DESCRIPTIVE EPIDEMIOLOGY for Public Health Professionals Part 1

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DESCRIPTIVE EPIDEMIOLOGYfor Public Health
Professionals Part 1

• Ian R.H. Rockett, PhD, MPH
• Department of Community Medicine
• West Virginia University School of Medicine

Prepared under the auspices of the Southeast
Public Health Training Center, University of
North Carolina, Chapel Hill, 2005.
irockett_at_hsc.wvu.edu
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Learning Objectives

• To introduce some key historical contributors to
  the evolution of epidemiology
• To present basic models of disease and injury
• To address data sources, classification, and
  measurement
• To build a bridge between descriptive and
  analytic epidemiology

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Performance Objectives

• To be sensitive to the history of epidemiology
  against the background of broad population change
• To identify mortality and morbidity data sources
• To calculate basic measures
• To generate hypotheses from descriptive data

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• POPULATION TRANSITIONS
• and HISTORY

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The Big Population Picture

Source Joseph A. McFalls, Jr. Population A
Lively Introduction. Third edition. Population
Bulletin 53(3) 1998 38.
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The Demographic Transition

• The demographic transition framework illustrates
  population growth in terms of discrepancies and
  changes in two crude vital rates mortality and
  fertility (ignores the third component of growth,
  migration)

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Source Joseph A. McFalls, Jr. Population A
Lively Introduction. Third edition. Population
Bulletin 53(3) 1998 39.
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Top 10 Causes of Death in the U.S. , 1900
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Top 10 Causes of Death in the U.S. , 2000
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Source Ian R.H. Rockett. Population and Health
An Introduction to Epidemiology. Second edition.
Population Bulletin 54(4) 1999 9.
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EPIDEMIOLOGY

• epi upon
• demos people
• logos study
• The scientific study of the distribution and
  determinants of health-related states or events
  in specified populations, and the application of
  resulting knowledge to the prevention and control
  of health problems

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Epidemiology as a Liberal Art

• An accessible low-technology science, which
  incorporates the scientific method, analogic
  thinking, deductive reasoning, problem solving
  within constraints, and concern for aesthetic
  values
• David Fraser, New England Journal of Medicine,
  316(6) 1987309-314.

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Some Epidemiologic History
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Hippocrates

• On Airs, Waters, and Places (5th century BCE)

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Hippocrates spearheaded a move away from looking
to blame demons for disease and injury

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FAST FORWARD

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Enter John
Graunt (1629-1674)

• vocation haberdasher (seller of mens
  accessories)
• avocation father/founder of
  demography and epidemiology

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Graunt counted rather than considered (Major
Greenwood)Among his observations, he noted

• regularity of biological phenomena in
  the mass
• that more males are born than females and more
  males die than females (annually)

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Partial Translation

• Ague Malaria
• Purples Spotted Feaver Meningococcal
  Meningitis
• Kings Evil Tuberculosis of the lymph
  glands of the neck

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Population Survivorship Two Populations













th
17
century




2002
Age


United States

London, England

0





100






100


6





64






99


16





40






99


26





25






98


36

16






97


46
10






95


56





6






91


66





3






81


76





1






63


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Miasmatists Vs Contagionists

• miasm pathogenic emanation dispersed in the
  atmosphere
• (malaria bad air)
• contagion vehicle of person-to-
  person disease transmission (forerunner
  of germ theory)

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Enter John Snow (1813-1858)
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Spot Map of Fatal Cholera Cases in London, 1854
Source Ian R.H. Rockett. Population and Health
An Introduction to Epidemiology. Second edition.
Population Bulletin 54(4) 1999 6.
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Filippo Pacini, 1812-1883