Introduction to

Epidemiology and
Biostatistics
FM EMVERDA
 John Snow video
 Students of journalism are taught
that a good news sto , whether it
be about a bank robbe , dramatic
rescue, or presidential candidate’s
speech, must include the
 5 W’s: what, who, where, when and
why (sometimes cited as why/how).
e 5 W’s are the essential
components of a news sto because
if any of the ve are missing, the
sto is incomplete.
 e same
epidemiologic is true in
events,characterizing
whether it
be an
cruise outbreak
ship of
passengers norovirus
or theamong
use
ofbreast
mammograms
cancer. to detect early
 e di erence is that
epidemiologists
synonyms for the tend
5 W to use
’s: diagnosis
or(who),
healthplace
event (what),
(where), person
time (when),
and causes, risk factors,
of transmission (why/how). and modes
 What is Epidemiology? (1)
Epidemiology is that eld of
medical science which is
concerned with the relationship of
various factors and conditions
which determine the frequencies
and distributions of an infectious
process, a disease, or a
physiologic state in a human
community. (Maxcy)
What is Epidemiology? (2)
Epidemiology is the study of the
distribution and determinants
of health-related states or
events in speci ed populations,
and the application of this
study to control of health
problems (Last)
What is Epidemiology? (3)
Epidemiology is a strategy for the
study of factors relating to the
etiology, prevention, and control of
disease; to promote health; and to
e ciently allocate e o s and
resources for health promotion,
maintenance and medical care in
human populations.
(Detels)

What is Epidemiology?
Greek word – epi = upon
 - demos = people
 - logos = study
It has its roots in what befalls a population.
“ the study of the distribution and
determinants of health-related states or
events in speci ed populations, and the
application of this study to the control of
health problems.”
Epidemiology
A study
A scienti c discipline
Involves processes and
methodologies
 e.g. Scienti c Method

Scienti c Method
A body of techniques for
 1. investigating phenomena
 2. acquiring new knowledge
 3. correcting and integrating previous
knowledge
A continuous process
 begins with obse ations
 developing hypotheses
 steps involved in the


Scienti
1. Make Obse ations
c Method
2. Formulate a Question
3. Formulate Hypotheses
4. Propose testable predictions
5. Gather data that will test our
predictions
6. Re ne, Change or reject the
Hypotheses
7. Develop general theories
Assumptions in pe orming
Scienti c methods
 1. Any phenomena can be
understood as an e ect of the
laws of nature.
 2. e laws of nature are the
same eve where.
Epidemiology
 Basic science of public health
1 - Quantitative discipline – relies on a working
 st
knowledge of probability, statistics and
sound research methods.
 2nd – a method of casual reasoning based on
developing and testing hypotheses
grounded in scienti c elds such as
biology, behavioral sciences, physics and ergonomics
to explain health-related behavior, states and events.
-CDC, 2012-
 As with all scienti c endeavors, the practice of
epidemiology relies on a systematic approach. In
ve simple terms, the epidemiologist:
 Counts cases or health events, and describes them
in terms of time, place, and person;
 Divides the number of cases by an appropriate
denominator to calculate rates; and
 Compares these rates over time or for di erent
groups of people.
Epidemiology is not just a
research activity
 but an integral component of public health,
 providing the foundation for directing practical and
 appropriate public health action based on this
science and causal reasoning.
Distribution
 Epidemiology is concerned with
the frequency and pattern of
health events in a population.
Frequency
 refers not only to the number of
health events such as the number
of cases of meningitis or diabetes
in a population, but also to the
relationship of that number to the
size of the population.
Pattern
 refers to the occurrence of
health-related events
by time, place, and person.
Timeannual,patterns may be

