Understanding the Fundamentals of Epidemiology an evolving text

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Bibliography NOTE: In-depth reviews of epidemiologic knowledge in both topical and methodological areas can be found in the periodical Epidemiologic Reviews, published by the American Journal of Epidemiology. The first issue of the year 2000 (Armenian and Samet, 2000) features essays addressing the current state of epidemiology in a wide range of areas and provides an excellent overview of the field. Textbook chapters: Charles Hennekens and Julie Buring. Epidemiology in medicine, ch. 1-2; Kenneth Rothman. Modern Epidemiology, 1 st ed., ch. 1; Kenneth Rothman and Sander Greenland, Modern Epidemiology, 2 nd ed., ch 1. Brian MacMahon and Thomas Pugh. Epidemiology: principles and methods. 1 ed., ch. 1-4; Judith Mausner and Shira Kramer. Epidemiology: an introductory text., ch. 1-2; Abraham Lilienfeld and David Lilienfeld. Foundations of epidemiology. 2 ed, ch. 1, 12; Mervyn Susser. Causal Thinking in the Health Sciences; David Kleinbaum, Lawrence Kupper, Hal Morgenstern. Epidemiologic research, ch. 2, 3. [Complete citations for these and many other textbooks are available at www.epidemiolog.net/] Armenian, Haroutune K., Jonathan M. Samet (eds). Epidemiology in the year 2000 and beyond. Epidemiologic Reviews 2000; 22(1):1-185 Bhopal RS. Which book? A comparative review of 25 introductory epidemiology textbooks. J Epidemiol Community Health 1997;51:612-622. Bhopal, Raj. Paradigms in epidemiology textbooks: in the footsteps of Thomas Kuhn. Am J Public Health 1999; 89:1162-1165. Duffy J. A history of public health in NYC. NY, Russell Sage, 1974. Especially chapter 3, Launching the NYC Health Department, 48-69. Koopman JS, Lynch JW. Individual causal models and population systems models in epidemiology. Am J Public Health 1999; 89:117-1174. Koplan, Jeffrey P.; Stephen B. Thacker, Nicole A. Lezin. Epidemiology in the 21 st century: calculation, communication, and intervention. Am J Public Health 1999; 89:1153-1155. Krieger N. Questioning epidemiology: objectivity, advocacy, and socially responsible science. Am J Public Health 1999; 89:1151-1153. Kuhn, Thomas S. The structure of scientific revolutions, 2nd ed, Chicago, University of Chicago, 1970. Marmot, Michael. Facts, opinions and affaires du coeur. Am J Epidemiol 1976; 103:519-526. _____________________________________________________________________________________________ www.epidemiolog.net, © Victor J. Schoenbach 1999, 2000 rev. 9/26/1999, 8/20/2000, 3/9/2001 1. Epidemiology Definition, functions, and characteristics - 14
McGavran EG. What is public health? Canadian Journal of Public Health 1953 (December), 47-61. Pattner, W.I. The public health movement. In: From poor law to welfare state. NY, The Free Press, Macmillan, 1974, 116-133. Rosner D. Health care for the “truly needy”, Nineteenth Century origins of the concept. Milbank Memorial Quarterly 1982; 60(3):355-385. Savitz DA, Poole C, Miller WC. Reassessing the role of epidemiology in public health. Am J Public Health 1999; 89:1158-1161. Schwartz S, Carpenter KM. The right answer for the wrong question: consequences of type III error for public health research. Am J Public Health 1999; 89:1175-1180. Sheps, Ceil G. Higher education for public health. New York, Prodist for the Milbank Memorial Fund, 1976. Shy, Carl M. The failure of academic epidemiology: witness for the prosecution. Am J Epidemiol 1997; 145:479-484. Stallones, Reuel A. To advance epidemology. Ann Rev Public Health 1980; 1:69-82. Terris, Milton. The epidemiologic tradition. Public Health Reports 1979;94(3):203-209. Winkelstein, Jr., Warren. Interface of epidemiology and history: a commentary on past, present, and future. Epidemiologic Reviews 2000; 22:2-6. _____________________________________________________________________________________________ www.epidemiolog.net, © Victor J. Schoenbach 1999, 2000 rev. 9/26/1999, 8/20/2000, 3/9/2001 1. Epidemiology Definition, functions, and characteristics - 15
Page 1 and 2: Understanding the Fundamentals of E
Page 3 and 4: Preface Introductory epidemiology c
Page 5 and 6: Table of Contents Chapter (in Acrob
Page 7 and 8: 1. Introduction Definition, charact
Page 9 and 10: problems (Schwartz and Carpenter, 1
Page 11 and 12: HIV - a new or newly-recognized vir
Page 13 and 14: d = principal investigator's degree
Page 15 and 16: Analytic studies typically involve
Page 17: Observational sciences especially a
Page 21 and 22: 2. An evolving historical perspecti
Page 23 and 24: Time line for the history of public
Page 25 and 26: as a one-room bacteriology laborato
Page 27 and 28: − Health surveys − Research fun
Page 29 and 30: his scientific peers of the correct
Page 31 and 32: Kuhn, Thomas S. The structure of sc
Page 33 and 34: 3. Studying populations - basic dem
Page 35 and 36: The demographic balancing equation
