CPP 503

EPIDEMIOLOGICAL METHODS

BY

DR DAYOM

INTRODUCTION
Epidemiology is the study of the distribution and determinants of health- related states or events in specified
populations and the application of this study to the control of health problems. It is a scientific research discipline
concerned with observing, measuring and analyzing health-related occurrences in human populations.

Epidemiology is concerned with investigations of patterns of disease distribution and of the factors influencing
these patterns. Epidemiology is also essentially a “comparative” discipline. That is, most epidemiological
investigations study diseases and the potential factors related to these diseases among different groups, different
periods and different places and then make comparisons.

One goal of epidemiologic studies is to define the parameters of a disease, including risk factors, in order to
develop the most effective measures for control.

Summarily, epidemiology utilizes an organized approach to problem solving by: (1) confirming the existence of an
epidemic and verifying the diagnosis; (2) developing a case definition and collating data on cases; (3) analyzing
data by time, place, and person; (4) developing a hypothesis; (5) conducting further studies if necessary; (6)
developing and implementing control and prevention measures; (7) preparing and distributing a public report;
and (8) evaluating control and preventive measures.

EPIDEMIOLOGIC METHODS

The three major epidemiologic techniques are:

1. Descriptive (organizing data by time, place, and person),

2. Analytic (incorporating a case-control or cohort study), and
3. Experimental.
Although all three can be used in investigating the occurrence of disease, the method used most is descriptive
epidemiology. Once the basic epidemiology (descriptive) of a disease has been described, specific analytic
methods can be used to study the disease further, and a specific experimental approach can be developed to
test a hypothesis.

Epidemiology utilizes an organized approach to problem solving by:

(1) confirming the existence of an epidemic and verifying the diagnosis; (2) developing a case definition and
collating data on cases; (3) analyzing data by time, place, and person; (4) developing a hypothesis; (5) conducting
further studies if necessary; (6) developing and implementing control and prevention measures.

DESCRIPTIVE STUDIES
This is the study of the amount and distribution of a disease within a population by persons, place and time. The
three broad questions necessary to describe the occurrence of a disease fully are:

Person - who is getting the disease (person distribution)? i.e. male or female, the age range, ethnicity, marital
status, social economic factors, social class, education, occupation, income level, family variables such as size,
type, birth order, maternal age, parental deprivation and personal habits.

Place - where is it occurring (place distribution)? This will answer for region, state, district, LGA, local community,
towns, village and wards either in the city or rural areas. Boundaries are also considered with precise location.

Time - when is the disease occurring (time distribution)? This includes the year, season, day of the week, month
and the time of the day. Certain diseases are common during the year for example measles in dry season, malaria
in wet season, flu in winter etc.

The description of diseases is usually done based on some characteristics which are shown in the table below:
Table 1: Characteristics Frequently Examined
Time Place Person
Year, season Climatic zones Age Birth order
Month, week Country, region Sex Family Size
Day, hour of Marital status Height. Weight
Urban/rural,
onset
Local
Duration Towns, Cities and Occupation, Social
Blood pressure,
Institutions status, Education
Blood cholesterol
and personal habits
In descriptive epidemiology, data that describe the occurrence of the disease are collected by various methods
from all relevant sources. The data are then collated by time, place, and person.

Four time trends are considered in describing the epidemiologic data.

The secular trend describes the occurrence of disease over a prolonged period, usually years; it is influenced by
the degree of immunity in the population and possibly nonspecific measures such as improved socioeconomic
and nutritional levels among the population.

The periodic trend. the periodic trend may indicate a change in the antigenic characteristics of the disease agent.
For example, the change in antigenic structure of the prevalent influenza A virus every 2 to 3 years results in
periodic increases in the occurrence of clinical influenza caused by lack of natural immunity among the
population.

This can be seen with some immunizable diseases when periodic decreases occur in the level of immunization in
a defined population. This may then result in an increase in the number of cases, with a subsequent rise in the
overall level of herd immunity.

The seasonal trend. This trend reflects seasonal changes in disease occurrence following changes in
environmental conditions that enhance the ability of the agent to replicate or be transmitted. For example, food-
borne disease outbreaks occur more frequently in the summer, when temperatures favor multiplication of
bacteria.

The epidemic occurrence of disease. An epidemic is a sudden increase in occurrence due to prevalent factors that
support transmission.

