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epidemiology

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the study of the occurrence and distribution of health-related states or events in specified populations, including the study of the determinants influencing such state, and the application of this knowledge to control the health problems

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scopes of epidemiology

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description of the disease pattern, search of causes, practical applications

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distribution, determinants and deterrents of morbidity and mortality

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three D's of epidemiology

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descriptive epidemiology

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describes the distribution of health, morbidity and mortality variable by person, place and/or time variables

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analytic epidemiology

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studies the determinants of health, morbidity and mortality

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experimental epidemiology

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compares various interventions; mostly clinical settings

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Hippocrates

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first of offer rational vs supernatural explanations for diverse occurrence based on observation. he advised to look for factors such as air, water, places, and personal habits

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avicenna

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persian philosopher and physician

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Fracastoro

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Renaissance physician from Verona

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John Graunt

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the father of biostatistics, used bills of mortality in a systematic manner, quantifying disease patterns

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William Farr

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founder of modern epidemiology, promoting multi-factorial epidemiology, understanding distribution and determinants of disease for prevention

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John Snow

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during cholera outbreak he conducted a natural experiment, to prove that water was contaminated water was from a certain pump was the vehicle of cholera spread

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James Lind

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navel surgeon, true experiment on soldiers suffering from scurvy - citrus fruit showed improvement

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Edward Jenner

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English surgeon, first to immunize against small pox using cowpox vaccine, observed milkmaids infected with small pox were immune

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Farmingham Heart Study

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longitudinal cohort was used to identify risk factors associated with cardiovascular disease

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MRFIT Study (multiple risk factor intervention trial)

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study thought to evaluate the effect of a multiple risk factor intervention on mortality and heart disease in high risk men

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Austin Bradford Hill

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process of randomization, proved causal relationship between smoking and lung cancer , developed criteria to judge causality of associations

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ecological model

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imbalance among host (factors affect susceptibility), agent (factor induces disease) and the environment (factors impacting exposure to agent, effectiveness of agent or susceptibility of host)

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holistic models of health

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go beyond the ecological model of disease by looking at multiple factors that influence health (SES, social environments, genetics)

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susceptibility, presymptomatic, disease, diminished capacity

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Four stages of disease - lead to cure or disability

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primary prevention

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attempts to reduce the frequency of new cases of disease (focus on general health promotion, risk factor reduction, immunization)

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secondary prevention

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attempts to reduce the number of existing cases of disease in a population (focus on early detection and treatment)

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tertiary prevention

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try to reduce complications, limit disability, and improve function following the onset of disease (focus on therapy and rehabilitation to reduce complications and improve QoL)

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1. research question/ plausible theory 2. the best (least biased) design to address the research question 3. measurement of exposure and outcome 4. analysis

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four hallmarks of epidemiological studies

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descriptive studies

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a class of observation studies that focus on characterizing morbidity and mortality in populations by person, place or time intervals; often have no hypothesis

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case report, case series, ecological studies, cross-sectional

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4 types of descriptive studies

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case series study

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study that describe the characteristics of a group or cluster of individuals with the same disease

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descriptive ecological studies

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in this study the unit of analysis is the group, not the individual. only an exposure or an outcome is asserted, no hypothesis

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descriptive cross-sectional studies

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study that is examined at one point in time, no hypothesis, designed to uncover patterns,study only one exposure OR one outcome

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analytic studies

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studies that are designed to test hypotheses about the association between an exposure and an outcome

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ecological, cross-sectional, case-control, prospective cohort, retrospective cohort, hybrid studies

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six types of analytic studies

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analytic ecological study

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study where the investigators have ecological unit measures of the exposure AND ecological unit measure of the outcome. The goal is to assess whether the exposure is related to outcome

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ecological

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......... fallacy is when the interpretation of statistical data that make inferences about the nature of individuals are deduced from inference for the group to which those individuals belong.

