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4 To explore the definition of epidemiology

4 To introduce key concepts in epidemiology

4 To introduce the concepts of risk, risk

measurement and standardization in
epidemiology
 u
 

,

4 The study of epidemics?

4 The study of diseases?

4 The study of diseases of the skin?

4 Something scientists and academics use to

confuse other people?
"


 " 



£The study of the distribution and

determinants of health related states or events in
specified populations and the application of this
study to control health problems´
- James Last
A Dictionary of Epidemiology
# 
  "




4 Study: Observing,recording,experimenting
4 Distribution : Who, where, when
4 Determinants: Why?
4 Health related states
4 Specified populations
4 Application
c

   

4 —erson- Who?

4 —lace- Where?

4 Time- When?

4 Helps us to understand: Why?

 
"
  


4 How many people in this room are infected

with the HIV virus?

4 How many people in Toronto are infected ?

4 How many people in Canada are infected?

u


    
" 
 


4 In order to be able to compare between two

populations, we need to know what the defined
population is

4 For example,if we say 50 people in this room

have an infection compared with 100 people in
the next room, does it mean that infections are
less common in this room?
[  


4 r
d)

4 umerator ± the top half of the fraction

4 Denominator- the bottom number in the

fraction
[  
 -

4 There may be fewer people in this room than in the

next room
4 Let¶s assume that there are 100 people in this room
and 1000 people in the next room
4 So 50 people with infections out of 100 people in this
room means half r50
100) of the people in this room
have infections
4 100 people with infections out of a 1000 in the next
room means only a tenth r100
1000) of the next room
have colds

 
 ".

4 There are 2 main measures used

4 —revalence

4 Incidence
+ 



4 + - the number of people with a

particular condition, habit at a specified time
within a defined population eg prevalence of
colds,smoking

4 
 - the number of EW cases of a

condition
habit in a defined population over a
specified period of time




 /


 +

4 —revalence includes both old and new cases

and is usually expressed as a percentage

4 Incidence includes only EW cases and is

expressed as the number of cases per
population per year

4 Time period and population must be specified

+

4 —revalence of colds in this class

4 umber of cases rpeople with colds) = 3
4 —opulation of class = 30
4 —revalence = 3
30
4 Expressed as a percentage = 3
30 X 100
=10%



4 umber of cases of newly diagnosed HIV

infection in a city in 2003 is 900

4 —opulation of the city is 100 000

4 Incidence of HIV is 900 per 100 000 in 2003

"

 


4 —robability that an event will occur

4 Different from causation

4 Chance that if exposed to certain risk factors

will develop condition

  
 "

4 iisk factors are factors that increase the

probability that a disease will occur
4 iisk factors could be
4 environmental
4 behavioural
lifestyle
4 genetic

""

 / 
 



4 iisk is about probability or likelihood

4 Causation is about £certainty´

4 Identifying a risk may be the first step to

understanding causation eg smoking and lung
cancer
'  " 


4 Absolute risk

4 ielative risk

4 Attributable risk
 " 
 0   

4 umber of cases in a defined population

4 Similar to incidence

4 If 100 people are infected with HIV in a town of 1000

people, the absolute risk of HIV in the town is 100 per
1000
4 But the people in the town have different lifestyles,
genes,living conditions which absolute risk does not
take note of
 " 
 0 
+ 


4 ùoing back to our example, we could divide the

population of the town into injecting drug users rIDUs)
and non-injecting drug users non-IDUs)
4 Count the number of cases of HIV in IDUs and count
the number in non-IDUs
4 ielative risk rrisk ratio) is the ratio between the two
I.e.iisk in the exposed
risk in the unexposed

+ 


4 In our example, there were 400 IDUs in the town, and

80 of them were diagnosed with HIV in the year of our
study. The risk of HIV in IDUs was therefore 80
400 =
0.2
4 There were 20 diagnoses of HIV in the non-IDU
population of 600, so the risk of HIV in non-IDUs was
20
600 = 0.033
4 The relative risk is therefore 0.2 divided by 0.033=6.06
u   
+ 
 ,

4 From the example, we obtained a relative risk

of 6.06
4 In simple terms it means that IDUs in the town
in that year were 6.06 times more likely to be
diagnosed with HIV than non-IDUs

  


4 Difference between risk in the exposed and

risk in the unexposed
4 iisk in exposed minus risk in unexposed
4 From our example the attributable risk for
smokers in the town was
0.2-0.033=0.167


4 iates are another means of expressing

measurement
4 3 broad types of rates commonly used in
epidemiology
4 Crude rates
4 Specific rates
4 Standardized rates
 

4 Looking at the death records in ewtown which has a

population of 100 000 we find that 500 people died in
2005

4 In neighbouring OldTown with the same population of

100 000, there were 800 deaths in 2005
 
  

4 ewtown had a crude death rate of 500 per 100 000

4 Oldtown had a crude death rate of 800 per 100 000

4 Oldtown appears to have a higher death rate than

ewtown, but do the crude rates tell the whole story?
 [// 1/

Age group umber of deaths

10-20 200 30
20-30 150 20
30-40 50 40
40-50 20 20
50-60 15 90
60-70 10 150
70-80 20 250
80-90 35 200
TOTAL 500 800
+
   0  
"
 

4 Looking at the number of deaths in different

age groups we get a different picture
4 The majority of deaths in Oldtown occurred in
people over the age of 60
4 The majority of deaths in ewtown occurred in
people under the age of 40
 
"
 

4 Specific rates give us more detail by looking at

the occurrence of events in a subgroup of the
population
4 In the example, we used age groups, but could
have used gender, ethnicity,occupation,etc
 
  2 



4 ùoing back to the example, we know that there

were different patterns in the deaths recorded
in the two towns
4 But we may find it difficult to compare rates
between the two towns
4 Why?
u 
3 ,

4 —erhaps Oldtown is a retirement town with many old

people and few young people?

4 —erhaps ewtown has very few old people and is a

barracks town consisting largely of soldiers going to
Iraq?

4 To enable valid comparison, we need to be comparing

like with like ± hence standardization
u  
3 ,

4 Standardized rates are rates that take into

account the structure of the population and
adjust for differences in population structure

4 iates can be age-standardized, sex-

standardized, etc


4 Epidemiology uses person, time and place to

study how illness and health are distributed in
populations
4 In epidemiology, specifying populations and
time periods is important
4 When interpreting epidemiology, always check
that like is being compared with like