ANALYTIC EPIDEMIOLOGY

This is the second major type of epidemiological studies. While descriptive studies looks at the entire population,
analytic studies only look at the individuals so affected within the population, analytical epidemiology analyzes
disease determinants for possible causal relations. However, even though individuals are evaluated in analytical
studies, the inference is made in respect of the population so selected.

In analytic epidemiology, we can determine whether or not a statistical association exists between a disease and
a suspected factor and if it does, what is the strength of association.
Analytic studies comprises of two distinct types of observational studies, these are: retrospective or case control
study and prospective or cohort study.

The case-control method starts with the effect (disease) and retrospectively investigates the cause that led to the
effect. The case group consists of individuals with the disease; a comparison group has members similar to those
of the case group except for absence of the disease. These two groups are then compared to determine
differences that would explain the occurrence of the disease.

An example of a case-control study is selecting individuals with meningococcal meningitis and a comparison
group matched for age, sex, socioeconomic status, and residence, but without the disease, to see what factors
may have influenced the occurrence in the group that developed disease.

The second analytic approach is the cohort method, which prospectively studies two populations: one that has
had contact with the suspected causal factor under study and a similar group that has had no contact with the
factor. When both groups are observed, the effect of the factor should become apparent. In prospective or
cohort studies, a group of persons are exposed to causative factors while others are not. A follow-up is made in
the nearest future to check the proportion of effects on the exposed and the non-exposed and comparism is then
made.

An example of a cohort approach is to observe two similar groups of people, one composed of individuals who
received blood transfusions and the other of persons who did not. The occurrence of hepatitis prospectively in
both groups permits one to make an association between blood transfusions and hepatitis; that is, if the
transfused blood was contaminated with hepatitis B virus, the recipient cohort should have a higher incidence of
hepatitis than the non-transfused cohort.

The case-control approach is relatively easy to conduct, can be completed in a shorter period than the cohort
approach, and is inexpensive and reproducible; however, bias may be introduced in selecting the two groups, it
may be difficult to exclude subclinical cases from the comparison group, and a patient's recall of past events may
be faulty.

The advantages of a cohort study are the accuracy of collected data and the ability to make a direct estimate of
the disease risk resulting from factor contact; however, cohort studies take longer and are more expensive to
conduct.
EXPERIMENTAL EPIDEMIOLOGY

This broadly refers to a planned experiment where the investigator has control over the population groups by
deciding which groups are exposed to a factor under scrutiny. The design and analysis methods employed in
these investigations are similar to those used in randomized clinical trials.

A hypothesis is developed and an experimental model is constructed in which one or more selected factors are
manipulated. The effect of the manipulation will either confirm or disprove the hypothesis. An example is the
evaluation of the effect of a new drug on a disease. A group of people with the disease is identified, and some
members are randomly selected to receive the drug. If the only difference between the two is use of the drug,
the clinical differences between the groups should reflect the effectiveness of the drug.

The use of experiments in this study is done with ethical considerations. The principle of conducting
experimental trials is that under the control of the investigator, some systems are subjected to manipulation,
creating an independent variable whose effect is then determined by the measurement of subsequent events or
outcome. This is known as dependent variable.

All the epidemiological studies complement one another. An observational study allows nature to take its course.
The investigator measures but do not intervene. Descriptive study is limited to describing disease occurrence in a
population. Analytical goes on to examine the relationship between health status and variables. Experimental or
interventional studies involve an active attempt to change disease determinant or the progress of a disease. It is
clearly acknowledged that epidemiology is a major tool in the formulation and implementation of national,
regional and local health policy, providing evidence on which policies can be based.

USES OF EPIDEMIOLOGY

Epidemiology is used for the following:

• To analyze the respective role of agent, host and the environment in the development and the natural history
of disease.
• To analyze the occurrence and distribution of disease according to characteristics such as age, sex, race,
occupation and heredity.
• To study, outline and define problems of health and disease by the analysis of incidence, prevalence and
mortality.
• To help complete the clinical features and natural history of diseases by group analysis
• To estimate an individual’s risk of developing a disease and his survival chances.
• To search for factors related to health and disease through the observation of group custom and habits.
• For planning and allocation and distribution of resources
• To evaluate the need for and the effectiveness of health service through field studies.