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Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.
CHAPTER 5
Epidemiologic
Principles and
Methods
Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Definition of Epidemiology
 Epidemiology is defined as “the study of the distribution and determinants of
disease frequency in human populations.”
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Step 1: Define the Disease
 Death is easy to determine.
– A death certificate states cause of death.
 A blood test or stool culture is needed to verify a diagnosis of certain diseases.
 Some diseases are hard to define.
– EMS and SARS
 Sometimes a definition changes as more is learned.
– AIDS
 Other health outcomes include injuries and risk factors.
Copyright
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2021
by
Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Disease Frequency
 Count the number of people with a disease and relate that to the population at
risk (PAR).
 PAR (denominator) may be the total population or exposed population, or one
gender or age group.
– PAR often comes from a census.
 Two ways to measure frequency are:
– Incidence, the number of new cases
– Prevalence, the number of existing cases
 Incidence is used for studying causes of disease.
Copyright
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Disease Frequency (cont.)
 Prevalence depends on incidence and prognosis.
– If causes or risk factors increase, incidence and prevalence increase.
– If ability to diagnose increases, incidence and prevalence appear to increase.
 Prevalence rates are most useful in assessing the societal impact of a disease
and planning for healthcare services.
 Mortality rates are used to measure frequency for diseases that are often fatal.
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Distribution of Disease
 Who:
– Sex, age, occupation, race, and economic status
 When:
– Looks for disease frequency over time: Season, year (long-term trends), elapsed
time since an exposure (epidemic curve)
– Is crucial in tracking an outbreak of infectious diseases such as hepatitis and
legionellosis
 Where:
– Neighborhood (e.g., clusters), latitude (climate), urban vs. rural, national variations
– Looks at comparisons of disease frequency in different countries, states, counties,
or other geographical divisions
Copyright
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Jones
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Bartlett
Learning,
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an
Ascend
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Company.
www.jblearning.com
Determinants of Disease
 Why is distribution as it is?
 We can make inferences from distribution.
 Epidemiologists usually speak of risk factors not causes.
Copyright
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Human Population
 Epidemiology studies human population, usually using observational rather
than experimental methods.
 Biomedical approach uses animal models to investigate the causes of disease.
 Experiments conducted on animals can yield clear answers as to cause and
effect.
 For ethical reasons, experiments cannot usually be done on humans.
Copyright
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Learning,
LLC
an
Ascend
Learning
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Kinds of Epidemiologic Studies
 Goal is to determine an association between an exposure and a disease or
other health outcome.
 Studies may be prospective or retrospective.
 Intervention study
 Cohort study
 Case-control study
Copyright
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Learning,
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Intervention Study
 Epidemiologists do not perform the experiments.
– Closest thing to an experiment.
 Start with two groups:
– Experimental group (gets the intervention or exposure)
– Control group
 Watch them over time and compare outcomes.
 Experimenter chooses who is in which group.
 Two groups should be as similar as possible so that intervention is the only
difference.
Copyright
©
2021
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Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Intervention Study (cont.)
 Randomized, double-blind, placebo control is ideal.
 Pharmaceutical companies conduct many clinical trials for new drugs.
 Physicians’ Health Study was a prevention study:
– Aspirin to prevent heart disease
– Beta carotene to prevent cancer
 Field trial of polio vaccine in 1954 was randomized and double-blind.
 Kingston–Newburgh study of fluoridation to prevent tooth decay was a
community trial.
Copyright
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2021
by
Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Cohort Study
 Are for situations when doing an intervention study would be unethical or too
difficult.
– Considered the next most accurate
 Choose a large number of healthy people, collect data on their exposures, and
track outcomes over time.
 The only difference from intervention is that people choose their own
exposures.
Copyright
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2021
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Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Cohort Study: Examples
 Framingham Heart Study
 Nurses’ Health Study
 British study of physicians on smoking and lung cancer
 Hammond–Horn study on smoking and lung cancer in the U.S.
Copyright
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2021
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Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Case-Control Study
 Faster and cheaper are the advantages.
 This is the least accurate approach.
 It is commonly done to follow up on a hypothesis generated by shoeleather
epidemiology.
 Choose people who already have disease.
 Choose a healthy control group of individuals, as similar as possible to cases.
 Interview them all and ask for their previous exposures.
 Estimate the strength of the association between exposure and disease by
calculating an odds ratio.
Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 1
 What is the difference between incidence and prevalence?
 Why is incidence more useful in identifying the cause of a disease?
 When is it most useful to use prevalence?
 Give examples for each.
Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 2
 Explain the interaction between incidence, prevalence, and prognosis.
 Give examples.
Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 3
 Why are the who, when, and where questions useful in determining the causes
of disease?
 Give examples.
Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 4
 Explain the three major types of epidemiologic studies.
 Which is most likely to yield a valid result? Why?
 Which is likely to yield an answer in the shortest period of time? Why?
Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 5
 Visit the National Institutes of Health website on clinical trials,
www.clinicaltrials.gov.
– Browse by condition.
 How many clinical trials are going on right now?
 Choose a condition and investigate what treatments are being tested for that
condition.
Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 6
 Visit the website of the Nurses’ Health Study, www.channing.harvard.edu/nhs.
 Read the most recent annual newsletter.
 What are the most recent findings of this cohort study?

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