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An introduction
Epidemiology matters: a new introduction to methodological foundations
Chapter 1
Epidemiology is the science of understanding the
causes and distribution of population health so that we
may intervene to prevent disease and promote health.
Epidemiology Matters – Chapter 1
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Examples of questions
epidemiologists ask
What is the incidence of myocardial infarctions between
2010-2020 among women born in 1950 in the United
States?
What are the causes of myocardial infarctions in this
population?
If we were to change population dietary habits, what
improvement in myocardial infarction incidence could we
affect?
Epidemiology Matters – Chapter 1
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1. Evolution of epidemiology
2. Our approach to teaching epidemiology
3. Seven steps to conduct an epidemiologic study
4. Farrlandia
5. Summary
Epidemiology Matters – Chapter 1
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1. Evolution of epidemiology
2. Our approach to teaching epidemiology
3. Seven steps to conduct an epidemiologic study
4. Farrlandia
5. Summary
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Evolution of epidemiology
Epidemiology is a relatively new as a formal scientific
discipline
Practice of conducting epidemiologic studies is not new;
‘counting’ health and disease goes back centuries
Many of design and analytic techniques that we use
today arose in response to health concerns during 19th
and 20th century
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Epidemiology, a beginning
John Graunt – 17th century - pioneered approaches to tabulating
population health and mortality in rates, ratios, and proportions
William Farr – 18th and 19th century - developed more
sophisticated life table approaches to understanding the force
and burden of mortality
John Snow – 19th century - used epidemiologic approaches to
understand London cholera epidemic; developed and applied
basic measures of disease frequency and occurrence
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Epidemiology history, continued
19th century – focus on infectious disease
20th century – high-income countries shifted
toward non-communicable diseases
Mid 20th century – methods formalized (1970s)
Late 20th century – Miettinen, Rothman, and
Greenland - modern epidemiology (1980s)
formalized central disciplinary principles
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Current conceptual movements
1.
Ecosocial perspective on population health – suggests policies,
institutions, and characteristics of context contribute to the
shaping of health
2.
Life course perspective – determinants of health are distributed
across the life course and even before conception
Therefore, epidemiology understands causes of population health
across levels of influence - from cells to society - and across life
course.
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An ecosocial framework
Social and Economic Policies
Institutions
Neighborhoods and Communities
Living Conditions
Social Relationships
Individual Risk Factors
``
Genetic/Constitutional
Factors
``
Pathophysiologic pathways
Individual/Population
Health
Kaplan, G. What’s wrong with social epidemiology, and how can we make it better? Epid Rev 2004; 26: 124-135
A lifecourse approach to health
production
Uauy, R. et al. Diet, nutrition, and the life-course approach to cancer prevention. J Nutr 2005; 135: 2934S-2945S
1. Evolution of epidemiology
2. Our approach to teaching epidemiology
3. Seven steps to conduct an epidemiologic
study
4. Farrlandia
5. Summary
Epidemiology Matters – Chapter 1
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Our approach to teaching epidemiology
We are interested in an epidemiology of consequence, an
epidemiology that can guide the improvement of the health of
population
Therefore, we focus here on teaching underlying concepts that start
from understanding populations, and lead the learner through the
key steps to designing an epidemiologic study
We will mention and adopt the labels that are used in many other
epidemiology textbooks (e.g., confounding) but only after we have
introduced the reader to the underlying concepts
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1. Evolution of epidemiology
2. Our approach to teaching epidemiology
3. Seven steps to conduct an epidemiologic study
4. Farrlandia
5. Summary
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Epidemiology of consequence, seven steps
1.
Define the population of interest
2.
Conceptualize and create measures of exposures and health
indicators
3.
Take a sample of the population
4.
Estimate measures of association between exposures and health
indicators of interest
5.
Rigorously evaluate whether the association observed suggests a
causal association
6.
Assess the evidence for causes working together
7.
Assess the extent to which the result matters, is externally valid,
to other populations
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Epidemiology of consequence, seven steps
Descriptive epidemiology
Step 1. Define the population of interest
Step 2. Conceptualize and create measures of exposures and health indicators
Step 3. Take a sample of the population
Step 4. Estimate measures of association between exposures and health indicators of
interest
Assessing for causal effect
Step 5. Rigorously evaluate whether the association observed suggests a causal association
Conceptualizing and testing for interactions
Step 6. Assess the evidence for causes working together
Step 7. Assess the extent to which the result matters (is externally valid) to other populations
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1. Evolution of epidemiology
2. Our approach to teaching epidemiology
3. Seven steps to conduct an epidemiologic study
4. Farrlandia
5. Summary
Epidemiology Matters – Chapter 1
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Farrlandia
Examples often based on hypothetical geographic area,
Farrlandia
Inspired by William Farr, pioneering epidemiologist and
statistician
Through use of Farrlandia examples, students will focus
on applying foundational concepts to populations
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1. Evolution of epidemiology
2. Our approach to teaching epidemiology
3. Seven steps to conduct an epidemiologic study
4. Farrlandia
5. Summary
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Summary
This book aims to provide learners with a systematic
grounding in the theoretical underpinnings of epidemiology
with an awareness of the practical considerations that are
essential for public health professionals
This text establishes a foundation by building on
methodological innovation and teaching of the previous
century, while adopting a novel approach to teaching
epidemiologic foundations
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epidemiologymatters.org
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