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Book Details
Abstract
Epidemiology, by award-winning educator and epidemiologist Leon Gordis, is a best-selling introduction to this complex science. Dr. Gordis leverages his vast experience teaching this subject in the classroom to introduce the basic principles and concepts of epidemiology in a clear, uniquely memorable way. He guides you from an explanation of the epidemiologic approach to disease and intervention, through the use of epidemiologic principles to identify the causes of disease, to a discussion of how epidemiology should be used to improve evaluation and public policy. It’s your best choice for an accessible yet rich understanding of epidemiology!
- Gain a solid foundation of basic epidemiologic principles as well as practical applications in public health and clinical practice.
- Visualize concepts vividly through abundant full-color figures, graphs, and charts.
- Check your understanding of essential information with 120 multiple-choice epidemiology self-assessment questions.
- Master the latest nuances in epidemiology thanks to a wealth of new and updated illustrations, examples, and epidemiologic data.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Epidemiology, 5/e | i | ||
| Copyright Page | iv | ||
| For Dassy | v | ||
| Preface | vii | ||
| Acknowledgments | xi | ||
| Table Of Contents | xiv | ||
| Second half title page | xvii | ||
| 1 The Epidemiologic Approach to Disease and Intervention | 1 | ||
| Sectiion 1_text | 1 | ||
| 1 Introduction | 2 | ||
| What is Epidemiology? | 2 | ||
| The Objectives of Epidemiology | 2 | ||
| Changing Patterns of Community Health Problems | 3 | ||
| Epidemiology and Prevention | 5 | ||
| Primary, Secondary, and Tertiary Prevention | 5 | ||
| Two Approaches to Prevention: A Different View | 6 | ||
| Epidemiology and Clinical Practice | 6 | ||
| The Epidemiologic Approach | 7 | ||
| From Observations to Preventive Actions | 8 | ||
| 1. Ignáz Semmelweis and Childbed Fever | 8 | ||
| 2. Edward Jenner and Smallpox | 11 | ||
| 3. John Snow and Cholera | 13 | ||
| When the Frequency of a Disease Declines, WHO Deserves the Credit? | 16 | ||
| Integrating Prevention and Treatment | 17 | ||
| Conclusion | 18 | ||
| References | 18 | ||
| 2 The Dynamics of Disease Transmission | 19 | ||
| Learning Objectives | 19 | ||
| Modes of Transmission | 19 | ||
| Clinical and Subclinical Disease | 21 | ||
| Clinical Disease | 22 | ||
| Nonclinical (Inapparent) Disease | 22 | ||
| Carrier Status | 22 | ||
| Endemic, Epidemic, and Pandemic | 22 | ||
| Disease Outbreaks | 25 | ||
| Immunity and Susceptibility | 26 | ||
| Herd Immunity | 26 | ||
| Incubation Period | 27 | ||
| Attack Rate | 30 | ||
| Exploring Occurrence of Disease | 30 | ||
| Who | 31 | ||
| Gonorrhea | 31 | ||
| Pertussis | 31 | ||
| When | 32 | ||
| Where | 32 | ||
| Outbreak Investigation | 34 | ||
| Cross-Tabulation | 35 | ||
| Conclusion | 36 | ||
| References | 36 | ||
| Review Questions for Chapter 2 | 37 | ||
| 3 The Occurrence of Disease: | 38 | ||
| Learning Objectives | 38 | ||
| Surveillance | 38 | ||
| Passive and Active Surveillance | 39 | ||
| Stages of Disease in an Individual and in a Population | 40 | ||
| Measures of Morbidity | 41 | ||
| Incidence Rate | 41 | ||
| People at Risk Who Are Observed throughout a Defined Time Period | 42 | ||
| When All People Are Not Observed for the Full Time Period, Person-Time, or Units of Time When Each Person Is Observed | 42 | ||
