General Epidemiology

and Demography

Introduction to Epidemiology

István Kiss, MD., PhD

istvan.kiss@aok.pte.hu

Department of Preventive Medicine

Reminder
1. Basics of Disease Prevention
2. General Epidemiology and Demography
3. Environmental Health
4. Preventive Medicine
5. Detailed Epidemiology
6. Occupational Medicine
Epidemics and Pandemics have shaped
our history…
1st Millenium
Middle Ages

20th Century

The mortality rate was 35%-70%

(25,000,000 deaths !!!)
Medieval Art & the Plague

(S.M.Poyer)
• During the 20th Century 100 million
people died from armed conflict & 300
million died as a result of smallpox.

(P. Katona)
Can the modern medicine in the 21st
century cure the diseases?
Change in the US Death Rates*
by Cause,1950 & 2005
Rate Per 100,000
600 586.8

1950
500
2005
400

300

211.1
193.9 183.8
200 180.5

100
46.6 48.1
20.3
0
Heart Cerebrovascular Pneumonia/ Cancer
Diseases Diseases Influenza
* Age-adjusted to the 2000 US standard population.
Source: US Mortality Volume 1950, National Vital Statistics Report
Coronary heart disease mortality in
Hungary (1969-2010)

30,000

25,000

20,000

15,000 Acute
myocardial
infarction
10,000
Chronic
5,000 ischaemic
heart
disease
0
1977

1989

2001
1969
1971
1973
1975

1979
1981
1983
1985
1987

1991
1993
1995
1997
1999

2003
2005
2007
2009
 Stroke Statistics (US)

• 8-12% of ischemic strokes and 37-38% of

haemorrhagic strokes result in death within 30 days.

• 22% of men and 25% of women who have an initial

stroke die within a year.
Relative Survival* (%) by Cancer Site
(USA, SEER Data)
100 All Sites
90
Colon and
80
Rectum
70
Pancreas
60
50 Lung and
40 Bronchus

30 Stomach
20
Liver and
10
Intrahepatic
0 Bile Duct
Female
1980

1985

1997

2002
1975
1976
1977
1978
1979
1981
1982
1983
1984
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1998
1999
2000
2001
2003
2004
Breast
Definition of Epidemiolgy

Epidemiology is the study of the

distribution and determinants of health-
related states or events in specified
populations, and the application of this
study to control of health problems.
(John M. Last, 2001)
 Epidemiology is a Greek word
that means to put people to
Other Definitions sleep with charts and graphs.”
The study of the distribution of a - Dr. Mark Johnson
In testimony before the House Judiciary Committee
disease or a physiological condition on the spread of HIV
in human populations and of the
factors that influence this
distribution. (Lilienfeld A.)
“epidemiology’s full value is achieved
only when its contributions are
placed in the context of public health
action, resulting in a healthier
“the product of [epidemiology] populace.”
is research and information (Koplan et al. 1999)
and not public health action
and implementation”.
(Atwood et al. 1997)
Epidemiology

• Epi – on, upon

• Demos – people, population

• Logos – study of
 Epidemiology

• Description of disease occurrences, patterns

(epidemiological triad: time, place, person)
COMPARISON (true differences vs. artifacts)

• Identification of the causative agents, risk factors,

protective factors

• Testing of the results

• Population level application of the results

Time trends in lung cancer incidence
rates (US)

(American Lung Association)

 Epidemiology

• Description of disease occurrences, patterns

(epidemiological triad: time, place, person)
COMPARISON (true differences vs. artifacts)

• Identification of the causative agents, risk factors,

protective factors

• Testing of the results

• Population level application of the results

Number of new breast cancer cases
(per 100,000)

US, Europe – high

China, Japan - low

(www.worldwidebreastcancer.com, based on Globocan2000 data)

 Epidemiology

• Description of disease occurrences, patterns

(epidemiological triad: time, place, person)
COMPARISON (true differences vs. artifacts)

• Identification of the causative agents, risk factors,

protective factors

• Testing of the results

• Population level application of the results

 Breast cancer statistics (USA, 2007)

http://www.medinfographics.com
 Epidemiology

• Description of disease occurrences, patterns

(epidemiological triad: time, place, person)
COMPARISON (true differences vs. artifacts)

• Identification of the causative agents, risk factors,

protective factors

• Testing of the results

• Population level application of the results

Epidemiology: Chain of evidence leading to a
hypothesis
Role of environmental
and/or lifestyle related
factors

Epidemiological Studies on immigrant

Nutrition is an important
populations: Rates
studies: Lower + slowly take up the rates factor in human
carcinogenesis
breast cancer rates of the new home
country
in Asian countries Other differences
in Eastern and
Epidemiological Western dietary
? studies: patterns

Hypothesis-testing

Lower breast cancer Soybean contains high Soybean is a traditional

rates because of higher amount of and important dietary
intake of phytoestrogens phytoestrogens constituent in Asia

Other
components in
soybean
Thank you for the attention!