Concepts of Epidemiology: An integrated introduction to the ideas, theories, principles and methods of epidemiology

Contents......Page 16
C......Page 21
E......Page 23
H......Page 24
M......Page 25
P......Page 26
S......Page 27
T......Page 28
Z......Page 29
1.1 The individual and the population......Page 30
1.2 Definition of epidemiology and statement of its central paradigm......Page 31
1.3 Directions in epidemiology and its uses......Page 32
1.4 Epidemiology as a science, practice, and craft......Page 33
1.5 The nature of epidemiological variables......Page 36
1.6 A disease and health problem: an illustration of the interdependence of clinical medicine and epidemiology......Page 40
1.7 Seeking the theoretical foundations of epidemiology......Page 43
Summary......Page 44
2.1 The individual and the population......Page 46
2.2 Harnessing heterogeneity in individual and group level disease and risk factor patterns......Page 50
2.3 Disease patterns as a manifestation of individuals living in changing social groups......Page 51
2.4 Sick populations and sick individuals......Page 55
2.5 Individual and population level epidemiological variables......Page 60
2.6 Epidemiology and demography: interdependent population sciences......Page 62
2.7 The dynamic nature of human population......Page 68
2.8 Applications of the population concept......Page 69
2.9 Conclusion......Page 71
Summary......Page 72
3.1 Introduction......Page 73
3.2 Reasons for analysing disease variations......Page 74
3.3 Variations and associations: real or artefact?......Page 76
3.4 Applying the real-artefact framework......Page 81
3.5 Disease clustering and clusters in epidemiology......Page 88
3.6 Applications of observations of disease variation......Page 96
Summary......Page 97
4.1 Introduction......Page 98
4.2 A classification of error and bias......Page 101
4.2.1 The research question, theme or hypothesis......Page 102
4.2.2 Choice of population......Page 105
4.2.4 Comparing disease patterns and risk factor-disease outcome relationships in populations which differ (confounding)......Page 108
4.2.5 Measurement......Page 115
4.2.6 Misclassification bias......Page 117
4.2.7 Analysis and interpretation......Page 119
4.2.9 Judgement and action......Page 120
4.3 A practical application of the research chronology schema of bias and error......Page 121
4.4 Conclusion......Page 123
Summary......Page 126
5.1 Introduction: causality in science and philosophy......Page 127
5.2 Epidemiological causal strategy and reasoning: the example of Semmelweiss......Page 130
5.3.1 Interplay of host, agent, and environment......Page 132
5.3.2 Necessary and sufficient cause......Page 142
5.4.1 Comparison of epidemiological and other concepts of causal reasoning......Page 144
5.4.2 Application of criteria to associations......Page 150
5.4.3 Interpretation of data, study design, and causal criteria......Page 158
5.6 Conclusion......Page 159
Summary......Page 161
6 Natural history, spectrum, iceberg, population patterns, and screening: Interrelated concepts in the epidemiology of disease......Page 162
6.1 Natural history of disease......Page 163
6.2 The population pattern of disease......Page 168
6.3 Spectrum of disease......Page 169
6.4 The unmeasured burden of disease: the metaphors of the iceberg and the pyramid......Page 171
6.5 Screening......Page 174
6.6 Applications of the concepts of natural history, spectrum, and screening......Page 185
6.7 Epidemiological theory: symbiosis with clinical medicine and social sciences......Page 189
Summary......Page 190
7.1 Introduction: risks, risk factors, and causes......Page 192
7.2 Quantifying disease frequency, risk factors, and their relationships......Page 193
7.3 Incidence and incidence rate: the concepts of incidence density, person-time incidence and cumulative incidence......Page 196
7.4 Numerator......Page 202
7.5 Denominator......Page 207
7.6 Prevalence and prevalence rate......Page 208
7.7 Relationship of incidence and prevalence......Page 214
7.9 Presenting rates......Page 217
7.10 Conclusion......Page 218
Summary......Page 219
8.1 Introduction......Page 220
8.2 Proportional morbidity or mortality ratio (PMR)......Page 221
8.3 Adjusted overall rates: standardization and the calculation of the SMR (Standardized mortality ratio)......Page 223
8.4 Relative measure: relative risk......Page 227
8.5 The odds ratio (OR)......Page 231
8.6 Measurements to assess the impact of a risk factor in groups and populations......Page 236
8.6.1 Attributable risk/exposed group......Page 239
8.6.2 Population attributable risk......Page 241
8.7 Presentation and interpretation of epidemiological data in applied settings......Page 243
8.8 Avoidable morbidity and mortality......Page 246
8.9 Comparison of summary measures of health status......Page 247
8.10 DALY, disability adjusted life years, and QALY, quality adjusted life years......Page 249
8.11 Numbers needed to treat (NNT) or to prevent (NNP)......Page 251
8.12 Describing the health status of a population......Page 252
8.13 The construction and development of health status indicators......Page 255
8.14 Conclusion......Page 257
Summary......Page 259
9.1 Introduction: interdependence of study design......Page 260
9.2 Classifications of study design: five dichotomies......Page 263
9.3 Case-series: clinical and population based......Page 264
9.4 Cross-sectional study......Page 271
9.5 Case-control study......Page 276
9.6 Cohort study......Page 280
9.7 Trials......Page 284
9.8 Overlap in the conceptual basis of the case-series, cross-sectional, case-control, cohort, and trial designs......Page 286
9.9 Ecological studies: design or analysis?......Page 291
9.10 Size of the study......Page 292
9.11 Data analysis and interpretation......Page 293
Summary......Page 294
10.1 The interrelationship of theory, methods, and application: a question of values......Page 296
10.2 Fundamental influences on health......Page 298
10.3 Setting priorities in health and health care......Page 300
10.4 Impact on health of local polluting industries: Teesside study of environment and health......Page 303
10.5 Paradigms: the evolution of epidemiology......Page 305
10.6 Epidemiology: forces for change......Page 306
10.7 Scope of epidemiology and specialization......Page 307
10.8 The context of epidemiological practice—academic and service, USA and UK......Page 308
10.9 The practice of epidemiology in public health......Page 309
10.10.2 Authorship......Page 310
10.10.3 Ethnicity and race......Page 311
10.11 Ethical guidelines......Page 313
10.12 Critical appraisal in epidemiology: separating fact from error and fallacy......Page 314
10.12.3 The fallacy of repeated citation......Page 316
10.12.9 The fallacy of obfuscation......Page 317
10.13 Some questions relevant to the appraisal of epidemiological research......Page 318
10.14 Building on an epidemiological education: role of historical landmarks......Page 320
10.15 Building on an epidemiological education: a reflection on the future of epidemiology......Page 322
Summary......Page 324
References and further reading......Page 326
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