A Short Introduction to Epidemiology DPHU

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Centre for Public Health Research,Massey University Wellington Campus. Private Box 756,Wellington New Zealand,Phone 64 4 3800 606. Fax 64 4 3800 600,E mail cphr massey ac nz,Website http www publichealth ac nz. Copies of this publication can be purchased in hard copy. through our website NZ 20 US 10 10 or downloaded for. free in pdf form from the website,2nd edition,February 2005. ISBN 0 473 09560 2,ISSN 1176 1237,To Irihapeti Ramsden.
Who needs another introductory are used to investigate In particular in. epidemiology text Certainly there are recent years there has been a revival in. many introductory epidemiology books public health applications of. currently in print and many of them are epidemiology not only at the national. excellent Nevertheless there are four level but also at the international level. reasons why I believe that this new text as epidemiologists tackle global problems. is justified such as climate change This text does. not attempt to review the more complex,measures used to consider such issues. Firstly it is much shorter than most,However it does provide a coherent and. introductory texts many of which contain,systematic summary of the basic. more material than is required for a short,methods in the field which can be used. introductory course This is a short,as a logical base for the teaching and.
introduction to epidemiology and is not,development of research into these more. intended to be comprehensive,complex issues,Secondly I have endeavoured to show. Chapter 1 gives a brief introduction to the,clearly how the different basic. field with an emphasis on the broad,epidemiologic methods fit together in a. range of applications and situations in,logical and systematic manner For.
which epidemiologic methods have been,example I attempt to show how the. used historically and will continue to be,different possible study designs relate to. used in the future,each other and how they are different. approaches to a common task Similarly, I attempt to show how the different study Part 1 then addresses study design. design issues confounding and other options Chapter 2 discusses incidence. types of bias relate to each other and studies including cohort studies and. how the principles and methods of data describes the basic study design and the. analysis are consistent across different basic effect measures i e incidence rates. study designs and data types and rate ratios It then presents. incidence case control studies as a more,efficient means of obtaining the same.
Thirdly in this context rather than,findings Chapter 3 similarly discusses. attempt a comprehensive review of,prevalence studies and prevalence case. available methods e g multiple methods,control studies Chapter 4 then considers. for estimating confidence intervals for the,study designs incorporating other axes of. summary risk ratio I have attempted to,classification continuous outcome.
select only one standard method for each,measures e g blood pressure such as. application which is reasonably robust,cross sectional studies and longitudinal. and accurate and which is consistent and,studies or more complex study designs. coherent with the other methods,such as ecologic and multi level studies. presented in the text,Finally the field of epidemiology is.
changing rapidly not only with regards to,its basic methods but also with regards. to the hypotheses which these methods, Part 2 then addresses study design of situations in which epidemiologic. issues Chapter 5 discusses issues of methods can be used However there are. study size and precision Chapter 6 undoubtedly many other types of. considers general issues of validity epidemiologic hypotheses and. namely selection bias information bias epidemiologic studies which are not. and confounding Chapter 7 discusses represented in this book In particular. effect modification my focus is on the use of epidemiology in. public health particularly with regard to, Part 3 then discusses the practical issues non communicable disease and I include. of conducting a study Chapter 8 few examples from clinical epidemiology. addresses issues of measurement of or from communicable disease outbreak. exposure and disease Chapters 9 11 investigations Nevertheless I hope that. then discuss the conduct of cohort the book will be of interest not only to. studies case control studies and cross epidemiologists but also to others who. sectional studies respectively have other training but are involved in. epidemiologic research including public, Finally Part 4 considers what happens health professionals policy makers and. after the data are collected with chapter clinical researchers. 12 addressing data analysis and chapter,13 the interpretation of the findings of.
epidemiologic studies Neil Pearce, I should stress that this book provides no Centre for Public Health Research. more than a very preliminary introduction Massey University Wellington Campus. to the field In doing so I have attempted Private Box 756. to use a wide range of examples which Wellington New Zealand. give some indication of the broad range,Acknowledgements. During the writing of this text my salary,was funded by the Health Research. Council of New Zealand I wish to thank,Sander Greenland and Jonny Myers for. their comments on the draft manuscript,I also wish to thank Massey University.
for support for my research programme,A Short Introduction to Epidemiology. 1 Introduction 9,PART 3 CONDUCTING A STUDY,Germs and miasmas 10. Risk factor epidemiology 11 8 Measurement of exposure and. Epidemiology in the 21st century 12 health status 95. Exposure 95,PART 1 STUDY DESIGN OPTIONS Health status 102. 2 Incidence studies 21,9 Cohort studies 109,Incidence studies 22. Defining the source population and,Incidence case control studies 28 risk period 109.
Measuring exposure 112,3 Prevalence studies 33,Follow up 113. Prevalence studies 33, Prevalence case control studies 38 10 Case control studies 117. Defining the source population and,4 More complex study designs 41 risk period 117. Other axes of classification 41 Selection of cases 118. Continuous outcome measures 42 Selection of controls 119. Ecologic and multilevel studies 47 Measuring exposure 122. PART 2 STUDY DESIGN ISSUES 11 Prevalence studies 125. Defining the source population 125,5 Precision 59 Measuring health status 126. Basic statistics 60 Measuring exposure 128,Study size and power 61.
