Chapter 3

Distribution of
Disease
 Section 1 Epidemic
Strength of Disease
Definition: epidemic strength of
disease refers to the variability and
characterization of incidence of a
certain disease in certain place,
certain population, and in certain
period time.
 There are three terms to describe the
epidemic strength of disease.
1.Sporadic
That means the number of incidence is
not lot, and there is no obvious
transmitting relationship among
patients, or incidence rate is no more
than general level in a certain place.
general level:average incidence rate of
former three years
 Reasons of sporadic:
(1)Some diseases are epidemic often in a
certain place, or people in this place have
been vaccinated , so they have high level
of immunity. Measles
(2)Infectious diseases in which covert infection
are mainly, most patients have no obvious
symptom,we can not find them. HB
(3)Infectious diseases which have a long
incubation period ,the spread speed is very
low. lepra
2. Epidemic
Epidemic refers to the incidence rate
of disease in some place is
obviously higher than sporadic
level.(3-10 times)
3.Outbreak
If many cases with the same
symptom suddenly occurred in
small community or collective unit
in short time, we can tell this
phenomenon as outbreak.
Short time : refers to the longest
incubation period of some disease.
Such as food poisoning, HA.
Reasons:
All of cases maybe contact with the
same source of infection, or
infected through the same route.

SARS
Section 2 Distribution
of Disease
 Definition
Distribution of Disease descript
the frequency and distribution
of diseases within different
time, place and population.
 Population
Age
Sex
Race
Behavior
 1 Age

Age is the most important

determinant among the
personal variables.Mortality
and morbidity rates of almost
all conditions show relation to
this variable.
 Aim to study distribution of
disease for age:

① To help explore the

determinants and provide clues
for study the cause of disease.
②To help pose important
protecting objects and find high
risk population.
 Mortality rate ---Age

Figure 6-1
Incidence rate---Age

Many infectious diseases such

as measles, are considered
childhood disease,that is to
say, the highest frequency of
occurrence is in the younger
age groups.
 incidence rate---Age

Figure 6-2
 2 Sex
The mortality and morbidity rates of
most diseases have also
relationship with sex. But there is
an interesting phenomenon. Death
rates are higher for males than
females, but morbidity rates are
generally higher in females.
Figure 6-1
This results may be due to sex
linked inheritance or to differences
in hormonal balance, environment
or habit patterns.
 The reasons of relatively high morbidity
and low mortality in women are:
① the women seek medical care more
freely and early and they can be
diagnosed early and then have a suitable
treatment .
② the same disease will tend to have a less
lethal course in women than in men.
 A good example:
depression
Rates of depression were twice as
high in women as in men, and the
rate of attempted suicide is also
higher in women.
However, completed suicide are
more common in men.
 3 Race
Mortality and morbidity rates of
some diseases are different
among variable races. This
probably due to different
inheritance, environment,
customs, religious ,and so on.
 For example: United
States
Blacks: higher rates of deaths caused
by hypertensive heart disease,
cerebrovascular accidents, tuberculosis,
syphilis, and accidental death.
Whites: higher rates of deaths from
arteriosderotic heart disease ,suicide,
and leukemia.
 4 Behavior
Such as smoking, drinking, taking
drugs ,and so on.
Smoking---lung cancer ,stomach
cancer, liver cancer, esophagus
cancer, and so on.
 AIDS:
These years,the incidence of AIDS
increases more quickly. Why?
The important reason is that they
took drugs with syringe and being
infected with HIV.
 Place
The frequency of disease often
varies by geographic location.
It implies that these variations
in frequency provide etiologic
clues.
two aspects :
One is native environment
factors,such as special graphic
location,weather condition.
The other is social environment
including custom habit and social
culture background.
 1.International
Comparisons
In different countries, disease
and death rates are also
different.
They also may provide clues to
causation of disease.
 Figure 6-12

Age-adjusted death
rate for breast
cancer,1966-1967.
13
Such marked contrasts provide
opportunities to formulate
etiologic hypotheses and test
them.
 2.Urban-Rural Difference
The distribution of disease in
urban or rural is very different
because they have different
characteristics.
In rural, there are a number of health problems
because of working farms, such as:
(1) farm accident--- cause disability and death
(2)skin cancers--- because farmers exposure usually to
ultraviolet radiation.
(3) exposure to pesticides---poisoned
(4)exposure to a variety of microorganisms – cause
different kinds of infectious disease.
(5) health condition is bad---infectious disease in
intestines
In urban ,people also face with a
variety of hazards to health.
Air pollution is very serious---cause
disease of respiratory system, such as
lung cancer, bronchitis, and so on.
But in urban, health condition is better
than rural ,so infectious disease in
intestines less than in rural.
 Time
Study of disease occurrence by time is a
basic aspect of epidemiologic
analysis.There are 3 major kinds of
change with time.
The first consists of long-term variations
called secular trend.
The second is periodic fluctuations on an
annual or other basis,cyclic change.
Finally,there is short-term fluctuation
talked about in other chapter.
 1.Secular Trend
This term refers to changes over a
long period of times,years or
decades.Such trend may occur in
both infectious and noninfectious
diseases.
Figure 6-14
Figure 6-15
Apparent secular trends in morbidity
or mortality may be due to these
reasons as below:
 change of diagnostic
methods;lung cancer
 change of treatment
methods;stomach cancer
 increasing of life level; CHD
 2.Cyclic variation
Cyclic variation refers to that
diseases occur every several
years.
For example,
measles : two or three years.
influenza A :two- to three- year
influenza B :four to six years.
Cyclic variation of some disease is not
invariable. It can be changed by use of
immunization.
For example, Measles: every 2 or 3 years
before immunization,
every 5 to 7 years after immunization.
The epidemic peak from February to April.
That is because the level of immunization in
population increases, then the susceptibility
in population decreases.
Seasonal Variation :
Seasonal variation refers to
incidence rates of some diseases
increase in certain season in
every year.
Infectious diseases:
(1) Strict seasonality: occur only in
some certain months, in other
months rarely, such as malaria
transmitted by mosquito, only
occurs in July to September
because mosquito can live only in
summer.
(2) Not strict seasonality:
Some diseases can occur all of one year, but
increase in certain seasons.
For example, bacterial dysentery can occur
every season but the epidemic peak is in
summer and autumn.
For measles, the incidence rate increases in
December to next year April. But this
characterization can change because of
immunization.
(3)No seasonality:
The diseases which are spread
through touching in daily-life,such
as tuberculosis, lepra, can occur in
every month.

Noninfectious diseases:
no obvious seasonality.
The reason of seasonal variation
maybe related to temperature,
humidity, insect vector, people’s
activity, custom and so on.
 Important consents:
1.What is distribution of disease.
2.Conception of sporadic, epidemic
and outbreak.