Epidemiological Methods - Part 1

Hand Hygiene
BSN315 Community Health Nursing
Epidemiological Methods and Measurements in

Community Nursing Practice.
Part 1
AY 2023 24
© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 1

Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z.
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Intended Learning Outcomes
1. Describe basic principles and models of

epidemiology.
2. Use epidemiological methods to describe the state
of health in a community.
3. Identify the natural history of disease process.
4. Recognize the epidemiological to characterize
population health.
5. Describe different study designs used in
epidemiology.

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© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae
What is Epidemiology
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• The study of the distribution of health & illness within

a population, factors that determine the population’s
health problems, and use of knowledge generated to
control the development of health problems (Clark,
2008).
• The study of the distribution and the determinants of

states of health and illness in human populations
(Gordis, 2004 cited in Lundy & Janes, 2016).

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Key Words
Study: Epidemiology is a quantitative discipline based on

statistics and research methodologies.
Distribution: Epidemiology characterizes disease based on
person, place and time.
Determinants: Epidemiology looks for causes or factors
associated with an increased risk of disease.
Health-related states:
Epidemiology applies to the whole spectrum of health-related
events. Chronic disease, environmental problems,
behavioral problems, injuries, and infectious disease.

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Key Words
Populations: Epidemiology deals with groups of people

rather than with individual patients.
Epidemic
The occurrence in a community or region of cases of an
illness (or an outbreak) clearly in excess of expectancy…
Pandemic
An epidemic on a worldwide scale; during a pandemic, large
numbers of persons may be affected and a disease may
cross international borders.” An example is a flu pandemic.
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Uses of Epidemiology
• Study effects of disease states in populations over

time and predict future health needs.
• Diagnose the health of the community.
• Evaluate health services.
• Estimate individual risk from group experience.
• Complete the clinical picture so that prevention can
be accomplished before disease is irreversible.
• Search for causes.

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Natural History of Disease

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WEB of CAUSATION
• The causes of most diseases are more complex than
simply an interaction between a host, agent, and
environment.
• Chronic diseases such as CAD is not attributable to
one factor alone. Rather the interaction of multiple
factors is necessary to produce the disease.
• Accordingly, simple solutions to these health problems
rarely exist.
• Interventions might need to address life style, social
support, stress management,…

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Example 1

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The Epidemiological Triangle
• The model consists of three

interactive factors: the causative
agent (those factors for which
presence or absence cause disease
—biologic, chemical, physical,
nutritional), a susceptible host (such
things as age, gender, race, immune
status, genetics), and the
environment (including such diverse
elements as water, food,
neighborhood, pollution).
• A change in the agent, host, and
environmental balance can lead to
disease.
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METHODS OF ANALYSIS
1. Descriptive Epidemiology:
Epidemiologist collects information
to characterize and summarize
health event. Person, place, and
time factors can form a framework
for disease analysis. Descriptive
epidemiology can then generate
hypotheses about the cause of
disease, and analytic epidemiology
approaches can test these
hypotheses.
2. Analytical Epidemiology:
Epidemiologist compares groups to
identify risk factors.
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Calculation of Rates
• The community health nurse must analyze data about the

health of the community to determine disease patterns.
• The nurse may collect data by conducting surveys or
compiling data from existing records (e.g., data from clinic
facilities or vital statistics records).
• Assessment data often are in the form of counts or
simple frequencies of events (e.g., the number of people
with a specific health condition).
• Community health practitioners interpret these raw
counts by transforming them into rates.
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• 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 (e.g., the population at risk).
• The numerator is the number of events occurring in a specified
period of time. The denominator consists of those in the
population at the specified time period (e.g., per day, per week,
or per year).
• The proportion is multiplied by a constant (k) that is a multiple of
10, such as 1000, 10,000, or 100,000, which is larger and easier
to interpret.
• Thus, a rate can be the number of cases of a disease occurring
for every 1000, 10,000, or 100,000 people in the population,
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• Incidence rates describe the occurrence of new events in a

population over a period of time relative to the size of the
population at risk.
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Prevalence: refers to all of the people with a particular

health condition existing in a given population at a
given point in time.
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Mortality rate: Is a measure of the frequency of occurrence of
death in a defined population during a specified interval.
Morbidity rate: Measures the portion of people in a specific

geographical location who contracted a particular disease
during a specific period of time. It indicates the frequency of
the disease appearing in a population.
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Analytical Epidemiology
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I. Observational Studies
• Epidemiologists use observational studies for descriptive
purposes, but they also use them to discover the etiology of
disease.
• The investigator can begin to understand the factors that
contribute to disease by observing disease rates in groups of
people differentiate by experience or exposure.
• Useful for detailed community assessment, study of morbidity

and underlying factors, especially chronic diseases are
economical and comparatively quick to perform.
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Cross-sectional Studies
• Sometimes called prevalence

studies, examine relationships
between potential causal factors
and disease at a specific time.
• Can identify associations among
disease and specific factors, it is
impossible to make causal
inferences.
• Useful for detailed study of
morbidity and underlying factors,
especially chronic diseases are
economical and comparatively
quick to perform.
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Cross-sectional Studies
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Prospective Studies
• Prospective in nature. The group under study is free from the

disease but exposed to risk factor and epidemiologist study
the development of a condition over time.
• These individuals, or the cohort, have a common experience
within a defined time period.
• It is expensive and time consuming.

