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Prof. dr. Bhisma Murti, MPH, MSc, PhD Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret
Definitions in Epidemiology
1. 2. 3. Definition and aims of epidemiology Study designs used in epidemiology Measures of Disease Frequency
Incidence (Cumulative Incidence and Incidence Density) Prevalence
4. 5. 6. 7. 8.
Epidemiology
A study of the distribution of disease frequency in human population and the determinants of that distribution Epidemiologists are not concerned with an individuals disease as clinicians do, but with a population distribution of the disease Distribution of disease by person, place, time Assumption:
Disease does not occur randomly Disease has identifiable causes
which can be altered and therefore prevent disease from developing
Definition of Epidemiology
The study of the distribution and determinants of health-related states or events in specified population, and the application of this study to control of health problems. Determinants: physical, biological, social, cultural, and behavioral factors that influence health. Health-related states or events: health status, diseases, death, other implications of disease such as disability, residual dysfunction, complication, recurrence, but also causes of death, behavior, provision and use of health services.
[source: Last (ed.) Dictionary of Epidemiology, 1995]
Descriptive epidemiology
2. Analytic epidemiology:
Case control: prospective or retrospective Cross sectional Case Reports / Case Series
Weakest evidence
Measles Children exposed Children ill Attack rate 251 201 0.80
Attack rate =
Attack rate is a Cumulative Incidence; it shows the risk (probability) of disease to occur in a population In regard to risk, measles is the most important disease to public health while rubella being the least
Transmission
Cases
Index the first case identified Primary the case that brings the infection into a population Secondary infected by a primary case Tertiary infected by a secondary case
T S Susceptible Immune Sub-clinical P
S
S T
Clinical
Timeline of Infectiousness
Dynamics of infectiousness
Susceptible
Latent period
Infectious period
Non-infectious
Time
Dynamics of disease
Susceptible
Incubation period
Symptomatic period
Non-diseased
Time
2.
3.
Endemic
Time
Epidemic
Environment
Weather
Housing
Geography Occupational setting Air quality
Food
Host
Behaviour
Nutritional status Health status
Types of Cause: Necessary cause: Mycobacterium tuberculosis Sufficient cause: HIV Contributory cause: Sufficient-Component Cause
(Stroke, MI)
Disease
Proximate cause
(Family History)
Environmental Factors
Distal cause
Lung Cancer
True association
causal non-causal
24
present
False association
likely
Confounding ?
unlikely likely
Chance ?
unlikely
25
True association
BIAS
Systematic errors in selection of study subjects, collecting or interpreting data such that there is deviation of results or inferences from the truth.
Selection bias: noncomparable procedure used to select study subjects leading to noncamparable study groups in their distribution of risk factors. Example: Healthy worker bias Information bias: bias resulting from measurement error/ error in data collection (e.g. faulty instrument, differential or non-differential misclassification of disease and/ or exposure status. Example: interviewer bias, recall bias)
Confounding
1. A mixing of effects
between the exposure, the disease, and a third factor associated with both the exposure and the disease such that the effect of exposure on the disease is distorted by the association between the exposure and the third factor
Birth order
Confounding
Observed (but spurious) association, presumed causation
Birth Order
Downs syndrome
True association
Unobserved association
Maternal age
Apakah Ada Hubungan antara Urutan Kelahiran dan Risiko Sindroma Down?
Confounding
[Biomedical Bestiary: Michael, Boyce & Wilcox, Little Brown. 1984]
Gambling
Unobserved association
True association