Descriptive Epidemiology for Public Health Professionals

DESCRIPTIVE EPIDEMIOLOGY for 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. [email protected]

Learning Objectives 1. To introduce some key historical contributors to the evolution of epidemiology 2. To present basic models of disease and injury 3. To address data sources, classification, and measurement 4. To build a bridge between descriptive and analytic epidemiology Performance Objectives

1. To be sensitive to the history of epidemiology against the background of broad population change 2. To identify mortality and morbidity data sources 3. To calculate basic measures 4. To generate hypotheses from descriptive data POPULATION TRANSITIONS and HISTORY

The Big Population Picture Source: Joseph A. McFalls, Jr. Population: A Lively Introduction. Third edition. Population Bulletin 53(3); 1998: 38. 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) Source: Joseph A. McFalls, Jr. Population: A Lively Introduction. Third edition. Population Bulletin 53(3); 1998: 39. Top 10 Causes of Death in the U.S. , 1900 Rank Cause of Death

1 2 3 4 5 Pneumonia Tuberculosis Diarrhea and enteritis Heart disease Chronic nephritis

(Brights disease) Unintentional injury (accidents) Stroke Diseases of early infancy Cancer Diptheria 6 7

8 9 10 Deaths per 100,000 202 194 140 137 81

Percent of all Deaths 12 11 8 8 5 76

4 73 72 4 4 64 40

4 2 Top 10 Causes of Death in the U.S. , 2000 Rank Cause of Death Deaths per 100,000

Percent of all Deaths 1 2 3 4 5 Heart Disease Cancer

Stroke Lung Diseases Unintentional injury (accidents) Diabetes Pneumonia and influenza Alzheimers Disease Nephritis, Kidney disease Septicemia

258 200 60 45 34 30 23 7 5 4

25 24 3 3 18 14 2

2 12 1 6 7 8 9 10

Source: Ian R.H. Rockett. Population and Health: An Introduction to Epidemiology. Second edition. Population Bulletin 54(4); 1999: 9. 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 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); 1987:309-314. Some Epidemiologic History Hippocrates On Airs, Waters, and Places (5th

century BCE) BCE Hippocrates spearheaded a move away from looking to blame demons for disease and injury FAST FORWARD Enter

John Graunt (1629-1674) vocation haberdasher (seller of mens accessories) avocation father/founder of demography and epidemiology 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) Partial Translation Ague = Malaria Purples & Spotted Feaver = Meningococcal

Meningitis Kings Evil = Tuberculosis of the lymph glands of the neck Population Survivorship: Two Populations Age 17th century London, England 2002

United States 0 100 100 6 64

99 16 40 99 26

25 98 36 16 97 10

95 56 6 91 66 3

81 76 1 63 46

Miasmatists Vs Contagionists miasm pathogenic emanation dispersed in the atmosphere (malaria bad air) contagion vehicle of person-toperson disease transmission (forerunner of germ theory) Enter John Snow (1813-1858)

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. Filippo Pacini, 1812-1883

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