 seasonal,
 weekly,
 daily,
 hourly,
 weekday versus weekend,
 or any other breakdown
 of time that may in uence disease
 or inju occurrence
Place patterns
 include geographic variation,
 urban/rural di erences, and
 location of work sites or schools.
Personal characteristics
include demographic factors
which may be related to risk of illness,
inju , or disability such as
age, sex, marital status, and
socioeconomic status,
as well as behaviors and
environmental exposures.
Determinant:
 any factor, whether event,
characteristic,
 or other de nable entity,
 that brings about a change
 in a health condition or
 other de ned characteristic.
Two wholy Trinities of Epidemiology
Disease characteristics: agent
host
environment
Health is a state of equilibrium between:
Agent Host
Environment
Prevalence =
# of Cases Existing in a Given
Population at a Single Point in Time__
Population at at Time
(odometer)
Incidence =
# of New Cases Occurring in a Given
Population in a Speci ed Time Period_
Population at Risk in at Time Period
(Speedometer)
 e following slides are from
CDC


A Public Health Approach

Su eillance Risk Factor Inte ention Implementation

28
Public Health Core Sciences

29
 Epidemiology Purposes

in Public Health Practice
• Discover the agent, host, and environmental factors that
a ect health
• Determine the relative impo ance of causes of illness,
disability, and death
• Identify those segments of the population that have the
greatest risk from speci c causes of ill health
• Evaluate the e ectiveness of health programs and se ices
in improving population health
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 Solving Health Problems
Step 1 -
Step 1 Step 1 -
Data Su eillance; determine time,
collection place, and person

Step 2 Step 2
Solving health Assessment Inference
problems
Step 3
Hypothesis
Step 3
testing Determine how and why
Step 4 Step 4
Action Inte ention
Action 31
 Knowledge Check
All of the following illustrate the purpose of epidemiology
in public health, except
A. identifying populations who are at risk for ce ain
diseases.
B. assessing the e ectiveness of inte entions.
C. providing treatment for patients in clinical settings.
D. determining the impo ance of causes of illness

32
 Knowledge Check
Epidemiologists use a model for studying infectious disease
and its spread that involves the microbe that causes the
disease, the organism that harbors the disease, and the
external factors that cause or allow disease transmission. is
is also known as
A. host, vector, and transmission.
B. transmission, host, and environment.
C. host, agent, and environment.
D. organism, transmission, and environment.
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 Epidemiology Key Terms
epidemic or outbreak: disease occurrence among a population that

is in excess of what is expected in a given time and place.
cluster: group of cases in a speci c time and place that might be
more than expected.
endemic: disease or condition present among a population at all
times.
pandemic: a disease or condition that spreads across regions.
rate: number of cases occurring during a speci c period; always
dependent on the size of the population during that period.
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 Knowledge Check
Match each term with the correct example.
A. endemic B. pandemic C. epidemic
A. endemic 1. Malaria is present in Africa at all times
because of the presence of infected
mosquitoes. Malaria is _____ in Africa.
C. epidemic 2. e Ebola virus in pa s of Africa is in
excess of what is expected for this region.
is virus is a/an ________.
B. pandemic 3. HIV/AIDS is one of the worst global
diseases in histo . It is a/an _________.
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 Knowledge Check
Choose the correct answer.
A. distribution B. cluster C. determinant
In March 1981, an outbreak of measles occurred
among employees at Facto X in Fo Wo h, Texas.
is group of cases in this speci c time and place can
be described as a ________________.
cluster

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 Rate Formula
To calculate a rate, we rst need to determine the
frequency of disease, which includes
• the number of cases of the illness or condition
• the size of the population at risk
• the period during which we are calculating the rate

37
Scenario: Unexplained Pneumonia
American Legion Health care provider at a veterans’ hospital in
Convention, Philadelphia calls CDC to repo cases

Philadelphia, of severe respirato illness among attendees
Pennsylvania of the American Legion Convention

