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El. knyga: Introduction to Epidemiology for Health Professionals

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Therearemanygoodepidemiologytextbooksonthemarket,butmostoftheseare addressedtostudentsofpublichealthorpeoplewhodoclinicalresearchwithe- demiologicmethods. Thereisaneedforashortintroductiononhowepidemiologic methodsareusedinpublichealth,geneticandclinicalepidemiology,becausehealth professionalsneedtoknowbasicepidemiologicmethodscoveringetiologicaswell asprognosticfactorsofdiseases. Theyneedtoknowmoreaboutmethodologythan introductorytextsonpublichealthhavetooffer. Insomehealthfaculties,epidemiologyisnotevenpartoftheteachingcurri- lum. Webelievethistobeaseriousmistake. Medicalstudentsarestudentsofall aspectsofdiseasesandhealth. Withoutknowingsomethingaboutepidemiologythe cliniciansandotherhealthprofessionalscannotreadagrowingpartofthesci- ti cliteratureinanyreasonablycriticalwayandcannotnavigateintheworldof "evidence-basedmedicineandevidence-basedprevention. "Withoutskillsine- demiologicmethodologytheyareinthehandsofexpertsthatmaynotonlyhavean interestinhealth. Some health professionals may believe that only common sense is needed to conductepidemiologicalstudies,butthescienti cliteratureandthepublicdebate onhealthissuesindicatethatcommonsenseisofteninshortsupplyandmaynot thrivewithoutsomeformaltraining. Epidemiologic methods play a key role in identifying environmental, social, and genetic determinants of diseases. Clinical epidemiology addresses the tr- sitionfromdiseasetohealthortowardmortalityorsocialormedicalhandicaps. Publichealthepidemiologyaddressesthetransitionfrombeinghealthytobeingnot healthy. Descriptiveepidemiologyprovidesthediseasepatternthatisneededtolook athealthinabroadperspectiveandtosettheprioritiesright. Epidemiologyisabasic scienceofmedicinewhichaddresseskeyquestionssuchas"Whobecomesill?"and "Whatareimportantprognosticfactors?"Answerstosuchquestionsprovidethe basisforbetterpreventionandtreatmentofdiseases. Many people contributed to the writing of this book: medical students in Denmark,studentsofepidemiologyattheIEAEEPEsummercourseinFlorence, Italy,andstudentsofpublichealthinLosAngeles. Withouttechnicalassistance v vi Preface fromGitteNielsen,JenadeShelley,NinaHoheandPamMasangkaythebookwould neverhavematerialized. LosAngeles,California JornOlsen Odense,Denmark KaareChristensen IowaCity,Iowa JeffMurray Stockholm,Sweden AndersEkbom Contents Part I Descriptive Epidemiology 1 Measures of Disease Occurrence ...3 IncidenceandPrevalence ...4 Incidence...6 RatesandDynamicPopulations ...7 CalculatingObservationTime...9 Prevalence,Incidence,Duration ...10 MortalityandLifeExpectancy ...11 LifeExpectancy ...12 References...13 2 Estimates of Associations ...15 3 Age Standardization...19 4 Causes of Diseases ...23 References...28 5 Descriptive Epidemiology in Public Health...29 GraphicalModelsofCausalLinks ...33 References...35 6 Descriptive Epidemiology in Genetic Epidemiology...37 OccurrenceDatainGeneticEpidemiology ...37 ClusteringofTraitsandDiseasesinFamilies ...38 TheOccurrenceofGeneticDiseases ...40 References...41 7 Descriptive Epidemiology in Clinical Epidemiology...43 SuddenInfantDeathSyndrome(SIDS)...44 CytologicalScreeningforCervixCancer ...45 ChangesinTreatmentofJuvenileDiabetes ...46 References...47 vii viii Contents Part II Analytical Epidemiology 8 Design Options...51 CommonDesignsUsedtoEstimateAssociations...51 EcologicalStudy ...52 Case-ControlStudy...54 CohortStudy ...5 5 ExperimentalStudy ...56 Reference ...57 9 Follow-Up Studies ...59 TheNon-experimentalFollow-Up(Cohort)Study ...59 StudyingRiskasaFunctionofBMI ...60 LongitudinalExposureData...62 DifferentTypesofCohortorFollow-UpStudies...63 10 Case-Control Studies...67 Case-CohortSampling ...69 DensitySamplingofControls...69 Case-Non-caseStudy...71 PatientControls ...72 SecondaryIdenti cationoftheSourcePopulation ...74 Case-ControlStudiesUsingPrevalentCases...74 WhentoDoaCase-ControlStudy? ...77 References...78 11 The Cross-Sectional Study...79 12 The Randomized Controlled Trial (RCT) ...81 Reference ...
