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Epidemiology is the study of the distribution of disease as well as its determinants and consequences in human populations. It uses statistical methods to answer questions on how much disease there is, what specific factors put individuals at risk, and how severe disease outcomes are in patient populations to inform public health policy-making. The term ”disease” encompasses not only physical or mental illnesses but also behavioral patterns with negative health consequences such as substance abuse or violence.
The measurement of disease occurrence begins with the estimation of incidence and prevalence. Disease incidence is the number of new cases in a population within a specific period of time. First-ever incidence picks up only first-ever onsets; in contrast, episode incidence records all onsets of disease events, including those of recurrent episodes. Cumulative incidence expresses the risk of contracting a disease as the proportion of the population who would experience the onset over a specific time period.
Prevalence is the number of people in a population with a specific disease. Point prevalence counts all diseased individuals at a point in time, whereas period prevalence records those with the disease during a stated time period. Cumulative prevalence includes all those with the disease during their lives or between two specific time points. The nature of the disease itself determines the appropriate choice of measure. For example, for single-episode conditions with a clearly defined onset such as chickenpox, first-ever and cumulative incidence rates are most useful, but for recurrent conditions with ill-defined onsets such as allergy, period and cumulative prevalence rates are most often analyzed.
Population epidemiology attempts to unravel causal mechanisms of disease with a view to prevention. Since most diseases are determined by multiple genetic and environmental factors, exposures to single risk factors are usually neither sufficient nor necessary causes of a disease. Consequently, efforts are devoted to quantify the level of increased risk when exposed to a particular risk factor. Risk is normally measured as either a ratio of the prevalence of disease in two populations or the ratio of the odds of exposure to a particular risk factor between two groups. Clinical epidemiology, in turn, aims at the identification of disease outcomes with the goal to control the damage done to the patients.
Since the 1980s epidemiological methods have been successfully applied to the study of social maladies (e.g., divorce, homicide, drug addiction, etc.) and a new subfield known as social epidemiology has emerged to use sociological constructs (e.g., social inequalities, racial discrimination, sexism, residential segregation, etc.) in the analysis of disease. Knowledge derived from these cross-disciplinary fecundations is widely adopted by grassroots activists and policy makers for the empowerment of marginalized at-risk populations. In 2005 the World Health Organization established the Commission on the Social Determinants of Health to assist developing countries to combat social injustices leading to ill-health and premature deaths. The growing consensus that interpersonal interactions, collective activities, and social institutions affect and are affected by health will herald an even closer collaboration between epidemiologists and sociologists in the coming years.
- Berkman, L. F., Kawachi, I. (eds.) (2000) Social Epidemiology. Oxford University Press, New York.
- Bhopal, R. S. (2002) Concepts of Epidemiology: An Integrated Introduction to the Ideas, Theories,
- Principles, and Methods of Epidemiology. Oxford University Press, New York. Cwikel, J. G. (2006) Social Epidemiology: Strategies for Public Health Activism. Columbia University Press, New York.
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