July 21–24 July 26–Aug 1 August 2 August 2

18 deaths 71 additional
repo ed among cases repo ed
conventioneers
Fraser DW, Tsai, T, Orenstein W, et al. Legionnaires’ disease: description of an epidemic of pneumonia. New Engl J Med
1977;297:1189–97. 38
 Legionnaires’ Disease, by Age Group
Hotel A Residents
Time: July 21–24, 1976
Frequency Unit size
Age (yrs) Sick Total Percentage
39  3 44 6.8
40–49 9 160 5.6
50–59 27 320 8.4
60–69 12 108 11.1
70 11 54 20.4
Unknown 0 2 0
Fraser DW, Tsai, T, Orenstein W, et al. Legionnaires’ disease: description of an epidemic of pneumonia. New Engl J Med
1977;297:1189–97. 39
Legionnaires’ Disease Rate
Hotel A Residents
Time: July 21–24, 1976
Frequency Unit Rate
Age (yrs) Sick Total Percentage
39  3 44 6.8
40–49 9 160 5.6
50–59 27 320 8.4
60–69 12 108 11.1
70 11 54 20.4
Unknown 0 2 0

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 Knowledge Check
On Day 1 of a technology conference in San Diego, 15 presenters who
were setting up for their sessions in Annex X became ill with u-like
symptoms. During the course of the conference, 20 pa icipants who
attended sessions in Annex X also became ill with the same
symptoms.
To begin calculating the rate of this outbreak, investigators should
rst determine
A. the size of the conference population.
B. the number of cases of illness.
C. the number of days the conference was held.
D. the location of the conference.
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Epidemiology Approach
and Methods

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 Epidemiology Study Types
Experimental
Epidemiology
study Descriptive
types
Obse ational
Analytic

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Descriptive and Analytic Epidemiology
Descriptive Analytic
epidemiology epidemiology
When was the How was the
population a ected? population a ected?
Where was the population Why was the
a ected? population a ected?
Who was a ected?

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Fatalities Associated with Farm Tractors
In 1982, the number of farm
tractor-associated deaths
was described in terms of
time, place, and person by
using records from an
existing su eillance system

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 Fatalities Associated with Farm Tractors

Goodman RA, Smith JD, Sikes RK, et al. Fatalities associated with farm tractor injuries: an epidemiologic study. Public Health
Rep 1985;100:329–33. 47
 Fatalities Associated with Farm Tractors

Goodman RA, Smith JD, Sikes RK, et al. Fatalities associated with farm tractor injuries: an epidemiologic study. Public Health Rep
1985;100: 329–33. 48
 Fatalities Associated with Farm Tractors

Goodman RA, Smith JD, Sikes RK, et al. Fatalities associated with farm tractor injuries: an epidemiologic study. Public Health Rep
1985;100:329–33. 49
 Knowledge Check
Choose the correct answer from the following choices:
A. Qualitative B. Experimental C. Obse ational
C. Obse ational An epidemiologist is doing a study on
the sleep patterns of college students
but does not provide any inte ention.
What type of study is this?

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 Knowledge Check
Match each term to the correct example below.
A. Descriptive B. Analytic
B. Analytic 1. A study of hea disease comparing a
group who eats healthy foods and
exercises regularly with one who does not
in an e o to test association
A. Descriptive 2. A study to describe the eating habits of
adolescents aged 13–18 years in
Community X
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Epidemiology Data Sources
and Study Design

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 Data Sources and Collection Methods
Source Method Example
Individual persons • Questionnaire • Foodborne illness outbreak
• Su ey • CDC’s National Health and
Nutrition Examination Su ey
• Health data on U.S. residents
Environment • Samples from the • Collection of water from area
environment (river water, streams — check for chemical
soil) pollutants
• Sensors for • Air-quality ratings
environmental changes
Health care • Noti cations to health • Repo cases of meningitis to
providers depa ment if cases of health depa ment
ce ain diseases are
obse ed
Nonhealth–related • Sales records • Cigarette sales
sources ( nancial, • Cou records • Intoxicated driver arrests
legal)
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