Page 37 and 38: ates. Similarly, bulges in the repr
Page 39 and 40: When the baby boom cohort retires 1
Page 41 and 42: The pervasiveness, strength, viciou
Page 43 and 44: Total fertility rate (TFR) Standard
Page 45 and 46: Life expectancy The technique, of u
Page 47 and 48: Excerpt from the U.S. 1993 abridged
Page 49 and 50: At the other end of the life table,
Page 51 and 52: to change, hopefully to decline. If
Page 53 and 54: Thought question: Professors typica
Page 55 and 56: Descriptive studies and surveillanc
Page 57 and 58: 4. The Phenomenon of Disease Concep
Page 59 and 60: Classification is the foundation As
Page 61 and 62: As we gain more sophisticated under
Page 63 and 64: To recapitulate the above discussio
Page 65 and 66: Classifying cause of death Since mo
Page 67 and 68: Laboratory and other objectively me
Page 69 and 70:
distribution but are not diabetic (
Page 71 and 72:
program in the general population,
Page 73 and 74:
Infectious disease Incubation "time
Page 75 and 76:
the direct effects of carcinogenic
Page 77 and 78:
patient outcomes. The design and ev
Page 79 and 80:
detected by screening will appear b
Page 81 and 82:
Morrison, Alan S. Screening in chro
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e relevant. Compromises might be fo
Page 85 and 86:
educational attainment by the numbe
Page 87 and 88:
Distributions - the fuller picture
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Per capita income: Should health ca
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Deaths of children < 1 year of age
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No. of persons with senile dementia
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Incidence Immigration Relationship
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Examples: arthritis, cholelithiasis
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Cohort - entrance into the populati
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Sample calculation: 200 people free
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• The units of time must be state
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Calculation of person-time in a coh
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Original Calculation of person-time
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average risk for a member of the co
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However: Nurses: 601 cases/89,538 w
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treated. If the rate at which patie
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Incidence and prevalence in a popul
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small prevalence. So if the seropre
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Appendix on weighted averages Becau
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Appendix on exponents and logarithm
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and epidemiology. The notation ln(x
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3. For the following hypothetical d
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c. ________________ 6 fatalities /
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Measuring disease and exposure - As
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5. a. Flow Diagram Population of si
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New cases Q ID = ------------------
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Overview 6. Standardization of rate
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differences between the groups in f
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∑ (stratum-specific rates �× s
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especially important when comparing
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copy this cell to the other columns
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where the RR k are the stratum-spec
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and the observed number of deaths i
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Directly standardized rate for A =
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5,022 Indirectly standardized = —
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the situation among older age group
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Appendix on Standardized Mortality
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across age strata, then the damage
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d. How would you feel about the con
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Cases per 100,000 Mean annual incid
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d. dt Indirectly standardized rates
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The second ingredient for an standa
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Group US rate /100,000 County pop.
