CHAPTER 3: EPIDEMIOLOGY,

DEMOGRAPHY, AND COMMUNITY

HEALTH
EPIDEMIOLOGY

Epidemiology: the study of what is upon the people; concerned with the
distribution and determinants of health and diseases, morbidity, injuries,
disability, and morality in populations
Population: people with a common characteristic (gender, age, place of
residence)
Epidemiology is a quantitative discipline based on principles of statistics and
research
John Snow: study of a cholera epidemic in London in 1853

DESCRIPTIVE EPIDEMIOLOGY

Focuses on the distribution of frequencies and patterns of health events with

groups in a population
Examines disease patterns and other health related phenomena accord to
person, place, and time
Provide data, info, and insight into the characteristics present in a group with
a disease

ANALYTIC EPIDEMIOLOGY

Seeks to identify associations between a disease and its etiology

Directed toward findings answers to how and why
Seek to identify the causes of the problem

LEVELS OF PREVNETION IN COMMUNITY HEALTH PRACTICE

Primary Prevention:
o General health promotion: nutrition, hygiene, exercise, and
environmental protection
o Specific health promotion: immunizations, wearing protective
devices to prevent injury
Secondary Prevention:
o Early detection and treatment of adverse health conditions
o Goal: detect and treat a problem at the earliest possible stage when
the disease already exists
Tertiary Prevention:
o After diseases or events have already resulted in morbidity

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Limit disability and rehabilitate

Examples: physical therapy for stroke victims, mental health
counseling for rape victims

DESCRIPTIVE MEASURES OF HEALTH

Demographics: certain human characteristics

o Age, race, gender, ethnicity, income, education level
Morbidity and Mortality:
o Morbidity: illness
o Mortality: death
Incidence:
o The number of people in a population who develop the condition
during a specified period of time
o New cases of the disease
Prevalence:
o The total number of people in the population who have the condition at
a particular time
o Existing disease, old and new cases
Ratios, Proportions, and Rates
o Ratio: one number divided by another
o Proportion: one number divided by another where the numerator is a
subset of the denominator
o Rate: measure the amount of disease, injury, disability, or death
within a unit of the population and within a unit of time

ANALYTIC MEASURES OF HEALTH

Relative Risk:
o Indicates the benefit that might happen to the person if the risk factor
is removed
o Internal and External Risk Factors:
When one group of people is exposed and another is not
exposed to an external factor (smoking, exercise)
Odds Ratio: a ratio of the odds in favor of having a health condition when
the suspected factors is present, and the odds in favor of having the
condition when the factor is absent
Attributable Risk: measures the difference between the incidence rates for
those exposed and those not exposed to the risk factor
Point estimate: a number that identifies whether those in the exposed
group will develop the disease when compared to those not exposed
Confidence intervals: whether or not an association exists between the
exposure and the disease
Variable: a factor that can vary
Constant: a factor that cannot vary
Control or Comparison groups

Dependent variable: the outcome or result the investigator is studying

Independent variable: the presumed causes of the dependent variable
Confounding variable: any factor that may influence a studys results
Determining Causation
o Association is strong
o Association is consistent
o Is temporally correct
o Is specific
o Is not the result of a confounding variable
o Is plausible and consistent with current knowledge

SOURCES OF COMMUNITY HEALTH DATA

Census
Vital statistics: data that describes births, deaths, marriages, and divorces
Notifiable disease reports
Vital record linkage: connects data and info contain in two or more
medical, morbidity, or mortality records
Medical and hospital records
National electronic disease surveillance system: public health lab and
clinical data
Autopsy

SCREENING FOR HEALTH CONDITIONS

Screening: the presumptive identification of unrecognized disease or

defects by tests, exams, or procedures
o Purpose: rapidly and economically identify people who have a high
probability of having a particular illness so they can be referred
o When to screen:
Early diagnosis and treatment can favorably alter the course of
the illness
Definitive diagnosis and treatment facilities are available
Person being screens is at risk for the illness
Screening is reliable and valid
Reliability: yields the same result even when given by different screeners
Validity: must distinguish between people who have a condition and who
dont
Sensitivity: the ability of a test to correctly identify people who have the
disease
Specificity: the ability of a test to correctly identify people who do not have
the disease

PRACTICAL AND ETHICAL CONSIDERATIONS

Which test should be selected, high sensitivity and low specificity, or low
sensitivity and high specificity?

High rate of false positives with low specificity

Most favorable balance of sensitivity and specificity

EPIDEMIOLOGIC APPROACHES TO COMMUNITY HEALTH RESEARCH

Epidemiologic triangle: agent is an organism capable of disease, host is

the population at risk, environment is physical, biological, and social factors
o Used to analyze the role and inter-relatedness of each of the factors
Person-Place-Time Model: examines the characteristics of the people
affected, the place or location, and the time period involved
Web of Causation: views a health condition as the result (not of individual
factors) of complex interrelationships of factors interacting to increase or
decrease risk of disease
o Attempts to identify all the possible influences on the health and illness
processes
Social Ecological Model: views health and wellness and disease as the
result of interactions of factors at different levels within society