Essentials of epidemiologyin public health.
FOURTH EDITION
ESSENTIALS OF
Epidemiology
IN PUBLIC HEALTH
Ann Aschengrau, ScD
Professor, Department of Epidemiology
Boston University School of Public Health
Boston, Massachusetts
George R. Seage III, DSc
Professor of Epidemiology
Harvard T.H. Chan School of Public Health
Boston, Massachusetts
1
,Essentials of epidemiologyin public health.
© Smartboy10/DigitalVision Vectors/Getty Images
Contents
Chapter Questions...............................................54
Preface..........................................................vii
Acknowledgments.......................................... xi
Chapter 1 The Approach and Evolution
of Epidemiology....................1
Introduction..........................................................1
Definition and Goals of Public Health......................2
Sources of Scientific Knowledge in Public Health.... 3
Definition and Objectives of Epidemiology...............5
Historical Development of Epidemiology................. 8
Modern Epidemiology.........................................27
Summary............................................................. 29
References.......................................................... 30
Chapter Questions...............................................31
Chapter 2 Measures of Disease
Frequency.......................... 33
Introduction........................................................33
Definition of a Population...................................... 34
Definitions of Health and Disease.......................... 36
Changes in Disease Definitions.............................37
Measuring Disease Occurrence.............................39
Types of Calculations: Ratios,
Proportions, and Rates...................................... 40
Measures of Disease Frequency............................ 41
Commonly Used Measures of Disease
Frequency in Public Health................................51
Summary............................................................. 52
References.......................................................... 53
2
,Essentials of epidemiologyin public health.
Vital Statistics.......................................................79
Chapter 3 Comparing Disease National Survey of Family Growth..........................84
Frequencies........................ 57 National Health Interview Survey.......................... 84
Introduction........................................................57 National Health and Nutrition
Data Organization...............................................58 Examination Survey......................................... 85
Measures of Comparison....................................... 61 Behavioral Risk Factor Surveillance System............ 85
Direct Standardization......................................... 69 National Health Care Surveys.................................86
Summary............................................................. 72 National Notifiable Diseases
References.......................................................... 73 Surveillance System..........................................87
Chapter Questions...............................................73 Surveillance of HIV Infection.................................. 87
Reproductive Health Statistics...............................88
Chapter 4 Sources of Public National Immunization Survey..............................89
Health Data......................... 77 Survey of Occupational Injuries
and Illnesses.................................................... 89
Introduction........................................................77 National Survey on Drug Use
Census of the U.S. Population.................................78 and Health....................................................... 90
iii
3
,Essentials of epidemiologyin public health.
iv Contents
Air Quality System..................................................90 Overview of Case–Control Studies......................163
Surveillance, Epidemiology and When Is It Desirable to Use a
End Results Program.......................................... 91 Particular Study Design?................................... 168
Birth Defects Surveillance Other Types of Studies.........................................170
and Research Programs......................................91 Summary........................................................... 177
Health, United States...............................................92 References........................................................ 178
Demographic Yearbook....................................... 92 Chapter Questions.............................................179
World Health Statistics............................................ 92
Cancer Incidence on Five Continents.................... 93 Chapter 7 Experimental Studies...........181
Other Resources..................................................93 Introduction......................................................181
Summary............................................................. 94 Overview of Experimental Studies.......................182
References.......................................................... 96 Types of Experimental Studies.............................185
Chapter Questions...............................................97 Study Population...............................................190
Sample Size........................................................191
Chapter 5 Descriptive Epidemiology......... 99 Consent Process................................................ 192
Introduction........................................................99 Treatment Assignment...................................... 192
Person................................................................100 Use of the Placebo and Masking..........................196
Place..................................................................102 Maintenance and Assessment
Time...................................................................104 of Compliance................................................ 197
Disease Clusters and Epidemics.......................... 105 Ascertaining the Outcomes..................................200
Ebola Outbreak and Its Investigation....................110 Data Analysis..................................................... 202
Uses of Descriptive Epidemiology.........................116 Generalizability................................................205
Generating Hypotheses About Special Issues in Experimental Studies.................205
Causal Relationships...................................... 116 Summary........................................................... 207
Public Health Planning and References........................................................ 207
Evaluation..................................................... 117 Chapter Questions.............................................209
Example: Patterns of Mortality
in the United States According to Age............ 118 Chapter 8 Cohort Studies.................... 211
Overall Pattern of Mortality.................................. 121
Introduction......................................................211
Examples: Three Important Causes
Cohort Study Definitions and Overview..............212
of Morbidity in the United States....................129
Types of Populations Studied.............................. 213
Summary........................................................... 144
Characterization of Exposure............................... 215
References........................................................ 145
Follow-Up and Outcome
Chapter Questions.............................................150
Assessment................................................... 215
Timing of Cohort Studies.................................... 216
Chapter 6 Overview of Epidemiological
Issues in the Selection of Cohort
Study Designs....................153 Study Populations......................................... 218
Introduction......................................................153 Sources of Information........................................224
Overview of Experimental Studies.......................156 Analysis of Cohort Studies................................... 229
Overview of Cohort Studies................................ 159 Special Types of Cohort Studies...........................231
4
FOURTH EDITION
ESSENTIALS OF
Epidemiology
IN PUBLIC HEALTH
Ann Aschengrau, ScD
Professor, Department of Epidemiology
Boston University School of Public Health
Boston, Massachusetts
George R. Seage III, DSc
Professor of Epidemiology
Harvard T.H. Chan School of Public Health
Boston, Massachusetts
1
,Essentials of epidemiologyin public health.
