ANALYTICAL

EPIDEMIOLOGY


GENTA JAGAD
EPIDEMIOLOGICAL
RESEARCH
Epidemiological research is a study of the
distribution and determinants of health-
related states or events in spesified of
populations, and the application of the study
to control health problems.
STUDY
Surveillance (pengawasan)
Observation (pegamatan)
Hypothesis testing (uji hipotesis)
Analytic research (penelitian analisis)
Experimental research (penelitian
dengan perlakuan)
DISTRIBUTION
refers to
analysis by time, place and
class of person affected.
DETERMINANTS
Are all the:
Physical (fisik/badan)
Biological (hayati/kehidupan)
Social (sosial)
Cross-cultural (lintas budaya)
Behavioural factors (perilaku)
that influence health
HEALTH RELATED STATES and EVENTS
Include
Diseases (penyakit)
Causes of death (penyebab kematian)
Behaviours such as (perilaku/kebiasaan)
- Use of tobacco
- Reactions to preventative regimens
and provision
- Use of health services
SPECIFIED POPULATIONS
are those with identifeable characteristic
such as precisely defined numbers
APLICATON OF STUDY TO CONTROL
HEALTH PROBLEMS
Makes explicit the aim of epidemiology:
To promote (meningkatkan)
To protect (melindungi/memelihara)
To restore
(memulihkan/menyempurnakan/memperbaharui)


HEALTH
TUJUAN EPIDEMIOLOGI
Mendiskripsikan distribusi,
kecenderungan, dan riwayat alamiah
penyakit
Menjelaskan etiologi penyakit
Meramalkan kejadian penyakit
Mengendalikan distribusi penyakit.
EPIDEMIOLOGY
DESCRIPTIVE EPIDEMIOLOGY
(provides the what, who, when and where)

ANALYTICAL EPIDEMIOLOGY
(attemps to provide the why and how)

DESCRIPTIVE STUDY
Does not try to quantity the relationship
Give us a picture what is happening in a
population (e.g. prevalence, incidence, or
experience of a group)
It can be case report, case series, qualitative
study or surveys which measure the
frequency of several factors, and hence the
size of the problem.
Sometimes also include analytic work
(comparing factors)

Distribution
Tendency
Impact
ANALYSE or ANSWER the PRESENT PROBLEM
at that time
What
Who
When
Where
ANALYTICAL
EPIDEMIOLOGY
Why and How
PROGRAM
POLICY
DECISION
DESCRIPTIVE
EPIDEMIOLOGY
Schema for an Epidemiologic Study Cycle
Descriptive studies
(data aggregation and analysis)
Formulation
of
hypotheses
Analytic studies
(to test hypotheses)
1. Analysis of results
2. Suggests further
descriptive studies
3. New hypotheses

STUDY DESIGN
in ANALYTICAL STUDIES
Treatment studies
(experimental studies)
Observational studies
Other terms
EXPERIMENTAL versus
OBSERVATIONAL STUDIES
In experiment, the investigator studies the
impact of varying some that he controls.

In observational study, the investigator can only
observe the occurrence of disease in people who
are already separated into groups determined by
exposure.
TREATMENT STUDIES
Randomized controlled studies
Double-blind randomized trial
Single-blind randomized trial
Non-blind trial

Nonrandomized trial
Interupted time series design
(measures on a sample or a series of sample from
the same population are obtained several times
before and after a manipulated event or a naturaly
occuring event)
considered a type of quasi-experiment.
OBSERVATIONAL STUDIES
Cohort study
Prospective cohort
Retrospective cohort
Time series study

Case-control study
Nested case-control study

Cross-sectional study
Community survey (a type of
cross-sectional study)
OTHER TERMS
Retrospective study
Superiority trials
Non-inferiority trials
Equivalence trials
Crosover study
Longitudinal study
Meta-analysis
Design of experimental
Epidemiology triangle
environment
agent host
Interaction between
host and agent
Goals of All Analytic Studies
Maximize internal validity (keabsahan)
Maximize external validity
Maximize precision (ketelitian)
ANALYTICAL EPIDEMIOLOGY
Bidang epidemiologi yang dirancang untuk
mempelajari paparan:

