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Overview of Epidemiological Studies

Epidemiology is the study of disease distribution and determinants in communities. Descriptive epidemiological studies describe disease occurrence patterns over time, place, and people using various data sources to understand disease burdens and generate hypotheses. Descriptive studies are less expensive and time-consuming than analytical studies, which identify risk factors for diseases or evaluate interventions through observational and experimental designs like case-control and cohort studies or clinical/community trials.

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7 views3 pages

Overview of Epidemiological Studies

Epidemiology is the study of disease distribution and determinants in communities. Descriptive epidemiological studies describe disease occurrence patterns over time, place, and people using various data sources to understand disease burdens and generate hypotheses. Descriptive studies are less expensive and time-consuming than analytical studies, which identify risk factors for diseases or evaluate interventions through observational and experimental designs like case-control and cohort studies or clinical/community trials.

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musa onyango obuya
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© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd

Epidemiology is concerned with the study of distribution and determinant

of disease or any health related problem in the community. Epidemiological


studies can be classified as

1. Descriptive studies: In descriptive studies, the pattern of disease


occurrence is described in terms of time, place and person. Descriptive
studies utilise information from diverse sources of data such as census,
vital statistical records, hospital records as well as national figures
about consumption of food, medications and other products.
Descriptive studies are conducted especially to understand the disease
pattern, extent of the problem and to generate research questions and
hypothesis. Descriptive studies are generally less expensive and time-
consuming than the analytic studies. Types of descriptive studies are

1. Case reports and case series


2. Correlational study
3. Ecological Study
4. Cross-sectional study

2. Analytical studies: are conducted to identify the risk factor(s) for


diseases or evaluate the interventions for control of disease(s) or other
health problems. The analytic studies include:

1. Observational studies: such as, case-control and cohort studies


2. Experimental: such as, intervention trials (clinical trial and community
trial)

1.1 Case report and case series:


Case reports and case series are the most frequently published articles in the
medical journals. Case reports and case series usually describe the
experience of a single patient (case report) or a group of patients (case
series) with a similar disease. Case report documents unusual medical
occurrences and can represent the first clues in the identification of new
disease or adverse effects of medications (e.g., emergence of new disease
like AIDS, thalidomide tragedy and use of oral contraceptive and
development of venous thrombosis etc.). Case series are collections of
individual case reports, which may occur, in fairly a short period of time.
Such studies are important especially to identify the beginning or presence
of an epidemic in the community. These types of studies where there are
unusual features of disease (or patient’s history) may lead into generation of
hypothesis. Although such studies provide important clues for generation of
hypothesis, they cannot be tested because of lack of an appropriate
comparison group. It is therefore necessary to design an appropriate
analytic study to identify the possible factor.

1.2 Correlational study:

Also called ecological study. In this study design, the investigator collects
or uses information from a community (or country) as whole rather than
from individuals and search for associations among various factors present
in the community. Main features of such study design are:

It usually compares mortality or disease prevalence in different groups


of people or community or country
The unit of observation is the entire community (or country)
The estimated exposure level found in that community or geographical
unit is a surrogate measure for exposure of all individuals in that unit
Linkage between individual exposure and individual suffering for a
certain disease (or death) cannot be ascertained
Once information is collected, scatter diagram of morbidity (or mortality)
rates against the average exposure rates in each community (or country or
geographical areas) is constructed to assess possible association between
exposure and outcome of interest. Other measures of association, such as
correlation coefficient, coefficient of determination, are also calculated to
quantify the relationship between the variables of interest and outcome.
Such studies especially help to generate hypothesis between exposure and
disease association. For example, to describe the pattern of morbidity of
coronary heart disease (CHD) in 1960, death rates from 44 states (in US)
were collected with per capita cigarette sales. It was observed that the death
rates were highest in states with most cigarette sales, lowest in those with
the least sales, and intermediate in the remainder. This observation
contributed to the formulation of hypothesis that cigarette smoking causes
fatal CHD, which has been documented subsequently in large number of
analytic studies.

The advantages of such study is that it utilises the available data from
different sources for analysis, thus can be conducted with minimum time
and resources. However, the limitations of such studies are a) unable to link
exposure with disease among individuals; b) correlational study presents
average exposure of values rather than actual individual levels and c)
subjected to potential confounding bias, which cannot be controlled during
analysis. For example, a correlational study found association between
increased pork consumption and breast cancer. Increased pork consumption
may merely be a marker for a number of other factors for the increased risk
of breast cancer, such as increased dietary fat, decreased vegetable intake or
higher socio-economic status of people. It is not possible to separate the
effects of such potential confounding factors while analysing data.

Common questions

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Case reports and series contribute to early identification of public health issues by documenting unusual medical occurrences, such as the emergence of new diseases or adverse drug effects. These reports provide valuable hypothesis-generating clues about potential risks. However, they are limited by the absence of a systematic comparison group, meaning they cannot test hypotheses or confirm causation .

Descriptive epidemiological studies cannot test hypotheses due to the lack of an appropriate comparison group, which is essential for establishing causation. As a result, while descriptive studies are useful for generating hypotheses, it is necessary to follow up with analytic studies that are designed to test these hypotheses and identify possible risk factors .

Scatter diagrams and correlation coefficients play a crucial role in correlational studies by visually and statistically assessing the strength and direction of relationships between exposure and disease outcomes. However, they do not establish causation, and the observed correlations may be influenced by hidden variables or biases. Therefore, while essential for initial analysis, they must be supplemented with further studies to confirm findings .

Using average exposure levels in correlational studies implies that individual variability within a community is not accounted for, which can affect the study outcomes by masking true individual-level associations. This approach can lead to ecological fallacies, where incorrect inferences about individual risk factors are drawn from group-level data, thus potentially overestimating or underestimating exposure-disease relationships .

The use of historical data in correlational studies can influence the validity of their conclusions by potentially introducing biases related to changes in exposure and disease reporting over time. While historical data enables hypothesis generation, such as the link between past cigarette sales and CHD mortality, it may not accurately reflect contemporary population behaviors or confounders, affecting the study’s validity and generalizability .

Case reports and case series are significant because they document unusual medical occurrences and can provide initial clues for identifying new diseases or adverse effects of medications. These studies are crucial for hypothesis generation, particularly when there are unusual disease features. However, they lack a comparison group, making it impossible to test the hypotheses they generate .

Correlational studies, or ecological studies, contribute to hypothesizing associations by comparing mortality or disease prevalence with exposure levels in communities. They generate hypotheses based on observed patterns, such as the link between cigarette sales and CHD death rates. However, they cannot ascertain linkage at the individual level and may introduce confounding biases due to using average community exposure levels as opposed to individual data .

Correlational studies differ by using aggregated data from communities or countries rather than individuals. This approach allows for the quick analysis of data from diverse sources, facilitating hypothesis generation concerning exposure-disease associations. However, it trades off the ability to make individual associations, introduces potential confounding biases, and uses average exposure levels as proxies, which may not reflect individual experiences .

Confounding factors can limit correlational study conclusions by introducing spurious associations that are not causal. For instance, increased pork consumption may correlate with breast cancer due to confounding factors like higher dietary fat and socio-economic status, rather than pork itself being a direct risk factor. Since these studies cannot separate or control these confounders, the true causal relationships remain uncertain .

Descriptive studies are generally more cost-effective than analytical studies because they utilize existing data and are less resource-intensive, making them ideal for initial hypothesis generation and understanding disease patterns. However, the lack of hypothesis testing capability necessitates follow-up with more expensive and time-consuming analytic studies to evaluate risk factors or interventions thoroughly .

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