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Hippocrates

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He departed from the belief that disease was due to supernatural causes. He suggested that environmental factors like water quality and air quality had implications on health. But he did not pinpoint agents.

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John Graunt

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Published a book with descriptive data on birth and death (season variations, infant mortality, and excess of male population)

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Sir Percival Pott

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Thought to be the first surgeon to describe an environmental cause for cancer. He noticed that chimney sweepers had higher scrotal cancer in comparison to other workers. He said that it was attributed to soot. First known carcinogen

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John Snow

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Cholera in London. English anesthesiologist who innovated many epidemiology methods utilized today. Broad street connect to a water pump in the area. Used Descriptive and Analytic epi.

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John Snow

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The factor experiment. He stated that if the workers inside the factory were not getting sick, then the people in the surrounding neighborhood were not getting sick because of the factory.

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Robert Koch

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German physician verified that a human disease was caused by specific organisms. He isolated the bacteria that caused anthrax and cholera.

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Uses of Epidemiology

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Historical uses community health use health services risk assessment Disease causality

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Ratio

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x/y

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rate

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x/deltaT

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Proportion

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a/(a+b)

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Percentage

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a/ (a+b) x 100

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Prevalence

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number of existing cases of a disease or death in a population at a certain time

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point prevalence

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all the cases of a disease, health condition, or deaths that exist at a certain time, relative to a specific population

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period prevalence

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all cases of the disease in a certain period of time

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lifetime prevalence

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denotes cases diagnosed at anytime during the person's life

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Incidence

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refers to the occurrence of new diseases of mortality within a defined period of observation (a week/month/year) in a specific population

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Population at risk

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members of a population who are capable of developing the disease

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Incidence rate

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number of new cases/ population at risk

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Proportional mortality rate (PMR)

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the number of deaths in a population due to a specific disease divided by the total number of deaths in the population

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crude death rate

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a type of rate that has not been modified to take account of any of the factors such as demographic make-up of the population that may affect the observed rate.

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Case fatality rate (CFR)

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refers to the number of deaths due to a disease to occur among persons who are afflicted by the disease. Measures the lethality of a disease.

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cause-specific rates

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Mortality (frequence of a given disease)/ population at midpoint of the time period

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age-specific rates

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the number of diseases per age group of the population during a specified time period.

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sex-specific rate

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refers to the frequency of a disease in a gender group / the total number of persons within that gender group during a time period times a multiplier.

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Factors that affect the reliability of data

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The nature of the data The availability of the data The completeness of the population coverage Appropriateness

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External validity

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refers to the generalizability of the findings to the population from which the data have been taken.

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Vital events

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deaths,births,marriages,divorces, and fetal deaths

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Death Statistics

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Data is very complete because deaths are unlikely to go unreported. A certificate in the US will include (Age, sex, race cause of death, immediate and contributing factors).

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Inaccuracies of death statistics

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They list multiple causes of mortality as well as the underlying cause. However assignment of the actual cause is sometimes arbitrary. The person may have had diabetes, but their cause of death might be put as heart failure, which was actually caused by their diabetes.

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Birth Statistics

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Include lived births and fetal deaths. They help calculate birth rates. Information is collected about a range of conditions that may affect the neonate, including conditions present during pregnancy, congenital malformations, birth weight, length of gestation and demographic background of the mother

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Inaccuracies of Birth Statistics

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possible inconsistencies and gaps in the mother's recall of events during the pregnancy. Some malformations may not be detected at the time of birth. States have different requirements for fetal death certificates

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Examples of Public Health Surveillance

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communicable and infectious diseases, noninfectious diseases and risk factors for chronic disease.

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Public Health Surveillance

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refers to the systematic and continuous gathering of information about the occurrence of diseases and other health phenomena.

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Syndromic surveillance

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using health related data that precede diagnosis and signal a sufficient probability of a case of an outbreak to warrant further public health response. It's utility for detecting outbreaks associated with bioterrorism is increasingly being explored by public health officials. These programs operate at local, national and international level.

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Communicable and infectious disease (surveillance program)

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In the US, health care providers and related workers send reports of diseases (notifiable and reportable diseases) to local health departments, which in turn forward them to the state departments and then to the CDC. The CDC reports the occurrence of internationally quarantinable diseases to the WHO

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Noninfectious diseases (surveillance program)

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focus on the collection of information related to chronic diseases such as asthma.

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Behavioral Risk Factor Surveillance system (BRFSS)

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A program used by the United States to monitor at the state level behavioral risk factors that are associated with chronic diseases.

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case registries

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is a centralized database for collection of information about a disease. Used to track patients and to select cases in case-control studies.

