Overview of Epidemiology+Descriptive Epidemiology

Epidemiology and Research Methods I

Dr. RJ Butacan||January 5, 2017

Content Outline: EPIDEMIOLOGY); Looks at the causes of a certain
I. Overview of Epidemiology disease, answers how and why
A. Definition • Epidemiologists assume that illness does not occur
B. Concepts randomly in a population, but happens only when the
C. Famous Epidemiologists right accumulation of risk factors or determinants
II. Descriptive Epidemiology exists in an individual.
A. Significance
i. Time 4. HEALTH-RELATED STATES/EVENTS
ii. Place • May be seen as anything that affects the well-being of
iii. Person
III. Descriptive Epidemiology of HIV-AIDS in the
a population
Philippines o Anything medically related to the population
IV. Mini Quiz • Originally focused on epidemics of communicable
diseases but subsequently expanded to include non-
LEGEND: communicable diseases, chronic diseases, injuries,
‼ maternal-child health, occupational health and
environmental health.
Presentation Mentioned in Remember Book
the lecture 5. SPECIFIED POPULATIONS
• Focuses on the collective health of the people in a
OBJECTIVES community or population.
• To explain the importance and application of epidemiology in o Identifying the exposure or source that
the practice of medicine caused the illness
• To analyze various illnesses in terms of descriptive o The number of other persons who may have
characteristics of time, place and person been similarly exposed
o The potential for further spread in the
OVERVIEW OF EPIDEMIOLOGY
community
Definition of Epidemiology o Interventions to prevent additional cases or
• EPI: meaning on or upon recurrences
• DEMOS: meaning people
• LOGOS: Meaning the study of 6. APPLICATION
• “The study of what befalls a population” • Applying the knowledge gained by the studies to
• Merriam-Webster: community-based practice
o A branch of medical science that deals with • Uses descriptive and analytic epidemiology as well as
the incidence, distribution, and control of experience, epidemiologic judgment, and
disease in a population understanding of local conditions in “diagnosing” the
o Sum of the factors controlling the presence health of a community
or absence of a disease or pathogen
The study of the distribution and determinants of health- Famous Epidemiologists
related states or events in specified populations, and the 1. JOHN GRAUNT (1620-1674) AND THE POPULATION OF
application of this study to the control of health problems. LONDON
• Developed early human statistical and census
1. STUDY methods (quantitative method in describing
• A quantitative discipline that relies on probability, population vital statistics)
statistics and sound research methods • Credited with producing the first life table
• A method of causal reasoning based on developing
Life table – gives the probability of survival of
and testing hypothesis
each age
• Epidemiology is data-driven and relies on a very
systematic and unbiased approach in the collection, • Considered as on the of first experts in epidemiology
analysis, and interpretation of data. • Wrote the book “Natural and Political Observations
• Not merely observation and data generation Made upon the Bills of Mortality”
o Used analysis of the mortality rolls in early
2. DISTRIBUTION Modern London to try to create a system to
• Frequency - refers not only to the number of health warn of the spread of bubonic plague in the
events, but also to the relationship of that number to city
the size of the population. Famous book which was concerned mostly
o Measure used to compare diseases across with public health statistics
populations
He tabulated all causes of deaths in London.
• Pattern - refers to the occurrence of health-related
He failed in creating the system; however, he was
events by time, place and person. (DESCRIPTIVE
successful in calculating the first estimation of the
EPIDEMIOLOGY); Answers when, where and who
population of London through statistics. Because
of that, he was elected into the Royal Society in
3. DETERMINANTS
1662.
• Any factor, whether event, characteristic, or other
definable entity, that brings about a change in a health
condition or other defined characteristic (ANALYTIC

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Overview of Epidemiology+Descriptive Epidemiology

2. JAMES LIND (1716-1794) AND THE SCURVY OF THE For almost all diseases / illnesses, three basic epidemiologic
SEAS questions may be asked:
• Scottish pioneer of naval hygiene in the Royal Navy 1. When does the disease occur? (TIME) 

