Epidemiology

• Epidemiology is an in integral part of Clinical Medicine

Clinical EpidemiologyBy Robert H. Fletcher, Suzanne W. Fletcher

Clinical Medicine

Epidemiology Spectrum

Though Epidemiology started out with the study of epidemics, it became clear multiple environmental, social, occupational, and personal factors where involved in chronic disease

Disease Factors

http://teaching.path.cam.ac.uk/partII/mpd/cam-only/lect62.pdf

Disease Factors Specifics

http://teaching.path.cam.ac.uk/partII/mpd/cam-only/lect62.pdf

Multiple levels interacted in Health

Variables and Health

What's wrong with social epidemiology, and how can we make it better? Kaplan GA EPIDEMIOLOGIC REVIEWS Volume: 26 Pages: 124-135; 2004

Epidemiological Fields of Research have Spread Out

Epidemiologic Field Spread

James S.House, “Understanding Social Factors and Inequalities in Health: 20th Century Progress and 21st Century Prospects,” Journal of Health andSocial Behavior, volume 43, number 2 (June 2002), pages 125–142

Epidemiology Divisions

• Environmental

• Nutritional

• Social

• Immunoepidemiology

• Genetic

• Molecular

• Occupational

• Qualitative vs. Quantiative

Environmental Epidemiology• Population study

• Environmental exposures - air pollution, hazardous waste, metals, pesticides, radiation and so on

• Health and Disease effects - cancer, cardiovascular disease, neurologic effects, reproductive effects, etc.

Social Epidemiology Definition

Examination of social factors in:• development and progression of

many important health problems • the natural history of the risk factors

for those diseases and conditions.

What's wrong with social epidemiology, and how can we make it better?

Kaplan GA EPIDEMIOLOGIC REVIEWS Volume: 26 Pages: 124-135; 2004

Population Health Determinants

“Multilevel Approaches to Understanding Social Determinants,” by Michael Marmot, from Social Epidemiology, edited by Lisa Berkman and Ichiro

Kawachi, copyright 1999 by Oxford University Press, Inc.

Multiple Health Links

James S.House, “Understanding Social Factors and Inequalities in Health: 20th Century Progress and 21st Century Prospects,” Journal of Health andSocial Behavior, volume 43, number 2 (June 2002), pages 125–142

World View of Risk in Heart Disease

3rd World

Preventive Medicine, volume 29, by G. A. Kaplan and J. W. Lynch, “Socioeconomic Considerations in the Primordial Preventionof Cardiovascular Disease,” pages S30–S35, 1999

Nutritional Epidemiology

• Population study

• Nutritional Determinants of disease

Nutritional Epidemiology Example

Willett W, Nutritional Epidemiology. Walter S. Willett 1989

Occupational Epidemiology

• Population of Workers

• Occupational exposures

• Health

• Risk reduction in workplace

Genetic Epidemiology

Analyzes family clustering of disease for possible modes of inheritance

• Isolated population (Newfoundland rod cone dystrophy)

• Twin studies

Molecular Epidemiology

Investigates the pattern of disease in families through DNA analysis.

Qualitative Epidemiology• Participatory Epidemiology - involves field

work intelligence gathering- observational;

• Uses rapid appraisal techniques

• Involves Ethnography - study of individuals in their natural environment

• Understand the “human factor” - attitudes, habits, group dynamics, reactions.

• Factors mitigating against random sampling and towards bias.

Quantitative Epidemiology

• Follows vital statistics and population data

• Uses statistical measures to determine relevance