© Smartboy10/DigitalVision Vectors/Getty Images
Contents
Chapter Questions...............................................54
Preface..........................................................vii
Acknowledgments.......................................... xi
Chapter 1 The Approach and Evolution
of Epidemiology....................1
Introduction..........................................................1
Definition and Goals of Public Health......................2
Sources of Scientific Knowledge in Public Health.... 3
Definition and Objectives of Epidemiology...............5
Historical Development of Epidemiology................. 8
Modern Epidemiology.........................................27
Summary............................................................. 29
References.......................................................... 30
Chapter Questions...............................................31
Chapter 2 Measures of Disease
Frequency.......................... 33
Introduction........................................................33
Definition of a Population...................................... 34
Definitions of Health and Disease.......................... 36
Changes in Disease Definitions.............................37
Measuring Disease Occurrence.............................39
Types of Calculations: Ratios,
Proportions, and Rates...................................... 40
Measures of Disease Frequency............................ 41
Commonly Used Measures of Disease
Frequency in Public Health................................51
Summary............................................................. 52
References.......................................................... 53
2
,Essentials of epidemiologyin public health.
Vital Statistics.......................................................79
Chapter 3 Comparing Disease National Survey of Family Growth..........................84
Frequencies........................ 57 National Health Interview Survey.......................... 84
Introduction........................................................57 National Health and Nutrition
Data Organization...............................................58 Examination Survey......................................... 85
Measures of Comparison....................................... 61 Behavioral Risk Factor Surveillance System............ 85
Direct Standardization......................................... 69 National Health Care Surveys.................................86
Summary............................................................. 72 National Notifiable Diseases
References.......................................................... 73 Surveillance System..........................................87
Chapter Questions...............................................73 Surveillance of HIV Infection.................................. 87
Reproductive Health Statistics...............................88
Chapter 4 Sources of Public National Immunization Survey..............................89
Health Data......................... 77 Survey of Occupational Injuries
and Illnesses.................................................... 89
Introduction........................................................77 National Survey on Drug Use
Census of the U.S. Population.................................78 and Health....................................................... 90
iii
3
,Essentials of epidemiologyin public health.
iv Contents
Air Quality System..................................................90 Overview of Case–Control Studies......................163
Surveillance, Epidemiology and When Is It Desirable to Use a
End Results Program.......................................... 91 Particular Study Design?................................... 168
Birth Defects Surveillance Other Types of Studies.........................................170
and Research Programs......................................91 Summary........................................................... 177
Health, United States...............................................92 References........................................................ 178
Demographic Yearbook....................................... 92 Chapter Questions.............................................179
World Health Statistics............................................ 92
Cancer Incidence on Five Continents.................... 93 Chapter 7 Experimental Studies...........181
Other Resources..................................................93 Introduction......................................................181
Summary............................................................. 94 Overview of Experimental Studies.......................182
References.......................................................... 96 Types of Experimental Studies.............................185
Chapter Questions...............................................97 Study Population...............................................190
Sample Size........................................................191
Chapter 5 Descriptive Epidemiology......... 99 Consent Process................................................ 192
Introduction........................................................99 Treatment Assignment...................................... 192
Person................................................................100 Use of the Placebo and Masking..........................196
Place..................................................................102 Maintenance and Assessment
Time...................................................................104 of Compliance................................................ 197
Disease Clusters and Epidemics.......................... 105 Ascertaining the Outcomes..................................200
Ebola Outbreak and Its Investigation....................110 Data Analysis..................................................... 202
Uses of Descriptive Epidemiology.........................116 Generalizability................................................205
Generating Hypotheses About Special Issues in Experimental Studies.................205
Causal Relationships...................................... 116 Summary........................................................... 207
Public Health Planning and References........................................................ 207
Evaluation..................................................... 117 Chapter Questions.............................................209
Example: Patterns of Mortality
in the United States According to Age............ 118 Chapter 8 Cohort Studies.................... 211
Overall Pattern of Mortality.................................. 121
Introduction......................................................211
Examples: Three Important Causes
Cohort Study Definitions and Overview..............212
of Morbidity in the United States....................129
Types of Populations Studied.............................. 213
Summary........................................................... 144
Characterization of Exposure............................... 215
References........................................................ 145
Follow-Up and Outcome
Chapter Questions.............................................150
Assessment................................................... 215
Timing of Cohort Studies.................................... 216
Chapter 6 Overview of Epidemiological
Issues in the Selection of Cohort
Study Designs....................153 Study Populations......................................... 218
Introduction......................................................153 Sources of Information........................................224
Overview of Experimental Studies.......................156 Analysis of Cohort Studies................................... 229
Overview of Cohort Studies................................ 159 Special Types of Cohort Studies...........................231
4
