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CHAPTER 4

Epidemiology: The Basic Science of Public Health

Epidemiology

Is the diagnostic discipline of public health

Is a major part of public health’s assessment function

Investigates causes of diseases

Identifies trends in disease occurrence

Evaluates effectiveness of medical and public health interventions

Patterns of Disease Occurrence

From the following information, epidemiologists can infer why a disease is occurring:

Who is getting the disease?

When did they get the disease?

Where is the disease occurring?

The ultimate goal is to use this knowledge to control and prevent the spread of disease.

Epidemic Surveillance

Is a major line of defense in protecting the public against disease

Important terms are:

Endemic versus epidemic

“Notifiable” diseases

“Shoeleather epidemiology”

System was created to control spread of known disease but also aids in recognizing new disease.

Importance has increased with threat of bioterrorism.

John Snow and Cholera

First example of use of epidemiology to study and control a disease was by Snow for cholera.

London had Cholera epidemics in mid-1800s.

Snow suspected an association with the water supply, the Thames River.

He conducted a “natural experiment”:

He questioned households where cholera death had occurred.

Most deaths were associated with one water supply company.

Outbreak Investigation

Verify the diagnosis.

Construct a working case definition.

Find cases systematically.

Apply active surveillance.

Ask who, where, and when questions to describe the epidemic by person, place, and time.

Consider the incubation period.

Look for a common source of exposure.

Epidemiology and Chronic Diseases

Identify risk factors.

Observe long-term trends.

Epidemiologic studies of chronic diseases are more complicated and difficult than for infectious diseases or toxic contamination.

Heart disease is leading cause of death in the U.S.

Framingham Study (started in 1948)

Lung cancer and smoking studies followed in the early 1950s.

British study of physicians

Hammond–Horn study in the U.S.

Discussion Question 1

Why is epidemiologic surveillance important for public health?

What role would it play if there were a bioterrorist attack?

Discussion Question 2

What has epidemiology contributed to people’s understanding of:

Heart disease?

Lung cancer?

Discussion Question 3

Visit the website of The Epidemiology Monitor, a weekly newsletter about epidemiology, and read the free news updates available on Mondays, www.epimonitor.net.

What issues are epidemiologists concerned about this week?

Discussion Question 4

Visit the website of CDC’s Morbidity and Mortality Weekly Report, www.cdc.gov/mmwr.

Has the CDC reported any new outbreaks or health risks this week?

What other issues is the nation’s epidemiology agency concerned about this week?

Discussion Question 5

Visit the website of the Framingham Heart Study, www.framingham.com/heart.

What are the most recent findings from this cohort study?