Descriptive Epidemiology: Submitted by Nirmal Varghese K

DESCRIPTIVE
EPIDEMIOLOGY
Submitted by
Nirmal Varghese K
INDEX
• INTRODUCTION
• EPIDEMIOLOGY
• DESCRIPTIVE EPIDEMIOLOGY
• STEPS OF DESCRIPTIVE EPIDEMIOLOGY
• USE OF DESCRIPTIVE EPIDEMIOLOGY
• CONCLUSION REFERENCE
INTRODUCTION
• Epidemiology covers not only the study of

disease & causation but also of health ,health
related events occuring in human population
• By identifing risk factors of chronic disease
evaluvating treatment modalities and health
services , it provide new oppurtunities for
prevention ,treatment planning & improving
the effectiveness & efficiency of health
services
EPIDEMIOLOGY
John M Last (1988)defines epidemiology as “the study of
distribution & determinants of health related states and
events in specified population and application of this study
to the control of health problems”
AIMS OF EPIDEMIOLOGY
• To describe the size and distribution of the disease
problems in human population
• To provide the data essential for planning , implementation
& evaluvation of health services for the prevention, control
& for the setting up of priorities among themselfs
• To identify the etiological factors in the pathogenesis of
disease
PRINCIPLES OF EPIDEMIOLOGY
• Exact observation
(strict,vigorous,accurate,precise)
• Correct interpretation(free from error)
• Rational explanation (intelligent, sesible,
reasonable)
• Scientific construction (by expert knowledge
and technique skill)
TOOLS OF MEASUREMENT IN EPIDEMIOLOGY
• RATE
• RATIOS
• PROPORTIONS
RATE
Measures the occurrence of some particular event
(disease,death)in a populationduring a given time
period
Rate= no. Of events in a specific period / population
at risk of experiencing the event or disease * 10n
Categories of rate
1 crude rates :actual observed rates
2 specific rates :disease ocuurring in specific group
or disease during specific time period
3standardized rates :obtained direct method of
standardization like age
RATIO
The relation in size between 2 random
quantities. Numerator is not a part of
denominator . A:B or A/B
PROPORTION
Relation in magnitude of a part of the whole.
The numerator is always a part of denominator.
There are 3 types of epidemiology

1. Descriptive epidemiology
2. Analytical epidemiology
3. Experimental epidemiology
DESCRIPTIVE EPIDEMIOLOGY
First phase of epidemiological investigation
Concerned with observation of the distribution of the disease
or any health related events in human population and
identification of the characteristics with which the disease
or conditions under study seems to be associated
STEPS OF DESCRIPTIVE EPIDEMIOLOGY

1 Defining population to be studied
2 Defining the disease under study
3 Defining the disease in terms
• TIME
• PLACE
• PERSON
4 Measurement of the disease
5 Comparing with unown indices
6 formulating an etiological hypothesis
DEFINING THE POPULATION UNDER STUDY

Can either be the total population in geographic
area or representative sample taken from that
population.
It can be special groups such as the age group, sex
group, school children etc..
The population taken for study must be remain
stable without any migration into or out of the
area.
Importance :-provides the denominator for
calculating the rates of frequency & distribution
of the disease
DEFINING THE DISEASE UNDER STUDY
The disease needs to be defined in an operational
definition . It is a definition with which the
disease or condition can be identified and
measured in the defined population with a
degree of accuracy
It will be precise & valid for epidemilogist & help
him to identify people with the disease from
those who not have the disease.
DESCRIBING THE DISEASE UNDER STUDY

• TIME
• PLACE
• PERSON
TIME DISTRIBUTION
There are 3 types of fluctuations or time trends
have been observed in the occurrence of disease.
1. Short term fluctuation
2. Periodic fluctuation
3. Long term fluctuation
SHORT TERM FLUCTUATION

