EPIDEMIOLOGY

SISWANTO CHUSNUL CHULUQ HARUN AL RASYID

SESSION OBJECTIVES

At the end of this lecture, students should be able to : Define epidemiology Understand the various study design in epidemiology Calculate prevalence rate, Incidence rate, ratio prevalence, relative risk and odds ratio Describe risk factors

SESSION OBJECTIVES

At the end of this lecture, students should be able to : Understand strength of association ( ratio prevalence, odds ratio and relative risk)

Epidemiology The study of disease and other health related phenomena in group of persons (Kramer MS, 1988) The study of the distribution and determinants of diseases and injuries in human populations ( Mausner JS, 1985)

Epidemiology is concerned with the patterns of disease occurrence in human populations and of the factors that influence these patterns ( Lilienfeld AM, 1980)
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The characterization of the distribution of health-related state, disease or events is one broad aspect of epidemiology called descriptive epidemiology. Epidemiology is also used to search for causes and other factors that influence the occurrence of health-related events. The latter is called analytic epidemiology

Descriptive epidemiology provides the What, Who, When and Where.

WHAT is the health problem , disease or event and what are its manifestations and characteristics ? WHO is affected with reference to age ,sex, social class, ethnic, occupation, heredity and personal habits ? WHEN does it happen, in terms of days, months, seasons or years ? WHERE does the problem occur, in relation to place of residence, geographical distribution and place of exposure ?

Analytic epidemiology attempts to provide the Why, How and So What HOW does the health problem, disease or event occur, and what is its association with specific conditions, agents, vectors, sources of infection, susceptible groups and other contributing factors ? WHY does it occur, in terms of the reasons for its persistence or occurrence ? SO WHAT interventions have been implemented as a result of the information gained and what was their effectiveness ? Have there been any improvements in health status ?

Epidemiologists always work with groups rather than with individual patients, so epidemiologists are more comfortable with probability ( The concept of risk factor)

INCIDENCE RATES
Incidence

rates are the most common way of measuring and comparing the frequency of disease in populations. Incidence rate expresses the probability or risk of illness in a population over period of time

INCIDENCE RATES
Since

incidence is a measure of risk, when one population has a higher incidence of disease than other , we say that the first population has a higher risk of developing of disease than the second ( Risk factor)

The formula for calculating an IR

new cases occuring during a given time period IR 100 population at risk during the same time period
NOTICE : 1.The numerator of an incidence rate should reflect new cases of disease which occurred or were diagnosed during the specified period. ( not include cases which occurred or were diagnosed earlier )

2. The denominator is the population at risk.This mean that person who are included in the denominator should be able to develop the disease. 3. The denominator should represent the population from which the cases in the numerator arose.

EXAMPLE
In 2006, 733 new cases of Tuberculosis were reported among the Malang civilian population. The 2006 mid-year population was estimated to be 246,552. Calculate the 2006 Tuberculosis IR ( permil) What does it mean ? Who are person have probability to get the disease ( Tuberculosis) ? Is the denominator representative for the population ?

persons having a particular disease during gv time p prevalence k population during the same time period

Example : In a survey of patient at a sexually transmitted disease clinic in Malang. 180 of 300 patients is interviewed use of a condom at least during 2 months before the interview. The periode prevalence of condom use ( 2 months) = 180 / 300 X 100 = 60 %

Comparison of prevalence and incidence

Numerator of Inc = new cases occurring a given time period Numerator of prv = all cases present during a given time period Note : The numerator of incidence consists only of persons whose illness began during a specified interval. Prevalence includes all persons ill from a specified interval regardless of when the illness began. It include not only new cases but also old cases

The factor that link incidence and prevalence. Diseases that are short-lived, because they are rapidly cured or are fatal at an early stage, will have a relatively low prevalence compared with their incidence Diseases with a low mortality and low cure rate, leaving people with the disabling effect of the disease will have a high prevalence compared with their incidence

EXAMPLE
Two survey were done of the same community 12 months apart. Of 5000 people surveyed the first time, 25 had antibodies to histoplasmosis. 12 months later, 35 had antibodies, including the original 25. Prev at the second survey = 35/5000 X1000 = 7/1000

Cont
Incidence during the 12-month period = ??? CALCULATE

RESEARCH DESIGN IN EPIDEMIOLOGY

THE RESEARCH

INTERVENTIONAL STUDIES (INFESTIGATOR DETERMINE WHO EXPOSED OR NOT EXPOSED)

NO COMPARISON GROUP

COMPARISON GROUP ANALYTIC

DESCRIPTIVE

CASE SURVEILLANCE REVIEW

SURVEY

CASE CON TROL STUDY

COHORT STUDY

CROSS SECTIONAL STUDIES

The comparison is made between a group of persons who has the disease and a group that does not have the disease, but the characteristic and/ or exposure of the two groups are observed in the same time
D+ DTOTAL

FR +

A+B

FR -

C+D

TOTAL

A+C

B+D

A+B+C+D
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Analysis of data Prevalence ratio = A/(A+B):C/(C+D)

Statistically method depend on variable scale

Interpreting a Prevalence Ratio

If PR > 1 We say that the probability of occurring is [insert PR here] times higher for group 1 than group 2, or we say the probability of occurring is [insert PR 1 expressed as a percent] higher for group 1 than group 2.

Interpreting a Prevalence Ratio

If PR = 1 We say that the probabilities are equal of occurring for group 1 and group 2

CASE-CONTROL STUDY
THE STUDY MOVE BACKWARD FROM DISEASE ( EFFECT) TO RISK FACTOR (CAUSE). PERSON WITH AND WITHOUT DISEASE ARE IDENTIFIED AND THEN THE PRESENCE OR ABSENCE OF PREVIOUS EXPOSURE TO THE RISK FACTOR IS DETERMINED

scheme of case-control study select cases select appropriate controls

obtain information about previous exposure to proposed risk of factors each group

compare the frequency of exposure between the two group

Odds ratio = Odds of cases : odds of controls

A/(A+C) C/(A+C) B/(B+D) D/(B+D)

=A/C:B/D=AD/BC

D+

D-

FR +

FR -

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COHORT STUDY

The study move forward from risk factor (cause) to disease (effect). Population exposed and not exposed to a risk factor are identified and then both population were followed to determine the frequencies of health problems.

Method of data analysis

RELATIVE RISK = A/ (A+B) : C/ ( C+D )
D+ D-

FR +

FR -

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References :

Principles of Epidemiology: an Introduction to applied Epidemiology and Biostatistics Sudigdo Sastroasmoro: Dasar-Dasar Metodologi Penelitian Klinis.Binarupa Aksara