• Conducted the first ever clinical trial and developed 2. Where does the disease occur? (PLACE) 

the theory that citrus fruits cured scurvy 3. Who develops the disease? (PERSON) 

o Clinical trial – research studies that test how
well a certain medical approach (treatment) I. TIME
to a disease work in people • The occurrence of disease changes over time.
Some of these changes occur regularly, while others
Scurvy is the chronic deficiency of Vitamin C, are sporadic.
which is essential for the synthesis of collagen.
• Health officials will be able to anticipate diseases
• Initially thought that scurvy is caused by the
occurring regularly and set preventive measures
putrefaction of the body which can be cured by
• For sporadic diseases, targeted actions may be
providing acids
applied.
• He gathered twelve scorbutic sailors and grouped
them into six groups of two and gave them the Three major kinds of change with time (temporal variations)
following: 
 may be identified:
o Group 1: quart of cider A. Secular trends: long-term variations (changes that vary
o Group 2: twenty-five drops of elixir of vitriol through long periods of time)
(sulfuric acid)
o Group 3: six spoonful of vinegar
o Group 4: half a pint of seawater
o Group 5: two oranges and one lemon
o Group 6: a spicy paste plus a drink of barley
water

This clinical trial only lasted for 6 days. The
sailors in groups 1 and 5 recovered from scurvy.
Thus, the theory that citrus fruits would cure scurvy
was developed. (It’s the ascorbic acid specifically that
cures this.)

3. JOHN SNOW (1813-1858) AND THE PATHOGENIC

POWER PUMP
• Considered one of the “fathers of modern Figure 1. Reported cases of Salmonellosis from 1972 to 2002
epidemiology”
• Inspired fundamental changes in the water and waste Reported cases of Salmonellosis showed an
systems and a significant improvement in general increasing trend starting from mid-70’s, peaking in the latter
public health around the world 80’s, then started to go down. When you look at these long
• Used a dot map to illustrate the cluster of cholera term variations (span of years), these are secular trends.
cases around the pump
• Used statistics, tabulations, and hypothesis B. Cyclic variations: periodic fluctuations on an annual basis
formulation to illustrate the connection between the (seasonal variations); recurrent alterations in the frequency of
quality of water source and cholera cases disease
• Hallmark event of the science of epidemiology

Descriptive Epidemiology
• Data familiarity
Thus, see the limitations, deficiencies, eccentricities,
and outliers in the data
• Reveals the extent and pattern of the public health
problem being investigated
• Creates description that can be easily communicated
with tables, graphs, and maps
This is very important when trying to convey
information to the general public
Figure 2. Positive cases for Influenza from 1994 to 2000, subdivided
• Information provides important clues to the causes of
into months
the disease, which can be turned into testable
hypotheses
Influenza has seasonal patterns, it will start to actually
Descriptive Epidemiology is the foundation or the increase around October-November and actually start
starting point of Analytic Epidemiology. decreasing around February-March. Always expect a spike
of cases of Influenza during winter. So having that data,
you can actually prepare and inform the public.

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C. Epidemic changes: short-term trends, opposite of secular
(span of days/weeks)

Figure 4. John Snow’s spot map

Blue dots = different locations of the pump

Figure 3. Reported cases for Salmonella Enteritidis in Chicago in a Green dot = Broad Street pump (pump of interest)
span of 8 days Red dots = death
Bigger blot = higher reported mortality
A relatively higher number of cases were reported at the
days immediately prior to the onset of the party, primarily due It can be seen that mortalities particularly surround a pump
to the presence of contaminated food at the event. As days (pump of interest). Upon investigation of said pump, it was
passed, the number of cases decreased. found that the pump was dug just 3 meters away from a septic
tank. The septic tank leaked fecal matter to the water source,
• Endemic rate - the usual rate of occurrence for a which was the true reason for the cholera outbreak. Upon
disease in a population terminating the use of the water pump, the further spread of
• Epidemic rate - a rapid and dramatic increase over cholera was stopped.
the endemic rate
• Pandemic - a rapidly emerging outbreak of disease III. PERSON
that affects a wide range of geographically • Organization and an analysis of data by “person”
distributed populations • May use :
o inherent characteristics (age, sex, race)
II. PLACE o biologic characteristics (immune status)
• Describing the occurrence of disease by place o acquired characteristics (marital status)
provides insight into the geographic extent of the o activities (occupation, leisure activities, use of
problem and its geographic variation. medications/tobacco/drugs)
• Characterization by place refers not only to place of o living conditions (socioeconomic status, access to
residence but to any geographic location relevant medical care)
to disease occurrence.

