Basic measurement in epidemiology
Incidence & Prevalence
Tools of measurement in epidemiology
Epidemiological methods
Descriptive epidemiology.
Distribution of disease in term of Time, Place and Person
2. Measurement of
▪ Mortality
▪ Morbidity
▪ Disability
▪ Presence or absence or distribution of characteristic or
attributes of disease
▪ Health care or health utilization
▪ Demographic variables
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▪ Incidence – the no. of NEW cases
occurring in a defined population
during a specified period of time".
▪ Prevalence – all current cases (old
and new) existing at a given point in
time, or over a period of time in a
given population.
▪ Prevalence = Incidence * Duration of
illness
5. ▪Rate
▪ It measures the occurrence of particular event in a population
during given time period.
▪ A rate comprises the following elements - numerator, denominator,
time specification and multiplier.
▪ Example:
Death rate = No. of death in a year/ Mid year population * 1000
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6. ▪Ratio
▪ It expresses a relation in size between two random quantities.
▪ The numerator is not a component of the denominator.
▪Proportion
▪ It is a ratio which indicates the relation in magnitude of a part of the
whole.
▪ The numerator is always included in the denominator.
▪ It is usually expressed as a percentage.
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7. ▪Descriptive
▪Analytic
▪Experimental
▪Study of the occurrence and
distribution of disease
▪Further studies to determine the
validity of a hypothesis concerning
the occurrence of disease.
▪Deliberate manipulation of the cause
is predictably followed by an
alteration in the effect not due to
chance
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8. OBSERVATIONAL STUDIES
DESCRIPTIVE STUDY ANALYTICAL STUDIES
✓ TIME
✓ PLACE
✓ PERSON
➢ ECOLOGICAL STUDY
➢ CROSS SECTIONAL STUDY
➢ CASE-CONTROL STUDY
➢ COHORT STUDY
EXPEREMENTAL STUDIES
➢ RANDOMIZED CONTROLLED TRIAL (RCT)
➢FIELD TRIAL
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9. ▪1st phase of an epidemiological investigation
▪Descriptive analysis is limited to a description of the
occurrence of a disease in a population & identifying the
characteristics associated with it
▪Relatively inexpensive and less time-consuming than
analytic studies.
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10. ▪Patterns of disease occurrence, in terms of,
▪When is the disease occurring – time distribution
▪Where is it occurring – place distribution
▪Who is getting a disease – person distribution
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11. ▪ Defining the population to be studied
▪ Defining the disease under study
▪ Describing the disease by
✓ Time
✓ Place
✓ Person
▪ Measurement of disease
▪ Comparing with known indices
▪ Formulation of etiological hypothesis
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12. ▪Define the population in
relation to:
1. Number
2. Age
3. Gender
4. Occupation
5. Cultural and other
characteristics
▪The defined population
can be:
1. Whole population
2. Sample
3. Specially selected
groups
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13. ▪Large enough
▪Stable (no migration)
▪Clear on who belongs to the population
▪Community participation
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14. ▪The epidemiologist defines the disease which can be
measured and identified in the defined population with a
degree of accuracy (operational definition).
▪This is different from the clinician’s definition of a disease.
▪Example - tonsillitis might be defined clinically as an
inflammation of the tonsils caused by infection, usually with
streptococcus pyogenes.
▪OD - presence of enlarged, red tonsils with white exudate,
which on throat swab culture grow predominantly S.
pyogenes.
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15. TIME PLACE PERSON
Climatic zones Age Birth order
Year, season
Month, week
Country,
region
Gender
Marital state
Family size
Height, weight
Day, hour
Duration
Urban/rural
Towns, cities,
institutions
Occupation
Social status
Education
BP.
Cholesterol,
habits
Objective of descriptive epidemiology?
This involves systemic collection and analysis of data.
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17. ▪An epidemic is the best known short term fluctuation.
▪It is defined as “ The occurrence in a community or region
of cases of an illness or other health related events clearly
in excess of normal expectancy”
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18. ▪ A graph of time distribution ofepidemic cases is called epidemic curve.