Faktor risiko
Kausa
Faktor-faktor yang dihipotesiskan
mempunyai hubungan dengan penyakit.
Outline of the Process of
an Epidemiological Study
Establish that a Problem exists
Confirm the Homogeneity of the Events
Collect all the Events
Charactherize the events as to
epidemiological factors
- Predisposing Fs
- Enabling/disabling Fs
- Precipitation Fs
- Reinforcing Fs
Look for patterns and trends
Formulate of a Hypothesis
Test of Hypothesis
Publish the result
STUDY DESIGN
STUDY DESIGN


- is more important than the analysis

- a badly designed study can never be retrieved

- whereas a poorly analysed one can usually be
reanalysed

- consideration of design is also important,
because the design of study will govern how
the data are to be analysed.
STUDY DESIGN (rancangan penelitian)
All Studies
Descriptive (PO) Analytic (PICO or PECO)
Survey
(cross sectional)
Qualitative
Experimental
Observational
(analytic)
Randomised
(paralel group)
Randomiised
(crossover)
Cohort study
Cross sectional
(analytic)
Case-control
study
Figure: Tree of different types of studies
CROSS - SECTIONAL STUDY
CROSS-SECTIONSL
STUDY
DESCRIPTIVE
ANALYTIC
OBSERVATIONAL
ANALYSE or ANSWER
the PRESENT
PROBLEM at that time
In observational study
the investigator can only observe
the occurrence of disease in people
who are already separated into
groups determined by exposure.
MEMPELAJARI
GAMBARAN/DISKRIPSI:
Distribusi
Kecenderungan
Dampak penyakit
CROSS SECTIONAL STUDY
Study that examines the relationship between
diseases (or other health-related characteristics)
and other variables of interest as they exist in a
defined population at one particular time
(ie exposure and outcomes are both measured at
the same time).

Best for quantifying the prevalence of a disease or
risk factor, and for quantifying the accuracy of a
diagnostic test.
Cross-secional study
Is a descriptive study in which desease and
exposure status are measured simultaneously
in a given population.

Can be thought of as providing a snapshot of
the frequency and characteristics of a desease
in a population at a particular point in time.

The type of data can be used to assess the
prevalence of the acute or chronic condition in
a population.
DATA COLECTION
DEFINED
POPULATION
Expose
Have
Disease
Expose
Do Not Have
Disease
Not Expose
Have
Disease
Not Expose
Do Not Have
Disease
GATHER DATA on EXPOSUR and DESEASE
Begin with
Data is usually collected through a survey. A population of interest in
queried on a variety of possible exposures and on a variety of diseases.
For each exposure and each disease, there are four possible outcomes.
These four groups can be compared to suggest possible relations between
exposure and disease.
Odds ratios, or various statistical methods such as correlation analysis can
be used to compare groups.


ADVANTAGES & DISADVANTAGES OF
the DESIGN
ADVANTAGES
Cheap and simple;
Ethically safe.

DISADVANTAGES
Establishes association at most, not casuality;
Recal bias susceptibility;
Confounders may be unequally distributed;
Neyman bias;
Group sizes may be unequal.
CASE - CONTROL STUDY
CASE-CONTROL STUDY
Sometime referred to as retrospective study,
differs substantially from a cohort study in that
the participants are selected on disease status,
not on exposure.

Patients with a certain outcome or disease and
an appropiate group of controls without the
outcome or disease are selected (usually with
careful consideration of appropiate choice of
controls, matching, ect) and than information is
obtained on whether the subjects have been
exposed to the factor under investigation.
Design of a Case-Control Study
CASES


DISEASES
CONTROLS


NO
DISEASES
EXPOSED
NOT
EXPOSED
NOT
EXPOSED
EXPOSED
Once the cases and control have been selected, the investigator collects
information from interviews, employment records, and medical records to
determine possible types of exposures
When Are Case-Control Studies
Particularly Valuable?
Rare disease
Multiple exposures of interest
Budget is tight
Particularly useful for evaluating
a bioterrorist attact
ADVANTAGES
Quick and cheap;
Only feasible method for very rare disorders
or those with long lag between exposure and
outcome;
Fewer subjects needed than cross-sectional
studies

DISADVANTAGES
Reliance of recall or records to to determine
exposure status;
Confounders;
Selection of control groups is difficult;
Potential bias: recall, selection.

ADVANTAGES & DISADVANTAGES
OF the DESIGN