| Identifying New Cases in Order to Calculate Incidence | 43 | ||
| Attack Rate | 46 | ||
| Prevalence | 46 | ||
| Problems with Incidence and Prevalence Measurements | 51 | ||
| Problems with Numerators | 51 | ||
| Problems with Denominators | 54 | ||
| Problems with Hospital Data | 55 | ||
| Relationship between Incidence and Prevalence | 55 | ||
| Spot Maps | 57 | ||
| Conclusion | 58 | ||
| References | 59 | ||
| Review Questions for Chapter 3 | 59 | ||
| 4 The Occurrence of Disease: | 61 | ||
| Learning Objectives | 61 | ||
| Measures of Mortality | 61 | ||
| Mortality Rates | 64 | ||
| Case-Fatality | 65 | ||
| Proportionate Mortality | 66 | ||
| Years of Potential Life Lost | 68 | ||
| Why Look at Mortality? | 70 | ||
| Problems with Mortality Data | 72 | ||
| Comparing Mortality in Different Populations | 75 | ||
| Direct Age Adjustment | 77 | ||
| Indirect Age Adjustment (Standardized Mortality Ratios) | 80 | ||
| The Cohort Effect | 81 | ||
| Interpreting Observed Changes in Mortality | 81 | ||
| Other Measures of the Impact of Disease | 81 | ||
| Quality of Life | 81 | ||
| Projecting the Future Burden of Disease | 82 | ||
| Conclusion | 84 | ||
| References | 85 | ||
| Review Questions for Chapter 4 | 85 | ||
| 5 Assessing the Validity and Reliability of Diagnostic and Screening Tests | 88 | ||
| Learning Objectives | 88 | ||
| Biologic Variation of Human Populations | 88 | ||
| Validity of Screening Tests | 89 | ||
| Tests with Dichotomous Results (Positive or Negative) | 90 | ||
| Tests of Continuous Variables | 92 | ||
| Use of Multiple Tests | 95 | ||
| Sequential (Two-stage) Testing | 95 | ||
| Simultaneous Testing | 96 | ||
| Net Sensitivity Using Two Simultaneous Tests | 96 | ||
| Net Specificity Using Two Simultaneous Tests | 97 | ||
| Comparison of Simultaneous and Sequential Testing | 98 | ||
| Predictive Value of a Test | 100 | ||
| Relationship between Positive Predictive Value and Disease Prevalence | 101 | ||
| Relationship between Positive Predictive Value and Specificity of the Test | 104 | ||
| Reliability (Repeatability) of Tests | 105 | ||
| Intrasubject Variation | 105 | ||
| Intraobserver Variation | 105 | ||
| Interobserver Variation | 106 | ||
| Percent Agreement | 106 | ||
| Kappa Statistic | 107 | ||
| Rationale of the Kappa Statistic. | 108 | ||
| Calculation of the Kappa Statistic—An Example. | 108 | ||
| Relationship between Validity and Reliability | 110 | ||
| Conclusion | 110 | ||
| References | 111 | ||
| Appendices to Chapter 5 | 112 | ||
| Review Questions for Chapter 5 | 114 | ||
| 6 The Natural History of Disease: | 116 | ||
| Learning Objectives | 116 | ||
| Case-Fatality | 117 | ||
| Person-Years | 118 | ||
| Five-Year Survival | 119 | ||
| Observed Survival | 120 | ||
| Rationale for the Life Table | 120 | ||
| Calculating a Life Table | 124 | ||
| The Kaplan-Meier Method | 126 | ||
| Assumptions Made in Using Life Tables | 128 | ||
| Example of Use of a Life Table | 129 | ||
| Apparent Effects on Prognosis of Improvements in Diagnosis | 131 | ||
| Median Survival Time | 133 | ||
| Relative Survival | 133 | ||
| Generalizability of Survival Data | 135 | ||
| Conclusion | 135 | ||
| References | 136 | ||
| Review Questions for Chapter 6 | 136 | ||
| 7 Assessing Preventive and Therapeutic Measures: | 138 | ||
| Learning Objectives | 138 | ||
| Selection of Subjects | 140 | ||
| Allocating Subjects to Treatment Groups Without Randomization | 140 | ||
| Studies without Comparison | 140 | ||