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▪ Common source epidemics-
a) Single/Point exposure
b)Continuous/Multiple exposure
▪ Propagated epidemics
a) person to person
b)arthropod vector
c) animal reservoir
▪ Slow(modern) epidemics
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20. ▪ Single exposure
It can occur due to an infectious agent or as a result of
contamination of the environment and develops within one
incubation period. Eg: Bhopal gas tragedy, Minamata
disease
The epidemic curve rises and falls rapidly, usually has one
peak
It tends to be explosive (i.e. clustering of cases within a short
time) 14
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22. ▪ Continuous exposure
It is when the exposure from the same source is prolonged
and the epidemic continues over more than one incubation
period.
The epidemic reaches a sharp peak, but tails off gradually
over a longer period of time.
Eg: A well of contaminated water or nationally distributed
vaccine(polio vaccine) or food; water borne cholera.
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24. ▪The epidemic shows gradual rise and tails off over a much
longer period of time
▪It is more likely to occur where there is
▪large number of susceptible are aggregated
▪regular supply of new susceptible individuals (Births,
Immigrants)
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26. COURSE OF A TYPICAL PROPAGATED EPIDEMIC
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27. ▪Seasonal trend-
▪Seasonal variation is characteristic of many
communicable diseases.
▪Eg: Measles, upper respiratory tract infections(seasonal
rise during winter), Malaria, etc.
▪Non-infectious diseases and conditions may sometimes
exhibit seasonal variation.
▪Example - Sunstroke, hay fever
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29. ▪Some diseases occur in cycles spread over short periods
of time (days, weeks, months or years) .
▪Eg: Influenza pandemics are known to occur at intervals
of 7-10yrs due to antigenic variations.
▪Non-infectious conditions may also occur in this trend.
▪Eg: Automobile accidents are more frequent on
weekends.
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30. ▪It refers to changes in the occurrence of disease over a
long period of time.
▪Eg: Coronary disease, diabetes showing consistent
upward trend,
▪decline in TB, polio in developed countries during the
past 50 yrs.
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32. InternationalVariation
▪Descriptive studies have
shown that the pattern
of a disease is not the
same everywhere
▪Eg: Cancer of the
stomach is very
common in Japan, but
unusual in the US.
NationalVariation
▪There are variations in
disease occurrence
within countries.
▪Example:
▪Endemic goitre,
▪Fluorosis
▪Malaria
▪Nutritional deficiencies
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33. ▪Due to differences in population density, levels of
sanitation, deficiencies of medical care, education and
environment factors, there exists a rural-urban variation
▪Chronic bronchitis, cardiovascular diseases, accidents are
more frequent in urban than rural areas.
▪Skin and zoonotic diseases and soil transmitted helminths
may be more frequent in rural than urban areas
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34. ▪These variations can be
studied with the help of “spot
or shaded” maps.
▪If the map showed clustering,
it may suggest a common
source of infection.
▪Eg: Study of Cholera epidemic
by John Snow in 1854
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35. ▪Way of distinguishing genetic and environmental factors.
▪Study of genetically similar groups but living under
different environmental conditions.
▪ Eg: Twins
▪Study of genetically different groups living in a
similar environment.
▪ Eg: Men of Japanese origin living in USA have higher rate of
coronary heart disease than the Japanese in Japan
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37. ▪Cross sectional study – Prevalence
▪It is based on a single examination of a cross section of
population at one point in time.
▪More useful for chronic diseases
▪Longitudinal Study – Incidence
▪The observations are repeated in the same population
over a prolonged period of time by means of follow up
examination.
▪Longitudinal is more useful, but it is time consuming.
▪Mortality, Morbidity & Disability
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38. ▪Making comparison
▪Asking question
▪It helps to
▪Arrive at clues to the disease’s etiology
▪Identify groups at increased risk
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39. ▪It is a supposition, arrived at from observation or
reflection
▪It should specify following:
▪ Population
▪ Specific cause being considered
▪ Expected outcome – the disease
▪ Dose-response relationship
▪ Time-response relationship
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40. ▪Contributes to research by describing variations in
disease occurrence by time, place and person
▪Clues to disease epidemiology – aetiological
hypothesis
▪Data regarding magnitude of disease load and types of
disease problems in community in terms of morbidity
and mortality
▪Background data for planning, organizing and
evaluating preventive and curative services
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41. ▪Epidemiological methods (Classification)
▪Descriptive epidemiology
▪Defining the population
▪Defining the disease under study
▪Describing the disease
▪Measurement of disease
▪Comparing with known indices
▪Formulation of etiological hypothesis
▪Uses
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Steps