public health dentistry

1. DESCRIPTIVE
EPIDEMIOLOGY
PRESENTED BY :-
DR SAKSHI KAUR CHHABRA
2ND YEAR POST GRADUATE
DEPARTMENT OF PUBLIC HEALTH DENTISTRY

2. DEFINITIONOF EPIDEMIOLOGY
Epidemiology has been defined by John M. last in 1988 as:-
‘The study of the distribution and determinants of health-related states or
events in specified populations and the application of this study to the control of
health problems.’

3. CLASSIFICATION OF EPIDEMIOLOGY
It can be classified into 2 types :-
[1] observational studies [2] Experimental or intervention
• Descriptive studies studies
• Analytical studies – {a} randomized controlled trials
{a} ecological or correlational or clinical trials
{b} cross-sectional or prevalence {b} field trials
{c} case – control or case- reference {c} community trials or community
{d} cohort or follow-up intervention studies

4. DESCRIPTIVE EPIDEMIOLOGY
 Descriptive studies are usually the first phase of
an epidemiological investigation. These studies
are concerned with observing the distribution of
disease or health-related characteristics in human
populations and identifying the characteristics
with which the disease in question seems to be
associated. Such studies basically ask the
questions.
[A] When is the disease
occurring ?
- time distribution
[B] Where it is occurring ?
- place distribution
[C] Who is getting the
disease ?
- person distribution.

5. PROCEDURES IN DESCRIPTIVE STUDIES

[1] Defining the population to be studied
[2] Defining the disease under study
[3] Describing the disease by
a. time
b. place
c. person
[4] Measurement of disease
[5] Comparing with known indices
[6] Formulation of an aetiological
hypothesis

6. [1] DEFININGTHE POPULATION TO BE STUDIEd
• Descriptive studies are investigations of populations, not individuals.
• The first step is, therefore, to define the "population base" not only in terms of the
total number, but also its composition in terms of age, sex, occupation, cultural
characters and similar information needed for the study.
• The "defined population" can be the whole population in a geographic area, or more
often a representative sample taken from it.
• The defined population can also be a specially selected group such as age and sex
groups, occupational groups, hospital patients, school children, small communities
as well as wider groupings.

7. [1] DEFININGTHE POPULATION TO BE STUDIEd
• The most essential ingredient of a descriptive epidemiological study is the
participation of the people of the community chosen for the study .
• Another important ingredient is the presence of a health facility should be close
enough to provide relatively easy access for patients requiring medical services.

8. [2] DEFINING THE DISEASE UNDER STUDY
• 2nd step is one must then define the disease under the study.
• Here the needs of the clinician and epidemiologist may diverge.
• The clinician may not need a precise definition of disease (e.g., migraine) for
immediate patient care.
• If the diagnosis is wrong, he can revise it subsequently. But the epidemiologist, whose
main concern is to obtain an accurate estimate of disease in a population, needs a
definition that is both precise and valid to enable him or observers working in field
conditions) to identify those who have the disease from those who do not .

9. [2] DEFINING THE DISEASE UNDER STUDY
• The diagnostic methods for use in epidemiological studies must be acceptable to the
population to be studied, and applicable to their use in large populations.
• In other words, the epidemiologist looks out for an "operational definition", i.e., a
definition by which the disease or condition can be identified and measured in the
defined population with a degree of accuracy.

10. [3] describing the disease under study
• The primary objective of descriptive epidemiology is to describe the occurrence and
distribution of disease (or health-related events or characteristics within populations)
by time, place and person, and identifying those characteristics associated with
presence or absence of disease in individuals. This involves systematic collection and
analysis of data.
• [a] time
• [b] place
• [d] person

11. 3[a] time distribution
• Time may be measured in terms of hours, days,week,months,years etc.
• 3 types of time fluctuations or time trends have been observed in the occurrence of
disease :-
I. Short-term fluctuations
II. Periodic fluctuations
III. Long-term or secular trends

12. Short -term fluctuations
• The best example of short – term fluctuation in the occurrence of a disease is an
epidemic.
• According to modern concepts an epidemic is defined as "the occurrence in a
community or region of cases of an illness or other health-related events clearly in
excess of normal expectancy".

13. Short -term fluctuations
Three major types of epidemics may be distinguished.
A. Common - source epidemics
(a) Single exposure or "point source" epidemics.
(b) Continuous or multiple exposure epidemics
B. Propagated epidemics
(a) Person-to-person
(b) Arthropod vector
(c) Animal reservoir
C. Slow (modern) epidemics

14. [A]Common –source
epidemics
[a] SINGLE EXPOSURE OR POINT SOURCE EPIDEMICS
• ‘POINT SOURCE EPIDEMICS’ are the response of a group of a people to a source of
infection or contamination to which they were exposed almost simultaneously . The
resultant cases all develop within one incubation period of the disease .
• If the epidemic continous over one incubation period,there are chances of either a
continuous or multiple exposure to a common source or a propagated spread .

