Epidemiologi Terapan untuk Farmasi

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• Faktor Penentu Kesehatan
• Epidemiology
• Measures of Disease Occurrence
• Study Design
Life expectancy by occupational class in England and Wales
(figures for 1997 to 1999)
 Faktor Penentu Kesehatan

Any factor, whether an event,

Determinant characteristic, or other identifiable
entity, that brings about, or contributes
is to, a change in health.

Distal Proximal
remote, either in position, time closer to the outcome of
or resemblance to the outcome concern
of concern
 Faktor Penentu Kesehatan

proximal distal
 Faktor Penentu Kesehatan

Simple model illustrating accumulation of disease risk over the life course, with
disease occurring once a threshold is crossed
 Faktor Penentu Kesehatan

Relationship Among the Determinants of Health

Stokols (1996) identifies core principles

of social ecology
1. Environment
2. Individu
3. Interplay between environment
and individual factors
4. Interdependence
5. Interdiciplinary

Mirage of Health (Rene Dubois)

 Faktor Penentu Kesehatan

Physical Social Characteristics and Behavior

• Natural
• Built
 Epidemiology

Epidemiology
derived from the Greek, translates to “the study of that which is upon the
people” ( epi , “on, upon” ; demos , “people” ; logos , “word, statement” )

The study of the distribution and determinants of health-

related states or events in human populations and the
application of this study to the control of health problems.

exposure outcome
 Epidemiology

PharmacoEpidemiology
• Study of the use of and the effects in large
numbers of people

• Application of epidemiologic techniques used

to study the effects of drugs in population
 Measures of Disease Occurrence

Prevalence: all people in a defined

population with the disease or condition at a
given point in time or over a given period of
time.

Incidence: new (iNcidence) cases of a disease

or condition that develop in a population
over a specified period of time.
 Measures of Disease Occurrence

Prevalence: all people in a defined

population with the disease or condition at a
given point in time or over a given period of
time.

EXAMPLE: In the past month, Town A reported

five new cases of HIV/AIDS. This brings the total
number of HIV/AIDS cases this year to 26. In
Town B, there were 10 new cases and over 100
total cases during the same time periods.
 Measures of Disease Occurrence

Prevalence rates
• Need an indication of how the number of cases relates to the
population
• Prevalence rate
• Total number of cases during a specified time period
divided by the population count
 Measures of Disease Occurrence
Prevalence rates
EXAMPLE
Five new cases of HIV/AIDS were reported. This brings the total number
of active HIV/AIDS cases this year (2006) to 56; total population is
100,000 and population at risk if HIV/AIDS is 20,000

Prevalence rate calculation:

Prevalence rate (P) = 56 active HIV/AIDS cases /100,000 total population
P = 56 per 100,000 (in 2006)

Prevalence rates are increased by:

An increase in the number of new cases (↑ incidence)
A reduction in deaths due to disease (↓ mortality)
New treatments that prolong life but not cure the disease
Prevalence rates are decreased by:
Reduced number of new cases
Increased number of cures
 Measures of Disease Occurrence
Incidence rates
• Cumulative incidence rate (number of new cases in a specified
time period divided by number of population that is at risk of
the disease)
 Measures of Disease Occurrence
Incidence rates
• Incidence rate or density (number of new cases in a specified
time period divided by the total number of person-time when at
risk)
 Measures of Disease Occurrence

Rate: number of events (births, cases of disease, or deaths) in a

given population over a given period or at a given point in time

Population-at-risk: those who are susceptible to disease or

death from a particular cause
 Measures of Disease Occurrence

Population-at-risk: those who are susceptible to disease or

death from a particular cause
 Study Design

Major Types of Study Designs within Epidemiology

Epidemiology
A nursing home has 100 residents. On the first day in
January 10 residents had a cold. Over the month of
January another 18 residents developed a cold.
Assuming that the number of residents did not change
over January, answer the following questions:

1. What proportion of the residents had a cold on

the first day of January?
2. What proportion of the residents had a cold some
time during the month of January?
3. What proportion of the residents who didn’t have
a cold at the start of January developed a cold
during the month of January?
Epidemiology
A nursing home has 100 residents. On the first day in
January 10 residents had a cold. Over the month of
January another 18 residents developed a cold.
Assuming that the number of residents did not change
over January, answer the following questions:

1. What proportion of the residents had a cold on

the first day of January?

Point Prevalence
10 had cold
100 residents

10/100 X 100% : 10%

Epidemiology
A nursing home has 100 residents. On the first day in
January 10 residents had a cold. Over the month of
January another 18 residents developed a cold.
Assuming that the number of residents did not change
over January, answer the following questions:
1. .
2. What proportion of the residents had a cold some
time during the month of January?

Period Prevalence
10 + 18 had cold
100 residents

28/100 X 100%: 28%

Epidemiology
A nursing home has 100 residents. On the first day in
January 10 residents had a cold. Over the month of
January another 18 residents developed a cold.
Assuming that the number of residents did not change
over January, answer the following questions:
1. .
2. .

3. What proportion of the residents who didn’t have

a cold at the start of January developed a cold
during the month of January?
First day of January Month of January
10 had cold 18 had cold
100 residents 90 residents at risk
: 90 residents at risk
Incidence
18/90 X 100%: 20%
 Summary
• Epidemiology is the scientific tool used in public
health to describe disease behavior and
distribution within a population;
• Measures of disease frequency include
prevalence, incidence, and mortality rates;
• Study designs are used to establish exposure-
to-disease associations and timelines, and
• Pharmacoepidemiology is the application of
these methods to study adverse events after a
medication is approved.