Epidemiology is a dynamic field concerned with the occurrence of disease and other health-related problems in human populations .

Its scope covers the description of disease patterns, the search for causes of disease, and practical allocations related to disease surveillance and control. Epidemiology has been referred to as the cornerstone of public health practice and provides the basis for our understanding health-related problems, including their distribution, nature history, antecedents, and prevention. Epidemiology is also important to the practice of medicine as increased knowledge of disease occurrence aids in diagnosis and reagent. Before defining epidemiology in greater detail, we will first take a closer look at its importance and applications. Epidemiology provides the basis for describing and explaining disease occurrence in a community. A typical epidemiologic question might be, How many new cases of acquired immune deficiency syndrome (AIDS) were reported among teenagers in the United States last year? If 300 new cases were reported, this tells us something about the occurrence of AIDS. We might, for example, want to compare the number of reported cases to numbers in prior years to get a sense of whether AIDS is increasing or decreasing in this age group. It would be better, however, to compare the rates of AIDS since the population of teenagers may have changed from one year to the next, and Rates allow us to make comparisons that account for differences in the sizes of the groups being compared. The importance of using rates instead of raw numbers to make comparisons is discussed in chapter 5. Describing public health problems from an epidemiologic perspective helps us to understand their potential significance and impact. Through comparisons of epidemiologic measures such as incidence, prevalence, and mortality rates we can identify potentially high-risk groups and perhaps begin to explain the reasons behind differences in disease occurrence. For example, the incidence of AIDS is almost three times higher in young adults, 20-24years of age, compared to teenagers. This suggests that the occurrence of AIDS varies by age. In seeking an exclamation for the difference, one might wan to examine behaviors or other factors that differ between the age groups and that might therefore account for the apparent difference in the risk of contracting the human immunodeficiency virus (HIV), WHICH has been implicated as the cause of AIDS. Greater promiscuous sexual activity and intravenous drug use, for example, are two factors that explain the higher rate of AIDS in young adults compared to teenagers in the United States. Epidemiology is also important to public health because it provides a basis for developing, prioritizing, and evaluating public health programs. Public health programs should be developed based on need, and the epidemiologic approach is helpful in needs assessment. As a prelude to developing new programs in public health, one might ask such questions as. What problems are present in the community? What problems have the greatest public health impact? and Are adequate health services available and accessible? These questions, and related ones, can be answered epidemiologically. Public health surveillance, a tool of epidemiology, and epidemiologic surveys can be used to assess the frequency and scope of particular public health problems. Measures of morbidity, mortality, years of potential life lost, as well as other epidemiologic measures, can be used to characterize the impact of public health problems. Finally, epidemiology can be used to evaluate the success of public health programs. Significant reduction in risk-taking behaviors, incidence of disease, or mortality may all be useful measures of a programs long-term success. Some other applications of

epidemiology are discuss By now, you should have a fairly good idea of what epidemiology is and why it is important to public health and medicine. It would be helpful, however, to have a good, concise definition of this field of study. For those who are interested in the origin of terms, epidemiology is derived from the Greek words epi (on or upon), demos(people), and logos(word or statement). Literally, it translates as a statement of what is upon the people. A more practical definition is offered below. This definition can be thought of as the 3-D definition of epidemiology, where each of the D words in the definition has special significance: Epidemiology is the study of the distribution, determinants, and deterrents of morbidity or mortality in human populations. The term distribution refers primarily to how morbidity (illness, disease, injure, etc.) or mortality (death) are distributed in a given population or community. Specifically, we are interested in describing the frequency and patterns of morbidity or mortality in terms of person, place, or time variables. Person variables related to who is affected; place variables relate to where they are affected; and time variables related to when they are affected. Table 1-2 lists some of the more common person variables that may be used to describe the distribution of morbidity or mortality. As an example, we might describe the distribution of lung cancer in the Unite States by age group, sex, race, smoking status, and occupation. This description would yield a fairly good picture of who is afflicted with lung cancer in the United States and would suggest what groups appear to be at greatest risk for this disease. Place variables include specific geographic areas (e.g., census tracts, neighborhoods, cities, counties, states, regions, countries) and general locations (urban or rural areas, schools or other institutions, indoors or outdoors, at home or at work, along the river, etc.). Time variables may include the time of onset of a given disease (i.e., hour of the day, day of the week, month of the year, etc.) or the time of diagnosis, especially for those health-related problems where it is virtually impossible to know the actual time of onset (e.g., depression ,arthritis, prostate cancer). Infectious diseases are usually classified by when the first symptoms of disease appear. Chronic diseases tend to be classified by the date of diagnosis. Classifying morbidity or mortality by time can also reveal temporal patterns of disease, which are illustrated in figure 1-1. Common temporal patterns of morbidity and mortality include: Short-term fluctuations Cyclic patterns Secular trends Generally, short-term fluctuations represent relatively brief, unexpected increases in the frequency of a particular disease. Short-term fluctuations are commonly manifested in epidemics. The sudden outbreaks of cryptosporidiosis in Milwaukee, Wisconsin, in this example over 400,000 people were afflicted with a parasitic infection causing diarrhea and abdominal pain over the course of several weeks. The source of the infection was traced to the protozoan Cryptosporidium partum, which was

spread through the public water supply. Once improvements were made in the water treatment system, the incidence of cryptosporidiosis dropped dramatically. Cyclic patterns represent periodic, often predictable, increases in the frequency of a particular cause of morbidity or mortality. For example, each year over the Labor Day weekend we expect that the number of traffic deaths will increase by anticipated amounted. Also, influenza tends to show a seasonal variation in frequency each year with the number of cases peaking in the late fall and winter months. Secular trends represent long-term changes in morbidity or mortality patterns. The U.S. mortality rate for septicemia, for example, showed a steady increase between 1951 and 1988. During the same time period, the mortality rate for cerebrovascular disease declined significantly and only recently has begun to level off. Caution must be exercised, however, in associating secular changes with external influences. Sometimes changes in diagnostic criteria, completeness of reporting, demographics, and other factors may explain part or all of secular trends. Describing the distribution of morbidity or mortality by person, place, or time variables is a major focus of descriptive epidemiology, this aspect of epidemiology is concerned with the variations of morbidity or mortality in a community. The characteristics of descriptive epidemiologic studies are discussed in chapter 4. While the term distribution in the definition of epidemiology refers to the who, where, and when of morbidity or mortality, the term determinants refers to why morbidity or mortality occur. The goal of this dimension of epidemiology, known as analytic epidemiology, is to identify the causes of morbidity and mortality. Uncovering the causes of morbidity and mortality is usually accomplished by testing hypotheses using a variety of epidemiologic research designs. Discovering the causes of morbidity and mortality is one of the most challenging aspects of epidemiology. The third D in the 3-D definition of epidemiology refers to deterrents. From a practical point of view, the ultimate goal of epidemiology is to prevent, reduce, or control morbidity and mortality in human populations. In a sense, describing the distribution and identifying the determinants of mortality and morbidity are a prelude to seeking deterrents. Morbidity and mortality can sometimes be controlled without fully understanding their distribution or determinants, as history has shown, but knowledge of these aspects often leads to more effective strategies for their prevention or reduction. Finally, epidemiology is concerned with human populations. As a branch of public health, epidemiology is a human science, and it seeks to understand and explain health-related problems in defined groups of people or communities (e.g., the population of a state or region, African Americans, woman between 45 and 54 years of age). Clinical epidemiology, an offshoot of classical epidemiology, is patient oriented; it seeks to use epidemiology to aid decision making about clinical cases of disease, such as in the diagnosis, proged in the section that follows.