DEFINITION

Epidemiology is the study of the determinants and distribution of health, disease, and
injuries in human populations.

It is a specialized form of scientific research that can provide health care workers,
including community health nurses, with a body of knowledge on which to base their
practice and methods for studying new and existing problems.

Goal of the epidemiology

The ultimate goals of epidemiology are to:

1. determine the scale and nature of human health problems,

2. identify solutions to prevent disease, and

3. improve the health of the entire Population

An epidemic refers to a disease occurrence that clearly exceeds the normal or expected
frequency in a community or region.

Epidemics: infections affecting a large number of people at the same time.

- Examples:

- In past centuries, epidemic of cholera, smallpox swept through community after community
, killing thousands of people, changing the community structure.

Pandemic:

An epidemic that worldwide in distribution.

- Pandemic: infections affecting extremely high numbers of people, usually in many

countries.

Examples: -Acquired Immunodeficiency Syndrome (AIDS) is worldwide in distribution

Endemic:

The continuing presence of a disease or infectious agent in a given geographic area.

Examples:
 Plague in Vietnam.

Malaria in the tropic of, Africa, Brazil and Indonesia.

CONCEPTS BASIC TO EPIDEMIOLOGY

The science of epidemiology draws on certain basic concepts and principles to analyze and
understand patterns of occurrence among aggregate health conditions.

I. Host, Agent, and Environment Model

Host, Agent, and Environment Model

Through their early study of infectious diseases, epidemiologists began to consider disease
states generally in terms of the epidemiologic triad, or the host, agent, and environment
model. Interactions among these three elements explained infectious and other disease
patterns.

The host is a susceptible human or animal who harbors and nourishes a disease-causing
agent.

Many physical, psychological, and lifestyle factors influence the hosts susceptibility
and response to an agent.

Physical factors include age, sex, race, and genetic influences on the hosts
vulnerability or resistance.

Psychological factors, such as outlook and response to stress, can strongly influence
host susceptibility.

Lifestyle factors also play a major role. Diet, exercise, sleep patterns, and healthy or
unhealthy habits all contribute to either increased or decreased vulnerability to the
disease-causing agent..

Agent is a factor that causes or contributes to a health problem or condition.

Causative agents can be factors that are present (eg, bacteria that cause tuberculosis,
rocks on a mountain road that contribute to an automobile crash) or factors that are
lacking (eg, lack of iron in the body that causes anemia; lack of seat belt use that
contributes to the extent of injury during an automobile crash).
 Agents vary considerably and include five types: biologic, chemical, nutrient,
physical, and psychological. Biologic agents include bacteria, viruses, fungi,
protozoa, worms, and insects.

The environment refers to all the external factors surrounding the host that might influence
vulnerability or resistance.

The physical environment includes factors such as geography, climate, weather, safety
of buildings, water and food supply, and presence of animals, plants, insects, and
microorganisms that have the capacity to serve as reservoirs (storage sites for
disease-causing agents) or vectors (carriers) for transmitting disease.

The psychosocial environment refers to social, cultural, economic, and psychological

influences and conditions that affect health, such as access to health care, cultural
health practices, poverty, and work stressors, which can all contribute to disease or
health.

Host, agent, and environment interact to cause a disease or health condition.

For example,

the agent responsible for Lyme disease is the spirochete Borrelia burgdorferi;

humans of all ages are susceptible hosts, along with dogs, cattle, and horses. Ticks
that feed on wild rodents and deer transfer the spirochete to human hosts after feeding
on them for several hours.

Environmental factors, such as working or playing in tick-infested areas, influence

host vulnerability.

SOURCES OF INFORMATION

Epidemiologic investigators may draw data from any of three major sources:

(1) existing data,

(2) informal investigations,

(3) scientific studies.

The community health nurse will find all three sources useful in efforts to improve the health
of aggregates.

1) Existing Data

A variety of information is available nationally, by state, and by section, such as county,

region, or urbanized area. This information

a. Vital Statistics

Vital statistics refers to the information gathered from ongoing registration of births, deaths,
adoptions, divorces, and marriages. Certification of births, deaths, and fetal deaths are the
most useful vital statistics in epidemiologic studies

Sources for vital statistical information include state

Web sites on the Internet, local and state health departments, city halls, and county halls of
records

b. Census Data

Data from population censuses taken every 10 years in many countries are the main source of
population statistics. This information can be a valuable assessment tool for the community
health nurse who is taking part in health planning for aggregates.