| Studies with Comparison | 140 | ||
| Historical Controls | 141 | ||
| Simultaneous Nonrandomized Controls | 141 | ||
| Allocating Subjects Using Randomization | 142 | ||
| What Is the Main Purpose of Randomization? | 144 | ||
| Stratified Randomization | 145 | ||
| Data Collection on Subjects | 146 | ||
| Treatment (Assigned and Received) | 146 | ||
| Outcome | 146 | ||
| Prognostic Profile at Entry | 147 | ||
| Masking (Blinding) | 147 | ||
| Crossover | 148 | ||
| Factorial Design | 151 | ||
| Noncompliance | 152 | ||
| Conclusion | 154 | ||
| References | 154 | ||
| 8 Randomized Trials: | 155 | ||
| Learning Objectives | 155 | ||
| Sample Size | 155 | ||
| Recruitment and Retention of Study Participants | 161 | ||
| Ways of Expressing the Results of Randomized Trials | 161 | ||
| Interpreting the Results of Randomized Trials | 162 | ||
| Generalizability of Results beyond the Study Population | 162 | ||
| What Can the Results of a Randomized Trial Tell a Treating Physician about an Individual Patient? | 163 | ||
| Comparative Effectiveness Research (CER) | 164 | ||
| Four Phases in Testing New Drugs in the United States | 165 | ||
| Three Major Randomized Trials in the United States | 166 | ||
| The Hypertension Detection and Follow-up Program | 166 | ||
| The Multiple Risk Factor Intervention Trial | 167 | ||
| Study of Breast Cancer Prevention Using Tamoxifen | 168 | ||
| Randomized Trials for Evaluating Widely Accepted Interventions | 169 | ||
| A Trial of Arthroscopic Knee Surgery for Osteoarthritis | 169 | ||
| Effect of Group Psychosocial Support on Survival of Patients with Metastatic Breast Cancer | 171 | ||
| Registration of Clinical Trials | 172 | ||
| Ethical Considerations | 172 | ||
| Conclusion | 173 | ||
| Epilogue | 173 | ||
| References | 174 | ||
| Review Questions for Chapters 7 and 8 | 175 | ||
| 2 Using Epidemiology to Identify the Causes of Disease | 177 | ||
| Section 2_text | 177 | ||
| 9 Cohort Studies | 179 | ||
| Learning Objectives | 179 | ||
| Design of a Cohort Study | 179 | ||
| Comparing Cohort Studies with Randomized Trials | 180 | ||
| Selection of Study Populations | 181 | ||
| Types of Cohort Studies | 182 | ||
| Examples of Cohort Studies | 183 | ||
| Example 1: The Framingham Study | 183 | ||
| Example 2: Incidence of Breast Cancer and Progesterone Deficiency | 184 | ||
| Cohort Studies for Investigating Childhood Health and Disease | 185 | ||
| Potential Biases in Cohort Studies | 186 | ||
| Selection Biases | 186 | ||
| Information Biases | 186 | ||
| When is a Cohort Study Warranted? | 187 | ||
| Conclusion | 187 | ||
| References | 188 | ||
| Review Questions for Chapter 9 | 188 | ||
| 10 Case-Control and Other Study Designs | 189 | ||
| Learning Objectives | 189 | ||
| Design of a Case-Control Study | 190 | ||
| Potential Biases in Case-Control Studies | 192 | ||
| Selection Bias | 192 | ||
| Sources of Cases | 192 | ||
| Using Incident or Prevalent Cases. | 192 | ||
| Selection of Controls | 192 | ||
| Sources of Controls. | 194 | ||
| Use of Nonhospitalized People as Controls. | 194 | ||
| Use of Hospitalized Patients as Controls. | 194 | ||
| Problems in Control Selection. | 195 | ||
| Information Bias | 197 | ||
| Problems of Recall | 197 | ||
| Limitations in Recall. | 197 | ||
| Recall Bias. | 198 | ||
| Other Issues in Case-Control Studies | 199 | ||
| Matching | 199 | ||
| Group Matching | 199 | ||
| Individual Matching | 199 | ||
| Use of Multiple Controls | 200 | ||