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analytic cross-sectional study

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study that assess both the exposure and outcome status at the same point in time. Goal is to assess whether the exposure is related to the outcome. Unit of analysis is the individual

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Difficult to determine whether the outcome followed exposure in time or exposure resulted from the outcome

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key limitation to cross-sectional studies

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prospective cohort studies

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these studies begin by classifying participants on the basis of their exposure status. Participants are typically free of the outcome at the start of the study. Participants are followed longitudinally to determine if the rate of development of the outcome is different in the exposed group compared to the unexposed Finding incidence implies that exposure is associated with outcome

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retrospective cohort study

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in this study design a historical cohort is reconstructed from existing data at the beginning. The study follow the cohort from the past to the present

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Case-control studies

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these studies begin by classifying participants according to their outcome status. Cases with the outcome are selected along with a comparable group of controls who do not have the outcome. Past exposures are assessed

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experimental studies

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studies that are designed to test hypotheses about the association between an exposure and outcome. Investigators control and manipulate the exposure status

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randomized controlled trials, community trials

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two major types of experimental studies

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Randomized Controlled Trials

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Four Steps to this study 1. selection of appropriate study sample 2. randomly assign 3. application of intervention 4. follow-up and outcome assessment

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Community Trials

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Four stages to this study: 1. selection of participating communities or groups 2. collection of baseline data of outcome 3. assignment and application of intervention 4. follow-up, outcome assessment and evaluation

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to conduct research that influences interventions, treatments, programs, and policies that aim to improve the health of populations by providing the evidence base for public health practice

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the ultimate goal of epidemiology

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risk perception

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the perceived size of a threat is an important element that affects human behaviour and health policy

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priority setting

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people tend to overestimate the risks from unusual or dramatic events, and risks that are beyond their control

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factors associated with risk amplification

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involuntary exposure, inescapable, risk from unfamiliar sources, risks from sources that are man made, risks that are poorly understood by science, inequitably distributed, affects vulnerable populations or identifiable victims

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politics of public health decision making

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there are several public health stakeholders that can impact public health decisions (researchers, industry, politicians, media, family doctors etc.)

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public health practice is influenced by

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evidence produced by researchers, perceptions of risk, the interests, views and priorities of other stakeholders

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proportion

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a ratio where the numerator is included in the denominator

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rate

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a ratio where time is expressed in the denominator

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prevalence rate

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the proportion of the population that has a given disease or other attribute at a specific time

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incidence rate

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the proportion of the population at risk that develops a given disease or other attribute during a specified time period

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Person Time Unit

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represent a single, combined measure of the number of persons at risk of an outcome and the total time they were at risk

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crude rate

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overall rate for the sample. determined by dividing the total # of events in a given time period by the number of people in the sample

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specific rates

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rates for distinct subgroup within a sample. Unlike crude rates, can be compared between samples without fear of confounding by the factors used to categorize the subgroups

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adjusted rates

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rates that have been modified mathematically- to remove the effect of one or more confounding factor

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causal

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in order to be considered .........a change in the exposure must result in a corresponding change in the outcome

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spurious associations

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are false associations that usually result from sampling error or bias

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sampling error

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the participants in the study are a figurative sample of the population they are drawn from. The participants could be different from the population, even if they are selected randomly

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noncausal associations

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are real associations but they are not causal. A change in exposure does not necessarily result in a change in the outcome. Usually represent secondary associations due to confounding factors. The association exists because the exposure is associated with another confounding factor that in turn is associated with the outcome

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causal associations

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........associations are those in which changes in the exposure produce changes in the outcome

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correct temporal sequence strength of association consistency of the association dose-response relationship biological plausibility experimental evidence

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Hills Criteria for Assessing Causation

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1. randomized controlled trial 2. randomized community trial 3. prospective cohort study 4. retrospective cohort study 5. case-control study 6. analytic cross-sectional study 7. analytic ecological study

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Types of Epidemiological Studies in Order of Causal Evidence Provided

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necessary cause

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an exposure the must be present for the occurrence of a given outcome

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sufficient cause

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an exposure that by itself can produce the outcome

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necessary and sufficient cause

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a causal factor whose presence is required for the occurrence of a given outcome, and which is able to cause the outcome by itself (rabies)

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necessary but not sufficient cause

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a causal factor whose presence is required for occurrence of a given outcome, but that outcome doesnt always occur when the factor is present (alcohol)

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not necessary but sufficient cause

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a causal factor which may or may not be present for the outcome to occur, but the outcome can occur when the factor is present by itself (radiation, pesticides and cancer)

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not necessary and not sufficient cause

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a causal factor which may or may not be present for the outcome to occur, and when it is present some other factor must also be present for the outcome to occur (diet factor and heart disease)

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direct causal association

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a causal pathway in which there are no intermediate steps

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indirect causal association

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involves one or more intermediate factors

Introduction to Epidemiology Test #1 – Flashcards

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