Research methodology

1. statistical methods in epidemiology

2. STATISTICAL EPIDEMIOLOGY
Epidemiology study of disease condition in population Epidemiology is the science that
studies the patterns ,causes, and effects of health and disease conditions in defined the
populations.
it is the cornerstone of public health and informs policy decisions and evidence-based
practice by identifying risk factors for disease and targets for preventive healthcare.
Fertility rate- study related to the birth
Mortality rate – study related to the death
Morbidity rate- study related to the disease condition

3. OBJECTIVES OF EPIDEMIOLOGY
 To determine the rates of disease by person, place and time - Absolute risk ( incidence,
prevalence)
 To identify the risk factors for the disease - Relative risk (or odds ratio)
To develop approaches for disease prevention - Attributable risk / fraction

4. MEASUREMENTS IN EPIDEMIOLOGY
 Epidemiology is about identifying associations between
To identify any association, exposures and outcomes must first be measured in a quantitative manner.
 “measures of disease frequency.”
 “measures of association or effect.”
 “measures of potential impact
MORBIDITY RATE:
The health workers are interested in assessing the health status of the communities through morbidity.
Morbidity relates to types and varieties of diseases one faces or experiences affecting the day-to –day
activities data for the study of morbidity of a community are available from registration through
hospitals
exposures
outcomes
.

5. INCIDENCE RATE:
• Incidence rate relates to the total number of new cases of specific disease in during year with mid year
population.
• Incidence is defined as a number of new cases of a disease occurring in a specified time period divided by the
number of individuals at risk of developing the disease during the same time
• Incidence is most relevant clinically
• Incidence rate = Total number of new cases of a specific disease during year × K
Mid year population
• K is constant value,
• The value of k may be taken as 100,10000 or 100000.base the numerator value we choose the value of K
Example:
 10,000 people without heart disease
 Follow population for 5 years
 3,000 people smoke
 410 of smokers develop heart disease
 350 of non-smokers develop heart disease
No loss to follow-up or change in smoking status over time

6. PREVALENCE
• Prevalence rate related to the total number of cases,(i,e) new or old excisting at a point of
time with total population.
• Prevalence is defines as a total number of affected individuals in a population at a specified
time period divided by the number of individuals in the population at the time
• Prevalence = Total number of cases, new or old existing at a point of time × K
total Population at a point of time
• Prevalence is equal to the probability of disease:
Mid year prevalence:
• Arithmetic mean of the population on 1 jan and the population on 31 december of a year.it is
used to calculate annual rates.

7. TYPES OF PREVALENCE
1.POINT PREVALENCE
 It is relates to prevalence with respect to a specific point in time. Point prevalence is the proportion
of a population that has the condition at a specific point in time.
 Eg . Did you have an asthma attack on Monday?
2.PERIOD PREVALENCE
 Related to prevalence over a defined period of time.
 Period prevalence is the proportion of a population that has the condition at some time during a given
period (e.g., 12 month prevalence), and includes people who already have the condition at the start of
the study period as well as those who acquire it during that period.
 Eg . Did you have an asthma attack in january?
3.LIFE TIME PREVALENCE
 Lifetime prevalence (LTP) is the proportion of a population that at some point in their life (up to the
time of assessment) have experienced the condition
 Eg . Have you ever had an asthma attack

8. RELATIVE RISK OR RISK RATIO (RR)
In statistics and epidemiology, relative risk or risk ratio (RR) is the ratio of the probability of
an event occurring (for example, developing a disease, being injured) in an exposed group
to the probability of the event occurring in a comparison, non-exposed group.
 Categorical data in medical/health/nutrition investigations are frequently used to calculate
the risk of disease who are exposed to a specific character and not exposed to a specific
character the basic requirement of this study is 2 × 2 table giving number of diseased cases
in those exposed and in those unexposed.
 Consider the first group as exposed and second group as unexposed if n11 & n 12 get the
disease in the respective groups.

9. Risk of the disease in the exposed group = n11 / n 1
Risk of the disease in the unexpected group = n12 / n2
Relative risk = n12 / n 2
n11 / n 1
Relative Risk interpretation
• Ratios > 1.0 indicate rate is higher among exposed than unexposed (indicates positive
association)
• Ratios = 1.0 indicate no association Ratios < 1.0 indicate rate is lower among exposed than
unexposed( indicates negative association)

10. ATTRIBUTABLE RISK (AR)
In epidemiology ,the attributable risk is the difference in the rate of condition between the
risk in exposed subjects and unexposed subjects is called attributable risk
 This can also be understood as risk difference.
 Attributable risk is mostly calculated in cohort studies, where individuals are assembled on
exposure status and followed over a period of time.
 Attributable risk gives more valid information to the health managers than the relative risk.
This happens particularly when the disease is rare but occurs several times more frequently if
a particular antecedent is present.
 Attributable risk is better index of the public health importance of the risk factor in terms of
the impact its reduction can make on the overall incidence of disease.
 Calculation of AR = risk(incidence) in exposed – risk(incidence) in non exposed which
provides the risk difference

12. ATTRIBUTABLE FRACTION (AF)
 AF is the proportion of disease incidence that can be attributed to a specific exposure
(among those who were exposed)
 AR divided by incidence in the exposed X 100%