Displaying the pattern of disease will give you the

idea of how diseases try to spread. With that you will have
an idea of how to stop the spread or recurrence of the
disease.

• Frequency of disease can be related to place of

occurrence in terms of areas set off either by natural
barriers (e.g. mountain ranges, rivers, desserts;
tropical versus temperate regions) or by political
barriers (e.g. rural-urban differences; migration of
people).
• Example: Malaria – its vector, Anopheles, tends to
thrive in free-flowing bodies of water (natural barrier);
difference between the management of HIV-Aids in
the Philippines vs management of HIV-Aids in the US
due to differences in health care policies (political
barrier). Figure 5. Lung cancer death graph of males and females (United
States)

• Male lung cancer deaths significantly outnumber

female lung cancer deaths

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III. DESCRIPTIVE EPIDEMIOLOGY OF HIV IN THE PHILIPPINES • Age group with the most number of cases with HIV: 25-29
years old
• Males have a significantly higher incidence rate than
females

Figure 6. HIV-AIDS In the world

Globally, there is a decreasing trend in HIV cases, except in

the 7 countries with more than 25% increase in HIV in the past
13 years:
o Armenia, Bangladesh, Georgia, Kazakhstan, Figure 8. Proportion of Causes of HIV-AIDS
Kyrgyzstan, Philippines, Tajikistan
• Majority attribute their infection through homosexual
• Descriptive epidemiology allows efficient information
contact
dissemination to the public by effectively presenting data
through graphs and figures.

At present, homosexual transmission is the predominating
mode of HIV-AIDS transmission, followed by the bisexual type.

IV. MINI QUIZ

1. Questions answered by DESCRIPTIVE EPIDEMIOLOGY include
the following EXCEPT:
A. What specific age groups are affected by the disease?
B. Is there a specific region in the country where the disease
predominantly occurs?
C. How was the disease transmitted?
D. Has there been an increase in the prevalence of the illness in the
last five years?

2. Which pattern of disease distribution according to TIME would be

most appropriate to monitor for chronic NON-COMMUNICABLE
Figure 6: Cases of HIV in the Philippines DISEASES like malignant neoplasms?
Pink – asymptomatic cases A. Short-term fluctuation
Black – full blown AIDS B. Secular trend
C. Seasonal pattern
From 1984-2014, D. All of the above
o 20,424 cumulative cases of HIV in the Philippines ---
18,567 of which are asymptomatic cases and 1,857 3. Which pattern of disease distribution according to TIME would be
are full blown AIDS cases. most appropriate to monitor for COMMUNICABLE diseases like
leptospirosis?
o Asymptomatic carriers may transmit the disease by
A. Short-term fluctuation
unprotected sexual contact
B. Secular trend
o Gender and age variation affects HIV cases. C. Seasonal pattern
D. Epidemic curve

4. A rapidly emerging disease outbreak that affects a wide range of

geographically distributed populations is referred to as a/an:
A. Endemic disease
B. Epidemic disease
C. Pandemic disease
D. None of the above

Answers:
1. C (Descriptive epidemiology is mainly concerned with the time, place
and person) 2. B 3. C (Short-term fluctuation is synonymous to
epidemic changes) 4. C
Figure 7. Reported HIV cases for males and females (1984-2014) REFERENCES
1. Dr. Butacan’s Powerpoint
2. 2019C transcription

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