Epidemiology : Concept,

Uses and Sources of data

Professor /Asmaa Abdel Aziz
Dr. Alaa Hassan
 Epidemiology
Epidemiology is the basic science of preventive and social

medicine. The word epidemiology means:

•Epi: Upon,
•demos: People,
• ology: Science.

•In the past, epidemiology was equated with the study of

epidemics.
•Recently, epidemiology emphasizes all diseases, whether
acute of chronic, physical or mental, communicable or non
communicable and health related states and events
occurring in human populations.
Consequently, the most recent definition is as
follows: It is the study of the distribution and
determinants of health related phenomena in
human populations.
What is Epidemiology?
Epidemiology is the Study of :

Distribution Determinants

Disease
(health related event)
 Epidemiology is the
study of:

Distribution Determinants
Of health related events Of health related events

Pattern
Why?
Frequency (Rates) Occurrence of health How?
A given distribution
related events by

Time characteristics

Place Characteristics

Personal Characteristics
Components of epidemiology :

Epidemiology has three components:

Disease Frequency

Disease Pattern

Disease Determinants
The basic measures of disease frequency are rates and
ratios (e.g. incidence rate, prevalence rate, etc..).
 This aspect of epidemiology is known as

descriptive epidemiology .
It is concerned with such questions :
•Who is getting the disease within the population (Males #
Females, Children # Adults, Rich # Poor)
•when does the disease occurr (Season, Month of the year,
Day of a month etc..)
•where the disease is occurring (Urban # Rural areas,
Coastal # Saharan areas).
Knowledge of disease frequency and
distribution is essential to formulate
hypothesis concerning possible causal or
preventive factors
 This aspect of epidemiology is known as:

analytic epidemiology.
It is concerned with testing the etiological hypothesis
and identifying the underlying causes or risk factors of
diseases.
 Epidemiology

Descriptive Analytical

• Studies the distribution

of health-related states • provide the Why and
or events How of such events
• Provides the What, • tests the etiological
Who, When, and hypothesis
Where of health-related • Identifies the underlying
events. causes or risk factors of
• Who is affected, when diseases.
does affection occur,
where does the event
occur
 John Snow
“The Father of Field Epidemiology”
Snow conducted his classic study in 1854 when an epidemic of cholera
developed in the Golden Square of London.

• He began his investigation by

determining where in this area
persons with cholera lived and
worked.

• He then used this information

to map the distribution of cases
on what epidemiologists call a
spot map.

• Because Snow believed that

water was a source of infection
for cholera, he marked the
location of water pumps on his
spot map, and then looked for
a relationship between the
distribution of cholera case
households and the location of
pumps.
• He noticed that more cases clustered around Pump A,
the Broad Street pump, than around Pump B or C, and
he concluded that the Broad Street pump was the most
likely source of infection.

• He realized, however, that it was too soon to draw that

conclusion because the map showed no cholera cases
in a two-block area to the east of the Broad Street pump.

• Upon investigating, Snow found that a brewery was

located there and that it had a deep well on the premises
where brewery workers, who also lived in the area, got
their water.
• To confirm that the Broad Street pump was the source of
the epidemic, Snow gathered information on where
persons with cholera had obtained their water.

• Consumption of water from the Broad Street pump was

the one common factor among the cholera patients.

• According to legend, Snow removed the handle of that

pump and aborted the outbreak.
Risk factors versus risk Markers
Risk factors Risk Markers
Modifiable Non-modifiable
• Cigarette smoking • Age
• High blood pressure • Sex
• Elevated serum • Genetic factors
cholesterol • Type of personality
• Diabetes
• Obesity
• Sedentary habits
• Stress
Uses of epidemiology:
1. Observation and description of the natural history of
diseases.
2. Help in definition and classification of diseases, e.g.
classification of viral hepatitis into A, B and C .
3. Identification of determinants of disease
4. Provision of the data necessary for the planning and
evaluation of health programmes.
5. Supply the essential data related to availability,
accessibility and utilization of health services.
Sources of epidemiological data :
1. Census
2. Population estimates
3. Vital records:
A) Birth registration:
B) Death registration :
4.Notification of infectious diseases
5. Disease registers
6. Hospital records
7. Special subgroups records
1. Census:

It is the periodic counting of the population of a country.

It is the most important source of information of the
size, composition

Size of the population :( age, sex, marital status and

socioeconomic condition) and

Distribution of a population
2. Population estimates:
The size of population in intercensal years could
be estimated by using the preceding census population
as a starting point and taking into account births,
deaths and migration.
Population data are useful in:
a) Planning the health services.
b) Computing morbidity and mortality rates
3. Vital records:
These include
A) Birth registration:
•The birth should be registered once the fetus
is borne alive
•This document characterizes births by sex, place of
residence and labour, birth date, birth weight, duration of
gestation and characteristics of both parents.
•Birth data are essential for computation of rates related to
infancy and to complications related to pregnancy, delivery
and puerperium
B) Death registration :
• Death is the most definite measure of ill health.
• All deaths, after the seventh month of pregnancy should be
registered, and a burial permission is only issued after
registration is done.
•Death register provides information about date and place of
death, residence, sex, marital status, occupation as well as
cause of death.
•At present the international classification of diseases
and related health problems (ICD.10) provides the
standard classification by which causes of death are
categorized.
• Death registration is the basic document for
determining the number of deaths and calculating
mortality rates
4.Notification of infectious diseases:
• Certain diseases are of sufficient importance to public
health to require reporting of their occurrence to the
health authorities.
• The public health law makes notification of most of the
infectious diseases compulsory.
Benefits of disease reporting are :
 Indicating the fluctuation of occurrence of diseases.
 Providing data for planning and evaluation of the
control or preventive measures.
5. Disease registers:
These may be
•National or
•Local,
usually for patients with diseases of major public
health importance, e.g. tuberculosis, cancer and
mental diseases.
6. Hospital records:

These include inpatient and outpatient records.

They are the best currently available records, yet they
show inaccuracies as well as missing of many
important health problems in which patients do not
require hospitalization.
7. Special subgroups records:
• Certain subgroups of the community can
provide opportunities for collection of
epidemiologic data through studying their
medical records. These include
•Records of school children,
• Insured workers and
•Armed forces.
8. Morbidity surveys:

These are field studies that are carried out to

find the frequency and distribution of a specific
disease or a group of diseases in the population as a
whole or in a representative sample.
9-Record Linkage:
It is the process by which medical records from
two or more different sources are brought together to
provide a single file for an individual, e.g. linking records
of all family members together or linking school medical
record to the occupational one or linking maternity
medical records to that of the newborn …etc.