The best example of a short fluctuation is an
epidemic
Epidemic is defined as “occurrence of cases of an
illness or other health related events in a region
or a community clearlyin excess of normal
expectency”
There are 3 major types of epidemics
1 common sources epidemics
• Single exposure or points sources epidemics
• Continuous or multiple exposure epidemics
2 propagated epidemics
• Persons to person
• Arthropod vector
• Animal reservoir
3 slow or modern epidemics
COMMON SOURCES EPIDEMICS

Single exposure or point source epidemics
Point source epidemics are the response simultaneously
of a group of people to a source of infection or
contamination to which they were exposed almost
An example of single exposure or point source epidemic
will be food poisoning
Continuos or multiple exposure epidemics
These are the common source epidemic in which
the exposure from the same source might be
prolonged. Can be continous , repeated or
intermitted- need not be at the same place or at
the same time. Example of this type of epidemic
is a well of contaminated water.
PROPAGATED EPIDEMICS
Propogated epidemics are most often infectious
orgin and usually results from person to person
transmission of the infectious agent
Eg:epidemics of hepatitisA & poliomyelitis are
example of propagated epidemic due to a person
to person transmission.
SLOW OR MODERN EPIDEMICS
The concept of an epidemic in the paast was to
describe an acute outbreak of infectious agent
more recently importance has been given to
excessive prevalance as the basic implication in
an epidemic
The time distribution of epidemics cases can be
represented graphically as an “epidemic curve”. It
is suggestive of a time relationship with exposure
to a suspected source & cyclic or seasonal pattern
which indicate a particular infection and the
common source or the propagated spread of the
disease. Eg HIV
PERIODIC FLUCTUATION
1. Seasonal variation
2. Cyclic trends
SEASONAL VARIATION /TRENDS
1. Is a prominent features of infectious disease occurence.
for eg
measles & varecella are usually found with their peak
incidence during summer season
UTI in winter season
2. Cyclic trends
Certain disease appear in cycles which may be spread periods
of time like days ,weeks, months or years
Eg: incidence of measles appeared incycles of peak every 2-3
years , before vaccines were invented against it.
LONG TERM OR SECULAR TREND