Population statistics can be analyzed by age, sex, race, ethnic background, type of
occupation, income gradient, marital status, educational level, or other standards, such as
housing quality. Analysis of population statistics can provide the community health nurse
with a better understanding of the community and help identify specific areas that may
warrant further epidemiologic investigation. Data from the KSA. Census Bureau is found on
their Web site.

c. Reportable Diseases

Each state has developed laws or regulations that require health organizations and
practitioners to report to their local health authority cases of certain communicable and
infectious diseases that can be spread through the community. This reporting enables the
health department to take the most appropriate and efficient action. All states require that
diseases subject to international quarantine regulations be reported immediately.

d. Disease Registries

Some areas or states have disease registries or rosters for conditions with major public health
impact. Tuberculosis and rheumatic fever registries were more common when these diseases
occurred more frequently. Cancer registries provide useful incidence, prevalence, and
survival data and assist the community health nurse in monitoring cancer patterns within a
community. Community health nurses can access these registries through state health
department Web sites.

e. Environmental Monitoring

State governments, through health departments or other agencies, now monitor health hazards
found in the environment. Pesticides, industrial wastes, radioactive or nuclear materials,
chemical additives in foods, and medicinal drugs have joined the list of pollutants

Concerned community members and leaders view these as risk factors that affect health at
both community and individual levels. Community health nurses can also obtain data from
federal agencies such as the Food and Drug Administration, the Consumer Product Safety
Commission, and the Environmental Protection Agency.

2) Informal Observational Studies

A second information source in epidemiologic study is informal observation and description.

Almost any client group encountered by the community health nurse can trigger such a study.

3) Scientific Studies

The third source of information used in epidemiologic inquiry involves carefully designed
scientific studies. The nursing profession has recognized the need to develop a systematic
body of knowledge on which to base nursing practice. Already, systematic research is
becoming an accepted part of the community health nurses role. Findings from
epidemiologic studies conducted by or involving nurses are appearing more frequently in the
literature
METHODS IN THE EPIDEMIOLOGIC

The goals of epidemiologic investigation are to identify the

causal mechanisms of health and illness states and to develop measures for preventing illness
and promoting health. Epidemiologists employ an investigative process that involves a
sequence of three approaches that build on one another: descriptive, analytic, and
experimental studies. All three approaches have relevance for community health nursing

Descriptive epidemiology

describes disease according to person, place, time ..

Analytic epidemiology

understand etiology of disease..........case-control, cross-sectional study, cohort

studies (development of disease)

Experimental studies

clinical trials, screening

Descriptive Epidemiology

The simplest measure of description is a count.

For example, an epidemiologic study of varicella deaths among all age groups
tracked varicella deaths through hospital discharge records and death
certificates in New York State

Rates are statistical measures expressing the proportion of people with a given health
problem among a population at risk.

Rates: Way of expressing the frequency of an event as a fraction or part of a whole

population.
 The total number of people in the group serves as the denominator for various types
of rates.

Descriptive Epidemiology

1. Counts

2. Rates

a. incidence rate

b. prevalence rate

c. period prevalence rate

Crude Mortality Rate

Cause-Specific Mortality Rate

Case Fatality Rate

Proportional Mortality Ratio

Age-Specific Mortality Rate

3. Computing Rates

3:1 mortality rate

3:2 morbidity rate

Analytic Epidemiology

A second type of investigation, analytic epidemiology, goes beyond simple description or

observation and seeks to identify associations between a particular human disease or health
problem and its possible causes. Analytic studies tend to be more specific than descriptive
studies in their focus

Prevalence Studies
 Case-Control Studies

Cohort Studies

Experimental Epidemiology

Experimental epidemiology follows and builds on information gathered from descriptive and
analytic approaches. It is used to study epidemics, the etiology of human disease, the value of
preventive and therapeutic measures, and the evaluation of health services (Valanis, 1999). In
an experimental study, the investigator actually controls or changes the factors

suspected of causing the health condition under study

and observes what happens to the health state. In human populations, experimental studies
should focus on disease prevention or health promotion rather than testing the causes of
disease, which is done primarily on animals.

Biostatistics:

Is the science of statically measuring population health condition.

- Biostatistics are the primary public health measurement and analytic science
underlying community health practice.

- Biostatistics helps to describe the extent and distribution of health, illness, and
conditions in the community.

- Biostatistics aids in the identification of specific health problems and community

strengths.

- It facilitates the setting priorities for program planning.

A few Statistics
Rate, ratio, incidence, and prevalence are common terms used to help describe illness and
disease among population groups.

A rate: A statistical measures expressing the proportion of persons with a given health
problem among a population at risk.

Number of events
A rate is= --------------------X100,000
Population at risk

A ratio:

which is simply the comparison of one number with another.

A ratio: is often used to compare one at-risk population with another.

The number of females: The number of males

Mortality: Death rate.

Morbidity: Illness rate.

Mortality and morbidity statistics are collected routinely and used as indicators of the
frequency of deaths and disease as they occur in time, place, and persons.

Incidence and Prevalence Rates

Incidence: Refers to the rate at which a specific disease develops in a population.

An incidence rate is the number of new cases of an illness or injury that occurs in a
specific time.
 Number of persons developing a disease

Incidence rate=------------------------------------- X 100,000

Total number at risk per unit of time.

Prevalence: measures all of the existing cases at a given point of time.

Prevalence includes the incidence (new cases) plus all of the existing cases.

The prevalence rate is influenced by how many people become ill, and by the number
of people who die, or do not recover.

Number of persons developing a disease

Prevalence rate= ---------------------------------X100,000

Total number at risk per unit of time