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Crude rates are comparable because
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The "Big Picture" 7. Relating risk
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Consider first the table on the lef
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The epidemiologist first arranges t
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(I1 - I0)/I0 = (0.01200-0.00800 / 0
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Descriptive adjectives for magnitud
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Odds ratio The odds ratio (OR) is a
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Duncan C. Thomas, "On the need for
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6. Odds of exposure in controls Pro
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CID = CI1 - CI0 = .20 - .10 = .10 (
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When both disease and exposure have
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variables is linear. An r of zero m
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2. In HIV-discordant couples in whi
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Incidence Diagrammatic representati
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PAR = AR × P1 = (I1 - I0)P1 = I -
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expresses the prevented cases as a
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Incidence Diagrammatic representati
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The result, (NHIH)/(NLIL+NHIH), is
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Proportion with = 0.5 ( 22 --- ) +
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CI may be preferred: � if the hea
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Appendix — Relating risk factors
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By definition, oddsr = risk / (1 -
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Bibliography Measures of effect: Te
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Relating risk factors to health - A
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4. In a study of adverse effects of
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number of "permanent" quits (define
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= I1n1- I0n1 + I0n0 - I0n0 ——
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2. Imprecision in determining the t
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Sometimes the appearance of a new s
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Case-control (case-referent, etc.)
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ealistic setting and results may th
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"ecologic fallacy", the erroneous i
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can vary substantially among indivi
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e estimated from that study since t
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Risk ratio Consider the example of
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Dietary Salt Intake and hypertensio
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Intervention trials can include tes
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Treatment allocation can be 1) fixe
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Example Cases Case-control studies
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Cases Controls ____________________
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population and that the controls we
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Estrogen users (N1) Nonusers (N0) N
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In the 3 × 10 6 unexposed women-ye
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similar to that in the case group t
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A modern perspective In general, de
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of exposed to unexposed persons sam
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Case-control studies: Armenian, Har
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Wingo, Phyllis A.; Howard W. Ory, P
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Part I Analytic study designs - Ass
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1. Doll and Hill state (page 1451,
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Part I Analytic study designs - Ass
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� Possible motivation to change b
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9. Causal inference * The desire to
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1955:35). Quarantine of sick person
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The mother who replaced the burned-
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As presented in Kleinbaum, Kupper,
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Popper maintains that it is fundame
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1. Is the association real or artef
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Temporality First exposure, then di
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confer upon us a freedom to ignore
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Lave, Lester B.; E.P. Seskin. Epide
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Precision The presence of random va
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the point estimate is based and thu
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methodological literature. Validity
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disease detection may be mistakenly
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In cohort studies, the primary sour
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present, then the D&C would detect
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Controls in an experiment In a true
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Southern endometrial cancer and est
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Cases ` The ` "detection bias" hypo
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from ETS, then a cohort study of ha
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employing lead exposure measures fr
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which the both measures increase in
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coefficient (slope) is to 1.0 and t
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_ _ Se = Pr(D'|D) Sp = PR(D'|D) _ _
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Differential misclassification, how
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subject plus or minus a random nois
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Appendix 2 More on the concern to a
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Bibliography Henneckens and Buring.