Changes in disease frequency that occur gradually over long
period of time.
Eg :oral cancer has shown a consistent upward trend during
past 50 years in many of developed countries.
Disease likeTB,typhoid fever, polio & diphtheria have show
downward trend
PLACE DISTRIBUTION
Variation in frequency of different disease from place to place has long
been identified.
These variation may be classified as
1. International variation
2. National variation
3. Rural – urban variation
4. Local distribution
INTERNATIONAL VARIATION
Descriptive studies conducted world wide have shown that pattern of
disease occurence varies from country to country.
Eg: oral cancer has highest incidence in countries like india ,
bangladesh , srilanka ,it is relatively rare in western countries.
NATIONAL VARIATION
it is observed that variations in disease occurrence exist within the
same country or national boundaries.
eg: in india a wide number of condition like endemic goiter, malaria&
fluorosis, normal variation with some part of the country affected
or not affected at all.
RURAL – URBAN VARIATION
It is well established that health & disease are not
equally distributed in urban& rural populations.
Disease like chronic bronchitis, cancer, accident,
drug addiction , and cardiovascular disease are
usually found in rural areas.
LOCAL DISTRIBUTION
Distribution of disease can also vary within the
cities or towns. Inner and outer city variation in
disease frequency are best studied with the aid of
spot maps or shaded map.
PERSON DISTRIBUTION
In descriptive epidemiology the disease is further
described by defining the person affected by the
disease in terms of the age, sex, occupation,
ethnic origin, social class, etc.
Age
In most disease the variation in frequency that
occurs between different age groups are greater
than those found with any other variables. Eg:
mostly measles found in childhood&
atherosclerosis in old age.
Biomodality
Is the occurrence of two separate peak in age
incidence of a disease. Eg : exhibiting bio
modality is dental caries , which usually found in
children as pit & fissure caries & in the old age as
root caries.
Gender
Variation in disease frequency observed in females
and male
In case of study of oral cancer females have less
incidence than males.
Ethnic group / ethnicity
Ethnic group can be defined in terms of race
religion, place, or combination of three.
Eg: variation in their frequency with regards to
ethnicity includes TB, coronary heart disease,
cancer, & sickle cell anemia.
Occupation
Certain disease are known by names that are
associated with their occupational origin like
chimney sweepers cancer, wool sorters disease
,farmers lung disease.
Behaviour
The disease which can be attributed mainly due to
behaviour of individual are coronary heart
disease ,hypertension, obesity etc.
Marital status
Many disease show association with it. Married person
are found to have lower mortality rate compared to
single, widowed, divorced ones.
Socioeconomic status
Frequency & distribution of disease is different in upper
and lower social classes. Eg: disease like dental caries,
hypertension, diabetes mellitus are more in upper class
and skin and zoonotic infections, periodontal disease
are common in lower classes.
MEASUREMENT OF DISEASE
The measurement of disease in terms of mortality &
morbidity indicators.
Morbidity can be expressed in terms of incidence and
prevalence
• INCIDENCE –LONGITUDNAL STUDY
• PREVALENCE- CROSS SECTIONAL STUDY
CROSS SECTIONAL STUDIES (prevalence studies)
The measurement of exposure & effect are made at the
same time providing information on the relationship
between a disease &other variables of interest as they
exist at one point of time. Relatively easy& economical
to carry out.
LONGITUDNAL STUDIES
The same individuals are examined upon repeated
occasions and the change within the group recorded in
terms of elapses time between observation
USE-Studying in natural history of the disease & its
outcomes
- identifying the risk factors associated with the
disease for calculating the incidence rate of the disease
but its time consuming difficult to organize.
COMPARING WITH UNKNOWN INDICES
By making comparison between different
populations. It is often possible to reach a
conclusion with regard to the disease etiology
& also to identify groups or sub groups which
are potentially at high risk for the
development of certain disease.
FORMULATING AN ETILOGICAL HYPOTHESIS

Final step in a descriptive epidemiological study
By studying determinants & 7 distribution of the
disease , it is possiblre to formulate a
hypothesis related to the disease etiology.
Hypothesis can be deined as a ‘a supposition
arrived at from by observation or by
reflection.
An epidemiological study should specify, the
population – characteristics of the persons to
whom the hypothesis applies
The cause being considered
The expected effect – the disease
The dose- response relationship – the amount of
the cause neede to lead toa stated incidence
of the effect
The time response relationship the time period
that will elapse between exposure to the
cause & observation of the effect.
USE OF DESCRIPTIVE EPIDEMIOLOGY
Provide data with regard to the types of disease
& their magnitude in the community
Provide information on the etiology of a disease
& help in formulation of an etiological
hypothesis.
Provide data required for the planning ,
organizing & evaluvating preventive& curative
care leads the path for research with regards
to a particular disease problems.
CONCLUSION
The most out standing contribution of
epidemiological is the study of association and
causation in health and states.
Among 3 types of epidemiological studies ,
descriptive study is considered as the first phase
of investigation.
It is also important for generating hypothesis about
the determinants of heealth and disease. By
providing hypothesis it also provides the starting
point of analytical epidemiology.
REFERENCES
• ESSENTIALS OF PUBLIC HEALTH DENTISTRY-
SOBEN PETER. 5TH EDITION (CHAPTER –
GENERAL EPIDEMIOLOGY)

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DESCRIPTIVE

• Epidemiology covers not only the study of

There are 3 types of epidemiology

STEPS OF DESCRIPTIVE EPIDEMIOLOGY

DEFINING THE POPULATION UNDER STUDY

DESCRIBING THE DISEASE UNDER STUDY

SHORT TERM FLUCTUATION

COMMON SOURCES EPIDEMICS

LONG TERM OR SECULAR TREND

FORMULATING AN ETILOGICAL HYPOTHESIS

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