

By
dr. Abdul Malik Setiawan, M.Infect.Dis.
OUTLINE

• What is Epidemiology
- Definitions of Epidemiology
- Triad Epidemiology
- Basic terms in epidemiology
• Measuring Health and Disease
- Measuring disease frequency
- Basic tools in epidemiological studies
• Types of Study
The story of John Snow
The Story of John Snow

• Dr. John Snow is an obstetrician

• He believed that water contaminated by sewage was the cause of
Cholera
• Snow published an article in 1849 outlining his theory, but doctors
and scientists thought he was wrong
• Ten of thousands of people in England died of Cholera between 1831
and 1854
• In August of 1854 Soho, a suburb of London, was hit hard by a terrible
outbreak of cholera. Dr. Snows himself lived near Soho.
The Story of John Snow

• Dr. Snow investigated when and how the outbreak started

• Most of the victims lived or worked around the Broad street pump
• Snow also investigated people who lived around soho but did not get
Cholera
• He found several important examples. A workhouse, or prison, near
Soho had 535 inmates but almost no cases of cholera.
What is Epidemiology?
Epidemiology

• Epidemiology is the study of the determinants,

distribution, and frequency of disease in human
populations
• Who gets disease and why
• Epidemiologists study sick and well people to
determine the crucial difference between those who
get disease and those who are spared
Purpose of Epidemiology

• To provide a basis for developing disease control

and prevention measures for groups at risk.
• Developing public health measures to prevent
or control disease.
Population Focus

• The focus of epidemiology is on the occurrence of

health and disease in the population.
• What happens to many

• In contrary with the concern of clinical medicine,

with health and disease in the individual.
• What happens to one
What is a Population?
• The common definition of a population is “All the
inhabitants of a given country or area considered
together;…”
• A “population” can also be groups of individuals that
share a common thread
• Clinical populations
• Subgroups of the population by age, race, etc…
Epidemiology as a population science

• Diseases are expressed biologically in individuals,

however, no epidemiological study can be done on
one person
• Epidemiology studies humans in the aggregate (i.e.
groups)
• Conclusions are directly applicable to the groups studied
• Conclusions are only indirectly applicable to individuals
Epidemiology is…

• The study of disease and its treatment, control,

and prevention in a population of individuals.
• Whole populations may be examined, but…
• Samples of the population may be examined.
• Samples that are studied must be representative
of the population for the results to be generalized
to the total population.
Measuring Health and Disease
Measuring Disease Frequency

• Population at Risk
• Incidence and Prevalence
• Case Fatality
• Mortality
• Morbidity
 Population at Risk

• The correct estimate

of the numbers of
people under study
• Only include people
who are potentially
susceptible to the
diseases being studied
Incidence

The development of new cases of a disease that occur

during a specified period of time in previously disease-
free or condition-free (“at risk”) individuals.

Number of NEW cases

of disease in population
in time period
Incidence =
Rate Population at risk during
The same time period
There are two fundamental approaches to
considering the incidence of disease or a
health condition
- Incidence Rate (IR)
- Cumulative Incidence
(IR x Time)
 Prevalence
• Prevalence: is the proportion of a population who have
(or had) a specific characteristic in a given time period
• It quantifies the “burden” of disease

Number of existing cases

of disease in population
Prevalence in time period
Rate = Persons in population
in same time period
Case-fatality

• Case-fatality is the frequency in which cases of disease die

• Case-fatality rate: the proportion of persons who die from
a disease
Basic Measurements of Disease or Health
Outcome Frequency in Epidemiology

• Measurement of Mortality (death)

• Measurement of Morbidity (incidence, prevalence)
 Mortality
• Mortality : is one of the major measures of disease in the
population
• information available from death certificates (required by law)

Number of deaths
in time period
Mortality rate / = Number at risk
Crude Death rate
of dying in period
Example of Mortality rate

Infant Mortality Rate:

assess the risk of dying during the first year of life

Number of deaths
under age 1 year
in time period
Infant Mortality Rate =
Number of live births
in time period
TIPES OF EPIDEMIOLOGICAL STUDIES
Types of Epidemiological Studies
• Observational studies;
1. Descriptive Study
2. Analytical Study
3. Cross Sectional
4. Case-control
5. Cohort
• Experimental Studies;
1. Randomized Controlled Trials (RCT)
Epidemiology Practices

• Descriptive Epidemiology
• Examining, identifying, and reporting on the frequency and
distribution of disease in a population. Learning the basic
features of its distribution.
• Example : Mortality rates of CVD in Indonesia in the last 10 years

• Analytic Epidemiology
• Identifying factors underlying disease or health events. Testing a
hypothesis by studying how exposures relate to outcomes
• Example : Risk factors of CVD in Indonesian smokers
Epidemiology Practices

• Experimental Studies
• Using information from analytical studies, develop
strategies centered around an important exposure
factor. Test these strategies with clinical trials.
• Example : Roles of Tobacco packaging warning messages on
decreasing smokers number in Malang
• Program Evaluation
• Examining the effectiveness of programs for disease
control in the community
• Example: program evaluation of vitamin A-fortified cooking oil to
reduce vitamin A deficiency in infants
There is a logical sequence to the practice of
epidemiology in disease prevention

Descriptive Analytical Interventions Programs

Disease
prevention
AN EXAMPLE OF EPIDEMIOLOGICAL STUDY

Framingham Heart Study :

• Study to determine the common factors or characteristics that
contribute to Cardiovascular Disease (CVD)
• Started in 1948 in the town of Framingham, Massachusetts – USA
• The original study involved 5,209 Men and Women 30-62 years old
with no symptoms of CVD / suffered a hearth attack or stroke.
• The respondents then followed for 20 years
Basic Question in Research
Are exposure and disease/outcome linked?

Is there an association between them?

Exposure Disease / Health Outcome

Types of Studies

• Cross-Sectional Study :
Measure the prevalence of disease and thus are often called
prevalence studies. In a cross-sectional study the measurements of
exposure and
effect are made at the same time
• Case-Control Study :
Provide a relatively simple way to investigate causes of diseases,
especially rare diseases. The investigators collect data on disease
occurrence at one point in time and exposures at a previous point in
time.
• Cohort Study :
Also called follow-up or incidence studies. Begin with a group of
people who are free of disease, and who are classified into subgroups
according to exposure to a potential cause of disease or outcome.
Variables of interest are specified and measured and the whole cohort
is followed up to see how the subsequent development of new cases
of the disease (or other outcome) differs between the groups with
and without exposure
Which Study is this ?
Which Study is this ?
THANK YOU