PART 4 ANALYSIS AND,6 Validity 67 INTERPRETATION OF STUDIES. Confounding 67,Selection bias 73 12 Data analysis 133. Information bias 74 Basic principles 133,Basic analyses 136. 7 Effect modification 83 Controlling for confounding 140. Concepts of interaction 83, Additive and multiplicative models 13 Interpretation 145. 88 Appraisal of a single study 145, Joint effects 89 Appraisal of all of the available.
evidence 148,CHAPTER 1 Introduction, In Pearce N A Short Introduction to Epidemiology 2nd ed Wellington CPHR 2005. Public health is primarily concerned with recognise the complementary nature of. the prevention of disease in human the former McKinlay 1993 and some. population It differs from clinical texts include the latter in their definition. medicine both in its emphasis on of epidemiology However the key. prevention rather than treatment and in feature of epidemiological studies is that. its focus on populations rather than they are quantitative rather than. individual patients table 1 1 qualitative observational rather than. Epidemiology is the branch of public experimental studies of the determinants. health which attempts to discover the of disease in human populations rather. causes of disease in order to make than individuals This will be my focus. disease prevention possible here while recognising the value and. Epidemiological methods can be used in complementary nature of other research. other contexts particularly in clinical methodologies The observational. research but this short introductory text approach is a major strength of. focuses on the use of epidemiology in epidemiology as it enables a study to be. public health i e on its use as part of the conducted in a situation where a. wider process of discovering the causes randomized trial would be unethical or. of disease and preventing its occurrence impractical because of the large. in human populations numbers of subjects required It is also. the main limitation of epidemiological, In this context epidemiology has been studies in that the lack of randomization. defined as Last 1988 means that the groups being compared. may differ with respect to various causes, the study of the distribution and of disease other than the main exposure. determinants of health related states or under investigation Thus. events in specified populations and the epidemiological studies in general. application of this study to control of experience the same potential problems. health problems as randomized controlled trials but may. suffer additional problems of bias because, This broad definition could in theory exposure has not been randomly. include a broad range of research allocated and there may be differences in. methodologies including qualitative baseline disease risk between the. research and quantitative randomised populations being compared. controlled trials Some epidemiologists, The defining features of public health populations and prevention.
Prevention Treatment,Populations Public health Health systems research. Individuals Primary health care Medicine including primary health care. Health education,1 1 Germs and Miasmas, Epidemiology is as old as public health ages However epidemiology was. itself and it is not difficult to find founded as an independent discipline in a. epidemiological observations made by number of Western countries in parallel. physicians dating back to Hippocrates with the industrial revolution of the 19th. who observed that century In Anglophone countries it is. considered to have been founded by the, Whoever wishes to investigate work of Chadwick Engels Snow and. medicine properly should proceed thus others who exposed the appalling social. in the first place to consider the conditions during the industrial. seasons of the year and what effects revolution and the work of Farr and. each of them produces when one others who revealed major. comes into a city in which he is a socioeconomic differences in disease in. stranger he should consider its the 19th century At that time. situation how it lies as to the winds epidemiology was generally regarded as. and the rising of the sun One should a branch of public health and focused on. consider most attentively the waters the causes and prevention of disease in. which the inhabitants use and the populations in comparison with the. ground and the mode in which the clinical sciences which were branches of. inhabitants live and what are their medicine and focussed on disease. pursuits whether they are fond of pathology and treatment of disease in. drinking and eating to excess and individuals Thus the emphasis was on. given to indolence or are fond of the prevention of disease and the health. exercise and labor Hippocrates needs of the population as a whole In. 1938 quoted in Hennekens and Buring this context the fundamental. 1987 importance of population level factors,the urban environment housing. Many other examples of epidemiological socioeconomic factors etc was clearly. reasoning were published through the acknowledged Terris 1987. Deaths and death rates from cholera in London 1854 in households supplied by the. Southwark and Vauxhall Water Company and by the Lambeth Water Company. Cholera per 10 000,Houses deaths houses,Southwark and Vauxhall 40 046 1 263 315.
Lambeth Company 26 107 98 37,Rest of London 256 423 1 422 59. Source Snow 1936 quoted in Winkelstein 1995, Perhaps the most commonly quoted 1983 Loomis and Wing 1991 Samet. epidemiologic legend is that of Snow who 2000 Vandenbroucke 1994 it is clear. studied the causes of cholera in London that Snow was able to discover and. in the mid 19th century Winkelstein establish convincing proof for the mode. 1995 Snow was able to establish that of transmission of cholera and to take. the cholera death rate was much higher preventive action several decades before. in areas supplied by the Southwark and the biological basis of his observations. Vauxhall Company which took water was understood Thus it was not until. from the Thames downstream from several decades after the work of Snow. London i e after it had been that Pasteur and others established the. contaminated with sewerage than in role of the transmission of specific. areas supplied by the Lambeth Company pathogens in what became known as the. which took water from upstream with infectious diseases and it was another. the death rates being intermediate in century in most instances before. areas served by both companies effective vaccines or antibiotic. Subsequently Snow 1936 studied the treatments became available. area supplied by both companies and Nevertheless a dramatic decline in. within this area walked the streets to mortality from these diseases occurred. determine for each house in which a from the mid nineteenth century long. A Short Introduction to Epidemiology 2nd ed Wellington CPHR 2005 Public health is primarily concerned with the prevention of disease in human population It differs from clinical medicine both in its emphasis on prevention rather than treatment and in its focus on populations rather than individual patients table 1 1 Epidemiology is the branch of public health which attempts to

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