MSc Public Health
LDP7004- Introduction to
Epidemiology
Week 2 : lecture 2- Fundamentals of
Epidemiology part 1
Module Director(s):
Lecturer(s):
#WeAreYSJ
@YorkStJohn
@YorkStJohnUniversity
Objectives
1. To provide an understanding on descriptive
epidemiology
2. To provide understanding on various
measures for disease occurrences and
distribution used in epidemiology
Link to prior learning
• Types of statistical test and analysis
used in epidemiology
Introduction- Descriptive epidemiology
Descriptive epidemiology seeks to understand the ‘Who, what,
when and where’ of the health event
• Who – age, gender, sociodemographics, occupation
• What – disease, injury, death
• When – time, seasonality, secular trends
• Where – place, neighborhood, city, county, census tract
• Distribution – frequency of the event and pattern of the
frequency
(CDC, 2014, Badrinath and Gillam, 2012)
Introduction- Descriptive epidemiology
• Descriptive epidemiology can identify patterns among cases
and in populations by time, place and person.
• From these observations, epidemiologists develop hypotheses
about the causes of these patterns and about the factors that
increase risk of disease.
• Epidemiologists can use descriptive epidemiology to generate
hypotheses, but only rarely to test those hypotheses.
(CDC, 2014, Badrinath and Gillam, 2012)
Types of descriptive epidemiology studies
Type Description
Case Report One case of unusual findings
Case Series Multiple cases of findings
Descriptive Epidemiology Population-based cases with
Study denominator
Measures of disease occurrence and distribution
Prevalence- A measure of the burden of
disease in a population
Incidence- as the number of new
The number of affected persons present in
cases that occur during a specified
the population at a specific time divided by
period of time in a population at risk for the number of persons in the population at
developing the disease that time
Rate:
• Rate:
Prevalence per 1000 =
• Incidence per 1000 =
* 1000
•
Point prevalence is the prevalence of a
The result has been multiplied by disease at the point in time
1,000 so that we can express the
incidence per 1,000 persons.
Learning check
How does incidence and
prevalence describe time,
place and person of a
disease/health event?.
Measures of disease occurrence and distribution
Mortality rate is the measure of the frequency of occurrence of death in a defined
population during a specified interval
• Mortality is expressed different ways
• Annual mortality rates (per 1,000 population) =
* 1,000
• Why would we use mid year?
• Using this formula create formula for: Annual mortality rate from all causes for
children younger than 10 years of age (per 1,000 population)
* 1,000
Measures of disease occurrence and distribution
• Case fatality and survival rates
• case fatality and survival rate are often used to compare the killing power of diseases.
• In case fatality the denominator is confined to those who already have the disease. It is a measure of the
severity of the disease The numerator should be restricted to deaths from that disease.
• Case fatality rate (percent)
• * 100
• If we assume that all cases either die or survive the case fatality rate is related to the
survival rate from a disease:
• Probability (survival) + Probability (death) = 1
Frequently used mortality rates
Measure Numerator Denominator 10n
Crude death rate Total number of deaths Mid-interval population 1,000 or
during a given time 100,000
interval
Neonatal mortality rate Number of deaths Number of live births 1,000
among children during the same time
< 28 days of age during interval
a given time interval
Infant mortality rate Number of deaths Number of live births 1,000
among children during the same time
< 1 year of age during a interval
given time interval
Maternal mortality rate Number of deaths Number of live births 100,000
assigned to pregnancy- during the same time
related causes during a interval
given time interval
Estimates of Association
• Incidence rates and prevalence proportions are used to describe the
frequency of diseases and health events in populations. They are
also used to estimate an association between supposed
determinants, exposures, and a disease.
• The term ‘exposure’ describes all possible determinants of diseases:
i.e broad range of events. e.g stress, exposures to air pollution or
occupational factors, habits of life (such as smoking), social
conditions (such as income), or static conditions (such as genetic
factors).
• In estimating how strongly these exposures are associated with a
disease (increase and decrease). This is achieved by comparing
disease frequencies in exposed and unexposed people.