Part I Descriptive Epidemiology
1 Measures of Disease Occurrence
3(12)
Incidence and Prevalence
4(2)
Incidence
6(1)
Rates and Dynamic Populations
7(2)
Calculating Observation Time
9(1)
Prevalence, Incidence, Duration
10(1)
Mortality and Life Expectancy
11(1)
Life Expectancy
12(1)
References
13(2)
2 Estimates of Associations
15(4)
3 Age Standardization
19(4)
4 Causes of Diseases
23(6)
References
28(1)
5 Descriptive Epidemiology in Public Health
29(8)
Graphical Models of Causal Links
33(2)
References
35(2)
6 Descriptive Epidemiology in Genetic Epidemiology
37(6)
Occurrence Data in Genetic Epidemiology
37(1)
Clustering of Traits and Diseases in Families
38(2)
The Occurrence of Genetic Diseases
40(1)
References
41(2)
7 Descriptive Epidemiology in Clinical Epidemiology
43(8)
Sudden Infant Death Syndrome (SIDS)
44(1)
Cytological Screening for Cervix Cancer
45(1)
Changes in Treatment of Juvenile Diabetes
46(1)
References
47(4)
Part II Analytical Epidemiology
8 Design Options
51(8)
Common Designs Used to Estimate Associations
51(6)
Ecological Study
52(2)
Case-Control Study
54(1)
Cohort Study
55(1)
Experimental Study
56(1)
Reference
57(2)
9 Follow-Up Studies
59(8)
The Non-experimental Follow-Up (Cohort) Study
59(1)
Studying Risk as a Function of BMI
60(2)
Longitudinal Exposure Data
62(1)
Different Types of Cohort or Follow-Up Studies
63(4)
10 Case-Control Studies
67(12)
Case-Cohort Sampling
69(1)
Density Sampling of Controls
69(2)
Case-Non-case Study
71(1)
Patient Controls
72(2)
Secondary Identification of the Source Population
74(1)
Case-Control Studies Using Prevalent Cases
74(3)
When to Do a Case-Control Study?
77(1)
References
78(1)
11 The Cross-Sectional Study
79(2)
12 The Randomized Controlled Trial (RCT)
81(4)
Reference
84(1)
13 Analytical Epidemiology in Public Health
85(4)
The Case-Crossover Study
86(1)
References
87(2)
14 Analytical Epidemiology in Genetic Epidemiology
89(6)
Disentangling the Basis for Clustering in Families
89(2)
Adoption Studies
89(1)
Twin Studies
90(1)
Half-Sib Studies
90(1)
Interpretation of Heritability
91(1)
Exposure-Disease Associations Through Studies of Relatives
91(1)
Gene-Environment Interaction
92(1)
Cross-Sectional Studies of Genetic Polymorphisms
93(1)
Incorporation of Genetic Variables in Epidemiologic Studies
93(1)
References
94(1)
15 Analytical Epidemiology in Clinical Epidemiology
95(8)
Common Designs Used to Estimate Associations
95(1)
Case-Reports and Cross-Sectional Studies
95(1)
Case-Control Studies
96(1)
Cohort Studies
97(1)
Randomized Clinical Trials (RCTs)
98(1)
References
99(4)
Part III Sources of Error
16 Confounding and Bias
103(4)
Reference
105(2)
17 Confounding
107(6)
References
111(2)
18 Information Bias
113(6)
References
117(2)
19 Selection Bias
119(4)
Reference
122(1)
20 Making Inference and Making Decisions
123(6)
References
127(2)
21 Sources of Error in Public Health Epidemiology
129(6)
Berkson Bias
131(1)
Mendelian Randomization
132(2)
References
134(1)
22 Sources of Error in Genetic Epidemiology
135(4)
Multiple Testing
135(1)
Population Stratification
136(1)
Laboratory Errors
136(3)
23 Sources of Error in Clinical Epidemiology
139(6)
Confounding by Indication
139(1)
Differential Misclassification of Outcome
140(1)
Differential Misclassification of Exposure
141(1)
Selection Bias
142(1)
References
142(3)
Part IV Statistics in Epidemiology
Additive Model
145(1)
Multiplicative Model
146(4)
Reference
150(1)
24 P Values
151(4)
25 Calculating Confidence Intervals
155(2)
Epilogue
157(2)
Reference
157(2)
Index 159
Jųrn Olsen is Professor and Chair of the Department of Epidemiology at the UCLA School of Public Health.
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