15. Common - source epidemics
[b] CONTINOUS OR MULTIPLE EXPOSURE EPIDEMICS
• These are the common source epidemics in which the exposure from the same source
might be prolonged – can be continuous,repeated or intermittent – need not be at the
same place or at the same time .

16. [B] Propogated epidemics
• A propagated epidemic is most often of infectious origin and results from person-to-
person transmission of an infectious agent .(e.g., epidemics of hepatitis A and polio).
• The epidemic usually shows a gradual rise and tails off over a much longer period of
time.
• Transmission continues until the number of susceptibles is depleted or susceptible
individuals are no longer exposed to infected persons or intermediary vectors.

17. PERIODIC FLUCTUATIONS
• Periodic fluctuations in the time distribution is of 2 types :-
[1] seasonal variations - Seasonal variation is a well-known characteristic of many
communicable diseases, e.g., measles, varicella, cerebro-spinal meningitis, upper
respiratory infections, malaria, etc.
[2] cyclic trends - Some diseases occur in cycles spread over short periods of time which
may be days, weeks, months or years. For example, measles in the pre-vaccination era
appeared in cycles with major peaks every 2-3 years and rubella every 6-9 years.

18. LONG TERMFLUCTUATIONS
SECULAR TRENDS
• The term "secular trend" implies changes in the occurrence of disease (i.e., a
progressive increase or decrease) over a long period of time, generally several years or
decades.

19. 3[B] PLACE DISTRIBUTION
• Studies of the geography of disease (or geographical pathology) is one of the
important dimensions of descriptive epidemiology. By studying the distribution of
disease in different populations we gain perspective on the fascinating differences (or
variations) in disease patterns not only between countries, but also within the same
country.
• The distribution of disease according to the place are :-
1. International variation
2. National variations
3. Rural – urban variations
4. Local distributions

20. 3[c] person distribution
• In descriptive studies, the disease is further characterised by defining the persons who
develop the disease by age,sex,occupation, martial status, habits, social class and other
host factors.
• These host factors are :-
1. Age
2. Biomodality
3. Gender
4. Ethnic group
5. Occupation
6. Socio-economic status
7. Behaviour

21. [4] MEASUREMENT OF DISEASE
• It is mandatory to have a clear picture of the amount of disease ("disease
load") in the population.
• This information should be available in terms of mortality, morbidity,
disability and so on, and should preferably be available for different
subgroups of the population.
• Morbidity has two aspects - incidence and prevalence
• Incidence can be obtained from "longitudinal" studies, and prevalence
from "cross-sectional" studies. Descriptive epidemiology may use a cross-
sectional

22. CROSS – SECTIONAL
STUDIES{PREVELANCE STUDIES}
• It is based on a single examination of a cross-section of population at one
point in time - the results of which can be projected on the whole
population provided the sampling has been done correctly.
• a cross-sectional study provides information about disease prevalence, it
provides very little information about the natural history of disease or
about the rate of occurrence of new cases (incidence).

23. [b] LONGITUDINAL STUDIES
• In simpler words , it can be said that,longitudinal studies are cross –
sectional studies done for a longer duration by repeating periodically .
• In a longitudinal study,the same individuals are examined upon repeated
occasions and the changes within the group recorded in terms of elapsed
time between observations.

24. [5] COMPARING WITH KNOWN
INDICES
• The essence of epidemiology is to make comparisons and ask questions.
• By making comparisons between different populations, and subgroups
of the same population, it is possible to arrive at clues to disease
aetiology.
• We can also identify or define groups who are at increased risk for
certain diseases.

25. [6] FORMULATION OF AN
ETIOLOGICAL HYPOTHESIS
• This is the final step in descriptive epidemiology .
• By studying the distribution of disease, and utilizing the techniques of
descriptive epidemiology, it is often possible to formulate hypotheses relating to
disease aetiology.
• A hypothesis is a supposition, arrived at from observation or reflection. It can be
accepted or rejected, using the techniques of analytical epidemiology.

26. [6] FORMULATION OF AN
ETIOLOGICAL HYPOTHESIS
• An epidemiological hypothesis should specify :-
[a] the population - the characteristics of the persons whom the hypothesis
applies
[b] the specific cause being considered
[c] the expected outcome — the disease
[d] the dose-response relationship - the amount of the cause needed to lead to a
stated incidence of the effect
[e] the time-response relationship - the time period that will elapse between
exposure to the cause and observation of the effect.

27. Uses of descriptive epidemiology
(a) provide data regarding the magnitude of the disease load and types of disease
problem in the community in terms of morbidity and mortality
(b) provide clues to disease aetiology, and formulation of an aetiological hypothesis.
(c) provide background data for planning, organizing and evaluating preventive and
curative services
(d) they contribute to research by describing the disease occurrence by time, place and
person.

28. 28