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An introduction

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. .

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An introduction

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  1. An introduction Epidemiology matters: a new introduction to methodological foundations Chapter 1

  2. 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

  3. 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

  4. Evolution of epidemiology • Our approach to teaching epidemiology • Seven steps to conduct an epidemiologic study • Farrlandia • Summary Epidemiology Matters – Chapter 1

  5. Evolution of epidemiology • Our approach to teaching epidemiology • Seven steps to conduct an epidemiologic study • Farrlandia • Summary Epidemiology Matters – Chapter 1

  6. 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 20thcentury Epidemiology Matters – Chapter 1

  7. Epidemiology, a beginning • John Graunt– 17thcentury - pioneered approaches to tabulating population health and mortality in rates, ratios, and proportions • William Farr – 18thand 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 Epidemiology Matters – Chapter 1

  8. 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 Epidemiology Matters – Chapter 1

  9. Current conceptual movements • Ecosocialperspective on population health – suggests policies, institutions, and characteristics of context contribute to the shaping of health • 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. Epidemiology Matters – Chapter 1

  10. Individual/Population Health An ecosocial framework Social and Economic Policies Institutions Neighborhoods and Communities Living Conditions `` Social Relationships `` Individual Risk Factors Lifecourse Genetic/Constitutional Factors Pathophysiologic pathways Environment Kaplan, G. What’s wrong with social epidemiology, and how can we make it better? Epid Rev 2004; 26: 124-135

  11. 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

  12. Evolution of epidemiology • Our approach to teaching epidemiology • Seven steps to conduct an epidemiologic study • Farrlandia • Summary Epidemiology Matters – Chapter 1

  13. 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 Epidemiology Matters – Chapter 1

  14. Evolution of epidemiology • Our approach to teaching epidemiology • Seven steps to conduct an epidemiologic study • Farrlandia • Summary Epidemiology Matters – Chapter 1

  15. Epidemiology of consequence,seven steps • Define the population of interest • Conceptualize and create measures of exposures and health indicators • Take a sample of the population • Estimate measures of association between exposures and health indicators of interest • Rigorously evaluate whether the association observed suggests a causal association • Assess the evidence for causes working together • Assess the extent to which the result matters, is externally valid, to other populations Epidemiology Matters – Chapter 1

  16. 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 Epidemiology Matters – Chapter 1

  17. Evolution of epidemiology • Our approach to teaching epidemiology • Seven steps to conduct an epidemiologic study • Farrlandia • Summary Epidemiology Matters – Chapter 1

  18. 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 Epidemiology Matters – Chapter 1

  19. Evolution of epidemiology • Our approach to teaching epidemiology • Seven steps to conduct an epidemiologic study • Farrlandia • Summary Epidemiology Matters – Chapter 1

  20. 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 Epidemiology Matters – Chapter 1

  21. epidemiologymatters.org Epidemiology Matters – Chapter 1

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