• (Olsen et.al., 2010)
Quantifying differences in risk
• Relative Risk tells us how much more at risk one population is
compared to another.
• There are two main ways of summarising these risks, as either a
proportion or as an odd.
• Odds ratio is another measure of effect that allows us to compare
risk between two groups. It refers to the odds of exposure in one
group divided by the odds of exposure in the other group.
• Relative Risks (rate ratios or risk ratios) are preferable to odds
ratios as they allow the calculation of the risk of developing the
condition unlike odds ratios.
• ( Badrinath and Gillam, 2012, Olsen et al.,2010)
Activity
Read the articles provided
What type of study?
Which measures were used? (Interpret
these)
Causes of disease – establishing a causal relationship
• An association between an exposure or risk factor and an
outcome or disease does not imply that the risk factor causes
the disease.
• Three possible factors are vital in considering whether a causal
association really exists:
Is the association due to a chance occurrence?
Is it due to a flaw in the methodology (bias)?
Is it due to some other factor linked to both exposure and
outcome (confounding)?
Hill (1965) can be used to assess causation
(Sommerville et al.,2012)
Establishing a causal relationship: Bradford Hill criterion
Bradford Hill criterion Description Evidence of link between smoking
and lung cancer
Strength of association: the stronger or greater the association, The relationship between smoking cigarettes and lung
the more likely there is a causal relationship; this is usually cancer
indicated is very strong
by large odds or risk ratios
A dose–response relationship: the higher the exposure to the risk The more cigarettes you smoke, the more likely you are to
factor, the greater is the incidence of disease. develop lung cancer
Temporality: the risk factor should precede the disease, and if there is Lung cancer takes around 20 years to develop: lung
an expected time period between exposure and outcome, cancer
the outcome must occur after that period has lapsed prevalence only started to increase approximately 20
years
after smoking prevalence increased in the same
population
Consistency: the same association is demonstrated repeatedly The above relationships have been established in
from multiple studies in different populations at different numerous
times by studies in many different countries and populations
different investigators
Biological plausibility : a biomedical reason or factor that fits in Cigarettes produce many substances that have been
with the known pathology of the disease adds weight to a demonstrated to be carcinogens, but it is worth noting
causal that
Relationship none had been identified when the original
epidemiological
studies demonstrating the above links were undertaken
Reversibility a reduction or withdrawal of the risk factor should The risk of developing lung cancer reduces over time in
result in a reduction or reversal of the outcome those
who have stopped smoking
(Source: Somerville et al.,2012)
Conclusion
• Epidemiological study designs are the backbone of many important pu
blic health discoveries and for testing new hypotheses & novel interven
tions
• Estimates of incidence are required to study the aetiology of disease
and to monitor preventive efforts
• Prevalence data are crucial in health planning.
• A measure of association quantifies the relationship between exposure
and disease among the two groups, thereby providing information as to
the cause
Conclusion of objectives
1. To provide an understanding on
descriptive epidemiology
2. To provide understanding on
various measures for disease occurrences
and distribution
Support available
• Academic Quality to check in with Iain Pullar following recruitment summer 2023
References
Badrinath, P., & Gillam, S. (2012). Epidemiology. In S. Gillam, J. Yates, & P.
Badrinath (Eds.), Essential Public Health: Theory and Practice (pp. 43-76).
Cambridge: Cambridge University
Press doi:10.1017/CBO9781139059442.008
Centers for Disease Control and Prevention (CDC). (2014) Introduction to Public
Health. In: Public Health 101 Series. Atlanta, GA: U.S. Department of Health and
Human Services, CDC;. Available at:
https://www.cdc.gov/publichealth101/epidemiology.html.
Olsen, J. Christensen, Murray, K , Ekbom. A (2010) .An Introduction to
Epidemiology for Health. Professionals. London: Springer
Somerville, M. Kumaran, K and Anderson, R. (2012). Public Health and
Epidemiology at a Glance. 2nd Ed. Oxford:Wiley-Blackwell
