INTRODUCTION TO EPIDEMIOLOGY

Prof. dr. Bhisma Murti, MPH, MSc, PhD

Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret

Epidemiology
A study of the distribution of disease frequency in

human population and the determinants of that distribution 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.
[source: Last (ed.) Dictionary of Epidemiology, 1995]

Definition of Epidemiology
Study: observation, hypothesis testing, estimation,

surveillance, analytic research, and experiments. Distribution: analysis by time, place, and person. 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.

Definition of Epidemiology
Specified populations: those groups of people with

identifiable characteristics Application to control: refers to the goal of epidemiology: To assess the public health importance of diseases, To identify the population at risk, To identify the causes of disease, To describe the natural history of disease, To evaluate the prevention and control of disease

Aims of Epidemiologic Research

1. Describe the health status of a

population 2. Explain the etiology of disease 3. Predict the disease occurrence 4. Control the disease distribution

Preventable Causes of Disease

BEINGS

Biological factors and Behavioral Factors

Environmental factors Immunologic factors

Nutritional factors
Genetic factors Services, Social factors, and Spiritual factors
[JF Jekel, Epidemiology, Biostatistics, and Preventive Medicine, 1996]

Causal Model of Risk Factors for CVD

Morbidity and Mortality
(Stroke, MI)

Biological Risk Factors

(Hypertension, Blood Lipids, Homocysteine)

Genetic Risk Factors

(Family History)

Behavioral Risk Factors

(Cigarette, Diet, Exercise)

Environmental Factors
(Socioeconomic Status, Work Environment)

Descriptive and Analytical Epidemiology

1. 2.

Descriptive epidemiology

the occurrence of disease (cross-sectional) Observational/ etiologic epidemiology - cause of disease (cohort, case-control) Experimental epidemiology - assessment of therapy (randomized controlled trial)

Analytic epidemiology:

Research Design Used in Epidemiology

1. 2. 3. 4. 5. 6.

Case Reports / Case Series Cross sectional Case control: prospective or retrospective Cohort: prospective or retrospective Randomized Controlled Trials (RCT) Systematic review, meta-analysis: secondary data analysis

Definitions in Epidemiology
Bias

Confounding
Frequency Measures Prevalence Incidence Measures of Association Causal Inference

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. 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 such as due to interviewer bias or 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

2.

This third factor is so called confounding factor

Confounding
[Biomedical Bestiary: Michael, Boyce & Wilcox, Little Brown. 1984]

Observed (but spurious) association, presumed causation

Gambling

Cancer Smoking, Alcohol, other Factors

Unobserved association

True association

Confounding
Observed (but spurious) association, presumed causation

Birth Order

Downs syndrome
True association

Unobserved association

Maternal age