Nutritional epidemiology
Epidemiology
• Originally, the study of
epidemics / outbreaks
• Study of the factors
that contribute to
illness in individuals
and communities, and
how to improve health
by altering those
factors
Epidemiology
and
Public Health
DEFINITIONS
• What is epidemiology?
• What is an epidemiologist?
How we view the world…..
• Pessimist: The glass
is half empty.
• Optimist: The glass
is half full.
• Epidemiologist: As
compared to what?
What is epidemiology?
EPIDEMIOLOGY is the study of the nature, cause, control and determinants of the
frequency and distribution of disease, disability, and death in human populations.
Epidemiology: the study of factors influencing the occurrence, transmission, distribution, prevention and control of disease in a defined population
What is epidemiology?
• “The study of skin diseases?”
• “The study of epidemics?”
• “The study of the distribution and
determinants of health-related states in
specified populations, and the application of
this study to control health problems."
What is epidemiology?
EPIDEMIOLOGY is the study of the nature, cause, control
and determinants of the frequency and distribution of disease,
disability, and death in human populations.
epidemiologists study sick and healthy people
to determine the crucial difference between those who get the disease
and those who are spared
epidemiologists study exposed and non-exposed people
to determine the crucial effect of the exposure
An EPIDEMIOLOGIST is a public health
scientist, who is responsible for carrying out
all useful and effective activities needed for
successful epidemiology practice
Disease-detective
Uses of Epidemiology..
Uses of Epidemiology..
Terminology
• Endemic
• Hyperendemic
• Holoendemic
• Epidemic/outbreak Terms used for reference
to various forms of
• Pandemic outbreaks
• Epizootic
• Incidence
• Prevalence
Endemic: a disease or pathogen present or usually prevalent in a given population or
geographic region at all times
Hyperendemic: equally endemic in all age groups of a population
Holoendemic: endemic in most of the children in a population, with the adults in the same population being less often
affected
Epidemic: a disease occuring suddenly in numbers far exceeding those attributable to endemic
disease; occurring suddenly in numbers clearly in excess of normal expectancy
Pandemic: a widespread epidemic distributed or occurring widely throughout a region,
country, continent, or globally
Epizootic: of, or related to a rapidly spreading and widely diffused disease affecting large numbers of animals in a given
region
Incidence: rate of occurrence of an event; number of new cases of disease occurring over a
specified period of time; may be expressed per a known population size
Prevalence: number of cases of disease occurring within a population at any one given point
in time
What is an Outbreak?
• An outbreak is the occurrence of
more cases of a disease than
expected in a population during
a certain time
• One case of smallpox, anthrax,
plague, botulism, or tuberculosis
anywhere in the US is an
outbreak requiring immediate
response
• An epidemic and an outbreak
mean the same thing
– Epidemic is often applied to
an outbreak of special
concern
How Are Outbreaks Detected?
• Recognized and reported by
individual doctors or groups (e.g.,
an emergency dept)
• Recognized and reported by those
affected (e.g., coworkers, school,
banquet)
• Detected by PH agency through
review of individual cases reported
by doctors, or review of lab reports
or other health care data
• Enhanced surveillance in
cooperation with state and federal
public health officials
Methods of Epidemiology
• Public Health Surveillance
• Disease Investigation
• Analytic Studies
• Program Evaluation
Surveillance
• The ongoing, systematic collection,
analysis, and interpretation of health
data essential to the planning,
implementation, and evaluation of public
health practice, closely integrated with
the timely feedback of these data to those
who need to know.
In public health, ‘surveillance’ means
tracking the occurrence of diseases of
importance – not watching individuals or
premises
Analytical studies
Observational:
Case-Control: Exposures, genes, and/or behaviors in individuals
with a particular disease (cases) are compared to individuals
without the disease (controls).
Cohort: A group of individuals with and without a particular
exposure are followed to compare disease outcomes.
Interventional:
Clinical Trials: Individuals are randomized to receive a
particular treatment within the clinic setting.
Community Trials: A community participates in a behavioral
intervention, a screening intervention, etc.
Analytical studies
Study Design:
Population-Based: Individuals under study belong
to a defined population, i.e., residents of a
geographic region.
Clinic or Hospital-Based: Studies are based upon
patients seen at a particular hospital or clinic.
Community-Based: Participants are volunteers in
the community.
Analytical studies
Behavior, Genetics, Environment, Social/Cultural Risk Factors
Pre- Cancer Recurrence Survivorship
Health
cancer
Risk Assessment, Early Detection, Tertiary Prevention
Primary Prevention Secondary Prevention
•Etiologic studies •Screening •Quality of life
• Genetic •Chemoprevention Trials •Predictors of survival
• Molecular •Chemoprevention Trials
• Environmental
• Social/Cultural
•Behavioral Interventions
All studies conducted in a population that is racially and
ethnically diverse
Population-Based Cancer Epidemiology
Surveillance Epidemiology and End Results (SEER)
Program
• Assemble and report estimates of cancer incidence and mortality in the
United States.
• Monitor annual cancer incidence trends.
• Provide continuing information on changes over time
in extent of disease at diagnosis, trends in therapy, and associated changes
in patient survival.
• Promote studies designed to identify factors amenable to cancer control
interventions.
Cancer In Arab Americans: Estimating Rates & Fostering Research
Schwartz K, N01 PC35154-RRSS
•Arab–American women have similar distribution of
breast cancer histology to European–American
women.
•Arab–American stage, age, and hormone receptor
status at diagnosis was more similar to African–
American women.
•Arab–American women have a better overall survival
than even European–American women.
•Arab/Chaldean men had greater proportions of
leukemia , multiple myeloma, liver, kidney, and
urinary bladder cancers.
•Arab/Chaldean women had
greater proportions of leukemia, thyroid, and brain
cancers.
Jemal et. al., 2010
Trends in lung cancer mortality rates by sex in select countries, 1950-2006 Jemal et. al., 2010
Kinds of Epidemiology
• Descriptive Study of the occurrence and
distribution of disease
• Analytic Further studies to determine the
validity of a hypothesis concerning
the occurrence of disease.
Deliberate manipulation of the
• Experimental cause is predictably followed by
an alteration in the effect not due
to chance
