Epidemiology

Nies and

Nies and McEwen: Chapter 4:

ATI: Chapter 3

Objectives --Epidemiology

Objective 1. Define and discuss the following terms; compare and contrast the
following methods and concepts of epidemiology related to community health
1. descriptive epidemiology
2. analytic epidemiology

Objective 2. Define the following epidemiological concepts, including their

identifying factors and interconnection in epidemiology and the disease process:
1. epidemiological triangle
a. agent
b. host
c. environment

Objective 3. Define and differentiate, and be able to calculate, as well as discuss

the implication of the following epidemiological rates:
1.
2.
3.
4.
5.

attack rate
incidence rate
prevalence rate
age-adjusted rate
proportionate mortality rate

Objective 4. Define and discuss the concepts of risk and risk factors as the two
terms relate to the epidemiological process

Objective 5. Define, discuss, and differentiate the concepts of screening and

surveillance as they relate to the epidemiological process

Objective 6. Define, discuss, and differentiate between the concepts of crosssectional studies and retrospective studies.

 Objective 1. Define and discuss the

following terms; compare and
contrast the following methods and
concepts of epidemiology related to
community health
descriptive epidemiology uses person, place,
and time variables to describe disease patterns.
analytic epidemiology analyzes complex
relationships among determinants of diseases.
The focus is on disease etiology.

 Objective 2: Define the following

epidemiological concepts, including
their identifying factors and
interconnection in epidemiology and the
disease process:

1. the epidemiological triangle

a. agent

b. host

c. environment

Objective 2

Objective 2

Agent Factors

Nutritive elements
Chemical agents
Physical agents
Infectious agents

Objective 2

Host Factors
Influence, exposure, susceptibility, or response to agent

Genetics
Age
Sex
Ethnic group
Physiological state
Prior immunological experience
Inter-current or preexisting disease
Human behavior

Objective 2

Environmental Factors
Influence Existence of the Agent, Exposure, or Susceptibility to Agent

Physical environment
Biological environment
Socioeconomic environment

Objective 2

The Epidemiological
Triangle

 Objective 3. Define and differentiate,

and be able to calculate, as well as
discuss the implication of the following
epidemiological rates:

1. attack rate

2.
3.
4.
5.

incidence rate
prevalence rate
age-adjusted rate
proportionate mortality rate

Incidence of
Rocky Mountain Spotted Fever
In The United States

Objective 3

Epidemiological Rates

Rates are arithmetic expressions that

help practitioners consider a count of
an event relative to the size of the
population from which it is extracted
Rate: Numerator/Denominator =
Number of health events in a specified period/Population in same area in same
specified period k

Objective 3

Attack Rate

An attack rate is a special incidence

rate that documents the number of
new cases of a disease in those
exposed to a disease.

Objective 3

Incidence Rate
Incidence rates
New cases
Number of New Cases in a Given Time Period
X 1000
Population at Risk During Same Time Period

Example: In a total population of 4000, where 250 individuals already have the
disease, 75 new cases are reported.
75
75
=
=0.02 x 1000 = 20 per 1000 per time period
4000 250
3750

Objective 3

Prevalence Rate

Prevalence rates
All cases
Number of Existing Cases
X 1000

Total Population
Example: In a population of 4000 , 250 individuals have
a particular disease.

250 = 0.0625 X 1000 = 62.5 per 1000

4000

Objective 3

Age-Adjusted Rate

Age-adjustment or standardized
rates reduce bias due to
unequivalent age distribution of the
populations being compared.

Objective 3

Proportionate Mortality rate

The proportionate mortality rate
(PMR) represents the percentage of
deaths resulting from a specific
cause relative to deaths from all
causes.

Objective 3

Comparing Rates

The occupational health nurse notes

that during the past year 4 of 628
factory employees have developed
asbestososis. He checks with MMWR,
and notes that the incidence rate of
asbestososis in the general population
is 5 per 1000.
Is the rate for the factory higher or
lower than for the general population?
Incidence in General Population
5 / 1000 = 0.005
0.005 X 1000 = 5 per 1000

Incidence in Factory
4 / 628 = 0.0064
0.0064 X 1000 = 6.4 per 1000

 Objective 4. Define and discuss the

concepts of risk and risk factors as
the two terms relate to the
epidemiological process

Objective 4

Objective 4

RISK FACTORS

a. Identification of risk factors is closely associated with

chronic disease reduction.
b. Risk factors are variables that have been shown to increase
the rate of disease in persons who have them or have been
exposed to them.
c. Identification of risk factors is critical to development of
prevention interventions.
d. Risk is the likelihood that healthy persons exposed to a
factor will acquire a specific disease.
e. Risk factor refers to the specific exposure factor. Risk
factors may be fixed characteristics non-modifiable-- (i.e.,
age, sex, genetics), or modifiable--lifestyle factors (dietary
habits, exercise regimens), or external to the individual (i.e.,
cigarette smoking, stress, noise).

 Objective 5. Define, discuss, and

differentiate the concepts of
screening and surveillance as they
relate to the epidemiological process

Objective 5

Screening

The purpose of screening programs is to identify risk factors and

diseases in their earliest stages. Screening is usually classified as
a secondary prevention activity because disease is discovered
after a pathological change has occurred.
Guidelines for screening programs include:
1. Adequate and appropriate follow-up should be planned for those

who test positive.

2.
Early diagnosis of the disease should be beneficial.
3.
Acceptable and medically sound treatment should be available.
4.
Procedures for ensuring confidentiality should be in place.
5.
Tests must be cost effective and acceptable to the client.
6.
Costs of program, follow-up, and resulting medical care should have
a bearing on the decision to screen.
7.
Screening tests should ideally have high sensitivity (the ability of a
test to detect those with the disease) and specificity (the extent to
which a test can identify those without the disease )

Objective 5

Surveillance
Surveillance allows ongoing
collection of information by
monitoring changes in disease
frequency and trends in occurrence
of risk factors.
The nurse evaluates trends in
morbidity by identifying new cases
and calculating incidence rates.

 Objective 6. Define, discuss, and

differentiate between the concepts of
cross-sectional studies and
retrospective studies.

Objective 6

Cross-Sectional Studies

Cross-sectional studies (also known

as prevalence or correlational
studies) examine relationships
between potential causal factors and
disease at a point in time.

Objective 6

Retrospective Studies

Retrospective (case control) studies

compare a group of individuals known to
have a disease with a similar group of
individuals who do not have the disease
to determine whether the diseased group
differs from the non-diseased group in its
exposure to a specific factor or
characteristic. Data collection extends
back in time to determine previous
exposure or risk factors.

Objectives ~ Epidemiology

Objective 1. Define and discuss the following terms; compare and contrast the following methods and concepts of
epidemiology related to community health
1. descriptive epidemiology
2. analytic epidemiology
Objective 2. Define the following epidemiological concepts, including their identifying factors and interconnection in
epidemiology and the disease process:
1. epidemiological triangle
a. agent
b. host
c. environment
Objective 3. Define and differentiate, and be able to calculate, as well as discuss the implication of the following
epidemiological rates:
1. attack rate
2. incidence rate
3. prevalence rate
4. age-adjusted rate
5. proportionate mortality rate
Objective 4. Define and discuss the concepts of risk and risk factors as the two terms relate to the epidemiological
process

Objective 5. Define, discuss, and differentiate the concepts of screening and surveillance as they relate to the
epidemiological process

Objective 6. Define, discuss, and differentiate between the concepts of cross-sectional studies and retrospective
studies.