This text introduces the history and the use of epidemiology as a discipline. It clearly explains the concepts and techniques associated with traditional epidemiology, the design of trials and the analysis of observational data and advanced biostatistical and epidemiologic techniques.

It includes practical exercises, case studies and real-world applications throughout and explains all new terminology with minimum use of technical language.


Preface to the Third Edition, xi

Preface to the First Edition, xiii

Acknowledgments, xv

1 Epidemiology Past and Present, 1

1.1 Epidemiology and its uses, 2

1.2 Evolving patterns of morbidity and mortality, 5

1.3 Selected historical figures and events, 8

1.4 Chapter summary, 30

Review questions, 31

References, 32

2 Causal Concepts, 36

2.1 Natural history of disease, 36

2.2 Variability in the expression of disease, 40

2.3 Causal models, 41

2.4 Causal inference, 48

Exercises, 58

Review questions, 61

References, 63

3 Epidemiologic Measures, 66

3.1 Measures of disease frequency, 67

3.2 Measures of association, 74

3.3 Measures of potential impact, 79

3.4 Rate adjustment, 82

Exercises, 90

Review questions, 98

References, 99

Addendum: additional mathematical details, 101

4 Descriptive Epidemiology, 104

4.1 Introduction, 104

4.2 Epidemiologic variables, 108

4.3 Ecological correlations, 116

Exercises, 121

Review questions, 123

References, 124

5 Introduction to Epidemiologic Study Design, 126

5.1 Etiologic research, 126

5.2 Ethical conduct of studies involving human subjects, 129

5.3 Selected study design elements, 130

5.4 Common types of epidemiologic studies, 137

Exercises, 138

Review questions, 140

References, 141

6 Experimental Studies, 142

6.1 Introduction, 142

6.2 Historical perspective, 144

6.3 General concepts, 146

6.4 Data analysis, 152

Exercises, 156

Review questions, 157

References, 157

7 Observational Cohort Studies, 159

7.1 Introduction, 159

7.2 Historical perspective, 161

7.3 Assembling and following a cohort, 163

7.4 Prospective, retrospective, and ambidirectional cohorts, 164

7.5 Addressing the potential for confounding, 165

7.6 Data analysis, 166

7.7 Historically important study: Wade Hampton Frost’s birth cohorts, 170

Exercises, 174

Review questions, 177

References, 177

8 Case–Control Studies, 180

8.1 Introduction, 180

8.2 Identifying cases and controls, 182

8.3 Obtaining information on exposure, 185

8.4 Data analysis, 186

8.5 Statistical justifications of case–control odds ratio as relative risks, 193

Exercises, 194

Review questions, 198

References, 199

9 Error in Epidemiologic Research, 201

9.1 Introduction, 201

9.2 Random error (imprecision), 203

9.3 Systematic error (bias), 209

Exercises, 217

Review questions, 219

References, 220

10 Screening for Disease, 222

10.1 Introduction, 223

10.2 Reliability (agreement), 224

10.3 Validity, 228

Summary, 238

Exercises, 239

Review questions, 243

References, 243

10.4 Chapter addendum (case study), 244

Further reading—screening for HIV, 248

Further reading—general concepts of screening, 248

Answers to case study: screening for antibodies to the human immunodeficiency virus, 249

11 The Infectious Disease Process, 255

11.1 The infectious disease process, 255

11.2 Herd immunity, 265

Exercises, 267

Review questions, 268

References, 270

12 Outbreak Investigation, 271

12.1 Background, 272

12.2 CDC prescribed investigatory steps, 273

Review questions, 282

References, 283

References—a drug–disease outbreak, 286

13 Confidence Intervals and p-Values, 302

13.1 Introduction, 303

13.2 Confidence intervals, 304

13.3 p-Values, 312

13.4 Minimum Bayes factors, 319

References, 322

14 Mantel–Haenszel Methods, 323

14.1 Ways to prevent confounding, 323

14.2 Simpson’s paradox, 325

14.3 Mantel–Haenszel methods for risk ratios, 325

14.4 Mantel–Haenszel methods for other measures of association, 329

Exercise, 335

References, 335

15 Statistical Interaction: Effect Measure Modification, 337

15.1 Two types of interaction, 337

15.2 Chi-square test for statistical, 340

15.3 Strategy for stratified analysis, 342

Exercises, 344

References, 345

16 Case Definitions and Disease Classification, 347

16.1 Case definitions, 347

16.2 International classification of disease, 351

16.3 Artifactual fluctuations in reported rates, 353

16.4 Summary, 354

References, 355

17 Survival Analysis, 356

17.1 Introduction, 356

17.2 Stratifying rates by follow-up time, 359

17.3 Actuarial method of survival analysis, 360

17.4 Kaplan–Meier method of survival analysis, 362

17.5 Comparing the survival experience of two groups, 364

Exercises, 369

References, 371

18 Current Life Tables, 373

18.1 Introduction, 373

18.2 Complete life table, 374

18.3 Abridged life table, 380

Exercises, 383

References, 384

19 Random Distribution of Cases in Time and Space, 385

19.1 Introduction, 385

19.2 The Poisson distribution, 386

19.3 Goodness of fit of the Poisson distribution, 390

19.4 Summary, 394

Exercises, 395

References, 396

Answers to Exercises and Review Questions, 398

Appendix 1: 95% Confidence Limits for Poisson Counts, 434

Appendix 2: Tail Areas in the Standard Normal (Z) Distribution: Double These Areas for Two-Sided p-Values, 436

Appendix 3: Right-Tail Areas in Chi-Square Distributions, 439

Appendix 4: Case Study—Cigarette Smoking and Lung Cancer, 441

Appendix 5: Case Study—Tampons and Toxic Shock Syndrome, 448

Index, 455
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