Epidemiology terminology

Epidemiology
Epidemiology: the study of the distribution,
determinants, and dynamics of health and
disease in groups of people in relation to their
environment and ways of living
General epidemiological descriptors of the
overall health of groups, and especially of
entire populations, include:
Population pyramids
Mortality
Life expectancy
Infant mortality
 Population pyramids
Population pyramids: histograms showing the
percentage of a population that falls in different
age groups (typically 5-year cohorts)but unlike a
conventional histogram, they are turned on their
side, and male and female data are shown on
opposite sides of the vertical axis
 Measures of life expectancy
Life expectancy: the average number of years of life that a
person is expected to live
Quality-adjusted life years (QALYs): Incorporates both life
expectancy and the perceived impact of illness and disability
on the quality of life
Healthy Life expectancy: Combines both morbidity and
mortality. This reflects the number of years remaining that
are expected to be free of serious disease.
Health-related quality of life (HR-QOL): The US centers for
Disease Control and Prevention (CDC) developed this index
based on several surveys. HR-QOL is a multi-dimensional
concept that includes domains related to physical, mental,
emotional, and social functioning. It goes beyond direct
measures of population health, life expectancy, and causes
of death, and focuses on the impact health status has on
quality of life.
 Terminology
Epidemic: An epidemic is the occurrence of a
number of cases of a disease that is in excess of
normal expectancy; outbreaks that affect large
numbers of animals are termed as epizootic
Endemic: An endemic is used to describe a
disease that is habitually present in a given
geographic area; hyperendemic refers to
persistent high levels of a disease
Pandemic: an epidemic that affects a wide
geographic area
 EPIDEMIOLOGY AND OUTBREAKS OF
DISEASE
Outbreak: outbreaks are occurrences of a number of
cases of a disease that are in excess of normal
expectationsbut unlike epidemics, outbreaks are
limited to a particular geographic area
Many diseases that have the potential to cause
outbreaks are reportable diseases, which physicians in
the United States are required to report to their state
health departments, which in turn report them to the
CDC
Vast majority of infectious diseases such as anthrax,
botulism, cholera, dengue fever, gonorrhea, hepatitis,
HIV, Lyme disease and non-infectious diseases such as
cancers, elevated blood lead levels, food- and water-
borne disease outbreaks, acute pesticide-related
illnesses, and silicosis
 OUTBREAK INVESTIGATIONS
Case definition: Develop a case definition
Epidermic curve is created
A curve starting with a steep upslope, which
then gradually tails off, suggests that the cases
were all exposed to the same cause at around
the same time: this would be a common source
epidemic
 OUTBREAK INVESTIGATIONS
If the curve has a narrow, sharp peak with a
rapid decline, this suggests a common point
source epidemic

For example, a group of people at a banquet eating the same contaminated at the
same time
 OUTBREAK INVESTIGATIONS
If the peak of the curve is rather broad, this
suggests a common continuous (or persistent)
source epidemic in which the exposure lasted
longer, such as where a contaminated product
remained in the food supply chain for some time.
 OUTBREAK INVESTIGATIONS
A curve with a series of progressively higher
peaks suggests a propagated epidemic, in which
each group of people who contract the disease
then pass it on to another group
 The natural history of disease
Predisease stage: The individual has various
factors that promote or resist disease
 The natural history of disease
Incubation period: The time interval between the
invasion of the organism and the development of
symptoms
 The natural history of disease
Latent (hidden) stage: The disease-producing
process is underway but no symptoms of disease
have become apparent.

WINDOW OF
OPPORTUNITY
 The natural history of disease
Symptomatic stage: The disease is advanced
enough to produce clinical manifestations
 Leavells levels of prevention
Primary prevention: keeps the disease process
from becoming established by eliminating causes
of disease or increasing resistance to disease
Primary prevention
at Predisease stage

No known risk Disease

factors susceptibility

Specific protection
Heath promotion
Nutritional
Healthy life-style,
supplements,
Nutrition
Immunizations
 Leavells levels of prevention
Secondary prevention: interrupts the disease
process before it becomes symptomatic
Secondary
prevention at latent
stage

Screening tests
And treatment if
disease found
 Leavells levels of prevention
Tertiary prevention: limits the social and physical
consequences of symptomatic disease
Tertiary prevention
at symptomatic
stage

Initial care Subsequent care

Rehabilitation
Disability limitation
Identify and teach
Medical or surgical
methods to reduce
Rx to limit damage
social disability
Methods of primary prevention

Health promotion

Nutritional Environmental Behavioral

factors and factors
occupational
factors
 Nutritional factors
Undernutrition:
Starvation, Marasmus, and Kwashiorkar
Synergism of Malnutrition and Infection
Overnutrition:
Factors contributing to nutritional excesses and
imbalances
Excess weight and obesity
Nutritional counseling
 Nutritional factors: Undernutrition
In areas of civil unrest, starvation is a
problem because of inadequate
resources of production,
transportation, storage and
processing
Severe malnutrition results in a
wasting syndrome called Marasmus;
causing total growth retardation as a
result of deficiencies in all nutrients
Kwashiorkar is a protein-energy
malnutrition due to inadequate
protein intake resulting in pot belly
(ascites), diarrhea and skin
pigmentation changes
 Nutritional factors: Undernutrition
Synergism between malnutrition and infection
is the underlying cause of a large proportion of
deaths of young children in poor countries.
Prevention programs should aim at:
Preventing infections
Vaccinations
Uncontaminated water supplies
Provide improved nutrition
 Nutritional factors: Overnutrition
Overnutrition is a major public health problem
in the developed countries such as US
Reasons for the trend of overnutrition:
Less physical activity
Consumption of animal products
Sedentary life-style
Availability to affordable and easy-to-
prepare fast foods
 Nutritional factors: Overnutrition
Overweight is defined as a Body mass index (BMI)
of 25-29.9; BMI is weight in kilograms divided by
the square of height in meters
Stages of obesity:
Stage I: BMI 30-34.9
Stage II: BMI 35-39.9
Stage III: BMI 40 or more
American medical association recognized
obesity as a disease in 2013
US Preventive Services Task Force encourages
nutritional counseling to promote healthy
eating
 Environmental and occupational
factors
Route of exposure to the environmental hazard:
Skin, GIT, airborne infections through lungs
Effects of exposure to the environmental hazard:
Acute exposure: Infectious organism, chemical
toxins, loud noise, heat, heavy blows
Chronic exposure: Irritation of human tissues
with chemicals such as lead, asbestos,
mercury
 Behavioral factors
Counseling of women during and after
pregnancy:
Folic acid supplements
CDC recommends enriched cereal grain
products with folic acid
Cigarette smoking- leading cause of premature
delivery
Alcohol consumption- Fetal alcohol syndrome
Illicit drug abuse
 Behavioral factors
Counseling of parents
Nutrition (i.e. breast feeding)
Safety (e.g., use of car seats, placement of
barriers at tops of stairs to prevent falls)
Immunizations
Routine medical check-ups
 Behavioral factors
Counseling of patients with risk factors
Diet modifications
Exercise
Other aspects of life-style, such as eliminating
smoking

Summary
Primary prevention begins with health promotion, which
is working to improve the nutritional, enviromental,
social, and behavioral conditions.
MEASURES OF MORBIDITY
 Incidence rate
The rate at which new cases appear in a
population

Attack rate is a type of incidence rate in

which the denominator is further
reduced for some known exposure
 Prevalence rate
All persons who experience an event in a
population
Relationship between incidence and
prevalence
Prevalence = Incidence x Duration of the
disease
Prevalence pot:
Incidence and prevalence: changes
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