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Sackett, D.L.: Bias in analytic res
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e. OPTIONAL: If the reported cumula
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Results from the Evans County Cardi
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2. I1 = incidence in the exposed P1
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makes most sense to view detection
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Sensitivity × cases + (1 - Specifi
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In the factual world, however, we c
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Hypertensive SI participants were t
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3,154 male managers and white colla
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Table 2 Relationship of CHD to Beha
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a group did indeed have higher CHD
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Confounding - comparison of weighte
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Type A smokers) are not very meanin
Page 353 and 354:
Different control groups for hypoth
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Confounding, then, is a function of
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Since the OR is the crossproduct ra
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Case-control study In a case-contro
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First and foremost, a potential con
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is defined in relation to the count
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poor. A scientific basis linking ra
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One way to obtain a better balance
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Stratified analysis is intuitively
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attributed to the exposure of inter
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Bibliography Rothman and Greenland
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Senior P, Bhopal RS. Ethnicity as a
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Some of the relationships just pres
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n1i _______________________________
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2. A 20-year retrospective cohort s
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No. of urinary tract infections Tab
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2. completely attributable to obesi
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5. a. C -- the adjusted relative ri
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of dietary antioxidants. However, c
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epidemiologic research is to identi
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Since the indicator variable (POP)
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Over two decades ago (Causes, Am J
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In this diagram, G and H exhibit ab
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In this situation, the first suffic
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Crude rates as weighted averages Re
Page 403 and 404:
Lung cancer rates by smoking and as
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{B0} Smk Smk Asb. Asb. {B1} {B2} {B
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Notation for joint effects R1 risk
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and R111 = R000 + RD100 + RD010 + R
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RR11 = RR10 × RR01 [End of aside]
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multiplicative model supports the u
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Effect modification as a reflection
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4. Defining subgroups for preventiv
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Bibliography Rothman and Greenland,
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Multicausality: Effect modification
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4. Several studies have shown a syn
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1. Multicausality: Effect modificat
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In these data, or, Expected ROC,SMK
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to drinking in the absence of smoki
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we determine that confounding is pr
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Association between reserpine and b
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R11 R10 × R01 R10 —— = ——
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Hypothetical data on incidence of m
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1. Data conform to an additive mode
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Difference measure - the CID The va
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Distribution of CIR, IDR, OR 0 +1 M
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1 wi = ---------------------------
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5 Y n B 3 n Y C 8 n Y C 4 Y Y D 7 Y
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R11 - R00 = (R10 - R00) + (R01 - R0
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You may well wonder what is the val
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Moreover, the logistic model, we wi
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Key epidemiologic assumptions in th
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a + b1X1 + b2X2 + b3X3 + …) on th
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Wilcosky, Timothy C. and Lloyd E. C
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Data analysis and interpretation Ep
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Range checks Range checks compare e
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� Decisions deferred have to be m
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� Simpler is better � Avoid ext
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educe bias and tend to introduce ad
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data. Perhaps too often generalitie
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When this "analogous experiment" is
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tests are based (e.g., see Sander G
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The probability associated with bei
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conclude that the association is su
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Exposed to diethylstilbesterol? Yes
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For example, suppose that we are co
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The idea behind small studies bias
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Confidence intervals address the qu
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Computing a confidence interval for
Page 491 and 492:
Bibliography General Ahlbom, Anders
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Thompson, W. Douglas. Statistical c
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Appendix Estimating sample size to
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p1 (1 - p1) p2 (1 - p2) σ 2 1 σ 2
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Margin of error (rounded) Point Sam
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Meditations on hypothesis testing a
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Independent replication is the corn
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More meditations on interpreting st
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Part I Data analysis and interpreta
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Part I 1. (a) Restriction Data anal
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9. ORCIG,HYP,OC [multiplicative mod
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15. Practical aspects of epidemiolo
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(CDC, which includes the National I
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cardiovascular area -- notably the
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Disease Control (CDC) decided again
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After submission but before the awa
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Journal of Medicine, Jan 14, 1999,
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Explore the data � Look at data (
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Recently, standardization has come
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Riesenberg, Don; Goerge D. Lundberg
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16. Data management and data analys
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implications, or suspicions or char
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1.4.1.2 Consistency Consistency is
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1.4.5.1.2 Series Runs in series are
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Obviously it will be easier to asse
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2.1.2.1 Statistical There are forma
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2.3.5 Bivariate displays If the sam
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errors. Related to this concern is
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3.3 Expected values Perhaps, the si
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Despite the best efforts, however,
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Complete data cases % distribution
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3.5 Outliers Outliers are now exami
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Bibliography Davidson, Fred. Princi
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attrib ckd length=$1 label='Check d
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17. Epidemiology and public health
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� Geneva - " . . . IFV and allied
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public health, since the best oppor
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Individual-level versus societal le
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14%, so that the burden of the envi
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1. exhausting various non-renewable
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O'Hare WP, Pollard KM, Mann TL, Ken
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� Health for all What contributes
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Challenges in the environment for e
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� What kind of population is requ
Page 579:
Bibliography American College of Ep
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