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SEER Program

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registers routinely collected data on patient demographics, primary tumor site, tumor morphology and stage at diagnosis, first course of treatment, and follow-up for vital status. It is the only comprehensive source of population-based information in the United States that includes stage of cancer at the time of diagnosis and patient survival data.

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National Center for Health Statistics

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extensive scope of information available. National Vital System , National Health care survey, National health interview survey and more

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Life expectancy

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refers to the number of years a person is expected to live, at any particular year.

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Maternal Mortality

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encompasses maternal deaths that result from cases associated with pregnancy.

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Maternal mortality rate

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# of deaths assigned to causes related to childbirth/ # of live births

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infant mortality rate

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defined as the number of infant deaths among infants aged 0 to 365 days / number of live births during the year

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fetal mortality rate

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defined as the deaths of the fetus when it is in the uterus and before it has been delivered. (divided from after 20 and 28 weeks of gestation)

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crude birth rates

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number of live births during a specified period (year)/ population size at midpoint of the year

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general fertility rate

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number of live births within a year/ number of women aged 15-44 years during the midpoint

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Perinatal mortality

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late infant deaths, after 28 weeks of gestations plus infant deaths within 7 days of birth / number of live births + number of late fetal deaths

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Descriptive epidemiology

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classifies the occurrence of disease according to the variables of person (who is affected), place (where the condition occurs), and the time (when and over what time period the condition has occurred)

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A descriptive epidemiologic study

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is one that is concerned with characterizing the amount and distribution of health and disease within a population.

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Aims of Descriptive epidemiology

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permit evaluation of trends in health and disease provide a basis for planning, provision, and evaluation of health services identify problems to be studied by analytic methods and suggest areas that may be fruitful for investigation

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Types of analytic studies

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case-control, cohort and experimental designs

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Types of descriptive epidemiological studies

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case reports, case series and cross-sectional studies

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case reports

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are accounts of a single occurrence of a noteworthy health-related incident or small collection of such events

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case series

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a larger collection of cases of diseases, often grouped consecutively and listing common features such as the characteristics of affected patients

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cross-sectional studies

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one that examines the relationship between diseases (or other health related characteristics) and other variables of interest as they exist in a defined population at one particular time.

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Urban-rural difference

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Exposure to pesticides Lead poisoning

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localized pattern of disease

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diseases associated with specific environmental conditions that may exist in a particular geographic area.

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secular trends

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refers to gradual changes in diseases over a long period of time

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Cyclic trends

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are increases and decreases in the frequency of a disease or other phenomenon over a period of several years or within a year

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point epidemics

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may indicate the response of a group of people circumscribed in a place to a common source of infection, contamination, or other etiologic factor to which they were exposed almost simultaneously.

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Bernardino Ramazzini

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The founder of occupational medicine . Authored De Morbis Artificum Diatriba

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Edward Jenner

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discovered Smallpox

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Cross-sectional study

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a type of investigation that examines the relationship between diseases (or other health related characteristics). A type of Prevalence study

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ecologic studies

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the unit of observation is the population or community. Disease rates and exposures are measured in each of a series of populations and their relation is examined

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Case Control Study

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Compares individuals who have a disease with individuals who do not have the disease in order to examine differences in exposures or risk factors for the disease.

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Cohort study

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A type of study that collects data and follows a group of subjects who have received a specific exposure. The incidence of a specific disease or other outcome of interest is tracked over time. The incidence in the exposed group is compared with the incidence in groups that are not exposed, that have different levels of exposure, or that have different types of exposures.

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Advantages of Ecological Studies

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May provide info about context of health can be performed when individual level measurements are unavailable Can be conducted rapidly with minimal resources

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Disadvantages of Ecological Studies

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The ecologic Fallacy Imprecise measurement of exposure Uncontrolled factors can change the outcome

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Advantages of Cross Sectional studies

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hypothesis generation intervention planning estimate magnitude and distribution of problem

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Disadvantages of Cross Sectional Studies

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Difficult to determine temporality Not good to study rare exposures No incidence data hard to tell exposure from outcome Can't study with low prevalence disease

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Advantages of Case Control Study

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Study low prevalence conditions relatively quick and easy Usually inexpensive small number of subjects

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Advantages of Cohort study

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Direct comparison of risk exposure factor defined Temporality is known

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Disadvantages of Case Control Studies

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Measure of exposure may be inaccurate representation of cases and controls may be inaccurate provide indirect estimates of risk temporality relationship between exposure factor and outcome can't always be ascertained

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Disadvantages of Cohort Study

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Expensive and time consuming complicated and difficult to carry out Subjects may be lost due to follow up during the course of the study (death) exposure can be misclassified

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