• It helps in studying the natural history of disease, estimating
incidence rates and risk of developing disease and identify the
relationship of the risk factor under study to other diseases or
problems.
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Prospective Studies
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Relative Risk
• Relative Risk: Relative risk quantifies the relationship between
exposure and disease.
• Relative risk helps in identifying the risk of developing a disease
in an exposed group versus risk of developing a disease in the
non exposed group in prospective studies.
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Relative Risk
Relative risk = A/(A+B)/C/(C+D)

Interpretation
•If the relative risk = 1, then there is no difference in risk between
the two groups.
•If the relative risk is less than 1, then there is less risk in the
exposed group relative to the unexposed group. (may have
protective effect)
•If the relative risk is greater than 1, then there is greater risk of
association with the disease in the exposed group than in the
unexposed group.
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Relative Risk
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Relative Risk
Relative Risk = (A / (A+B)) / (C / (C+D)) = 2.67
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Relative Risk
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Retrospective/Case-control
• Data collection extends back in time to determine

previous exposure or risk factors.
• Investigators analyze data by comparing the proportion
of subjects with disease who possess the exposure or
risk factors with the corresponding proportion in the
control group.
• A greater proportion of exposed cases than of exposed
controls suggests a relationship between the disease
and the risk factor.
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Retrospective/Case-control
• Investigators often use retrospective study designs because these designs

address the question of causality better than cross-sectional studies.
• Retrospective studies also require fewer resources and less data collection
time than prospective studies.
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Odds Ratio - Definition
• Is the “measure of association” for a case-control study.

It quantifies the relationship between an exposure
(such as eating a food or attending an event) and a
disease in a case-control study.
• The odds ratio is calculated using the number of case-
patients who did or did not have exposure to a factor
(such as a particular food) and the number of controls
who did or did not have the exposure.
• The odds ratio tells us how much higher the odds of
exposure are among case-patients than among
controls.
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Odds Ratio - Calculation
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Odds Ratio Interpretation
• 1.0 (or close to 1.0) indicates that the odds of exposure among
case-patients are the same as, or similar to, the odds of exposure
among controls. The exposure is not associated with the
disease.
• Greater than 1.0 indicates that the odds of exposure among case-
patients are greater than the odds of exposure among controls.
The exposure might be a risk factor for the disease.
• Less than 1.0 indicates that the odds of exposure among case-
patients are lower than the odds of exposure among controls. The
exposure might be a protective factor against the disease.
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Odds Ratio Interpretation
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Exercise
Calculate and interpret the OR

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Establishing Causality
• The principal goal of epidemiology is to identify etiological

factors of diseases to encourage the most effective prevention
activities and develop treatment.
• Establishing causality, particularly in chronic disease, is a
challenge. The following six criteria establish the existence of
a Cause-and-Effect relationship:
1. Strength of association
2. Dose-response relationship
3. Temporally correct relationship
4. Biological plausibility
5. Consistency with other studies
6. Specificity
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1. Strength of Association: Morbidity or mortality rates must be

higher in the exposed group than in the nonexposed group and
correlation tests indicate whether the relationship between the
exposure variable and the outcome is causal. For example,
epidemiological studies demonstrated an higher relative risk for
heart disease among smokers than among nonsmokers.
2. Dose-response relationship: An increased exposure to the risk
factor causes an associated increase in disease rate. For example
the risk of heart disease mortality is higher for heavy smokers than
for light smokers.
3. Temporally correct relationship: Exposure to the causal factor
must occur before the effect, or disease. For heart disease,
smoking history must precede disease development.
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4. Biological plausibility: The data must make biological sense and

represent a coherent explanation for the relationship. For example,
Nicotine and other tobacco-derived chemicals are toxic to the vascular
endothelium.
5. Consistency with other studies: Varying types of studies in other

populations must observe similar associations.
6. Specificity: The exposure variable must be necessary and sufficient

to cause disease. However, smoking is not “necessary and sufficient” to
the development of heart disease because there are nonsmokers who
also have coronary heart disease. Therefore, the causal criterion of
specificity more frequently pertains to infectious diseases.

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Hand Hygiene

BSN315 Community Health Nursing

Epidemiological Methods and Measurements in

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 1

Intended Learning Outcomes

1. Describe basic principles and models of

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 2

• The study of the distribution of health & illness within

• The study of the distribution and the determinants of

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 4

Study: Epidemiology is a quantitative discipline based on

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 5

Populations: Epidemiology deals with groups of people

• Study effects of disease states in populations over

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 7

Natural History of Disease

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 10

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 11

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 12

• The model consists of three

• The community health nurse must analyze data about the

• Rates are arithmetic expressions that help practitioners consider

• Incidence rates describe the occurrence of new events in a

Prevalence: refers to all of the people with a particular

Morbidity rate: Measures the portion of people in a specific

• Useful for detailed community assessment, study of morbidity

• Sometimes called prevalence

• Prospective in nature. The group under study is free from the

• It is expensive and time consuming.

Relative risk = A/(A+B)/C/(C+D)

Relative Risk = (A / (A+B)) / (C / (C+D)) = 2.67

• Data collection extends back in time to determine

• Investigators often use retrospective study designs because these designs

Odds Ratio - Definition

• Is the “measure of association” for a case-control study.

Odds Ratio - Calculation

Odds Ratio Interpretation

Odds Ratio Interpretation

Calculate and interpret the OR

• The principal goal of epidemiology is to identify etiological

1. Strength of Association: Morbidity or mortality rates must be

4. Biological plausibility: The data must make biological sense and

5. Consistency with other studies: Varying types of studies in other

6. Specificity: The exposure variable must be necessary and sufficient

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