| Controls of the Same Type | 201 | ||
| Multiple Controls of Different Types | 201 | ||
| When is a Case-Control Study Warranted? | 202 | ||
| Case-Control Studies Based in a Defined Cohort | 203 | ||
| Nested Case-Control Studies | 203 | ||
| Case-Cohort Studies | 205 | ||
| Advantages of Embedding a Case-Control Study in a Defined Cohort | 206 | ||
| Other Study Designs | 206 | ||
| Case-Crossover Design | 206 | ||
| Ecologic Studies | 208 | ||
| Cross-Sectional Studies | 210 | ||
| Conclusion | 212 | ||
| References | 212 | ||
| Review Questions for Chapter 10 | 213 | ||
| 11 Estimating Risk: | 215 | ||
| Learning Objectives | 215 | ||
| Absolute Risk | 215 | ||
| How Do We Determine Whether a Certain Disease is Associated with a Certain Exposure? | 216 | ||
| Relative Risk | 217 | ||
| The Concept of Relative Risk | 217 | ||
| Interpreting the Relative Risk | 217 | ||
| Calculating the Relative Risk in Cohort Studies | 218 | ||
| The Odds Ratio (Relative Odds) | 220 | ||
| Defining the Odds Ratio in Cohort and in Case-Control Studies | 220 | ||
| The Odds Ratio in Cohort Studies | 221 | ||
| The Odds Ratio in a Case-Control Study | 222 | ||
| Interpreting the Odds Ratio | 222 | ||
| When Is the Odds Ratio a Good Estimate of the Relative Risk? | 222 | ||
| Examples of Calculating Odds Ratios in Case-Control Studies | 224 | ||
| Calculating the Odds Ratio in an Unmatched Case-Control Study | 224 | ||
| Calculating the Odds Ratio in a Matched-Pairs Case-Control Study | 224 | ||
| Conclusion | 227 | ||
| Reference | 227 | ||
| Review Questions for Chapter 11 | 227 | ||
| Appendix to Chapter 11 | 229 | ||
| (1) Formula 1: | 229 | ||
| (2) Formula 2: | 229 | ||
| (3) Formula 3: | 229 | ||
| 12 More on Risk: | 230 | ||
| Learning Objectives | 230 | ||
| Attributable Risk | 230 | ||
| Attributable Risk for the Exposed Group | 230 | ||
| Formula 12-1 | 231 | ||
| Formula 12-2 | 231 | ||
| Attributable Risk for the Total Population—Population Attributable Risk (PAR) | 232 | ||
| Formula 12-3 | 233 | ||
| Formula 12-4 | 233 | ||
| An Example of an Attributable Risk Calculation for the Exposed Group | 233 | ||
| Formula 12-1 | 233 | ||
| Formula 12-2 | 234 | ||
| An Example of an Attributable Risk Calculation in the Total Population (Population Attributable Risk—PAR) | 234 | ||
| 3 Applying Epidemiology to Evaluation and Policy | 307 | ||
| Section 3_text | 307 | ||
| 17 Using Epidemiology to Evaluate Health Services | 308 | ||
| Learning Objectives | 308 | ||
| Studies of Process and Outcome | 309 | ||
| Studies of Process | 309 | ||
| Studies of Outcome | 310 | ||
| Efficacy, Effectiveness, and Efficiency | 310 | ||
| Efficacy | 310 | ||
| Effectiveness | 310 | ||
| Efficiency | 310 | ||
| Measures of Outcome | 310 | ||
| Comparing Epidemiologic Studies of Disease Etiology and Epidemiologic Research Evaluating Effectiveness of Health Services | 311 | ||
| Evaluation Using Group Data | 312 | ||
| Outcomes Research | 312 | ||
| Potential Biases in Evaluating Health Services Using Group Data | 314 | ||
| Two Indices Used in Ecologic Studies of Health Services | 315 | ||
| Evaluation Using Individual Data | 315 | ||
| Randomized Designs | 316 | ||
| Nonrandomized Designs | 317 | ||
| Before–After Design (Historical Controls) | 317 | ||
| Simultaneous Nonrandomized Design (Program–No Program) | 318 | ||
| Comparison of Utilizers and Non-utilizers | 319 | ||
| Comparison of Eligible and Non-eligible Populations | 319 | ||
| Combination Designs | 319 | ||
| Case-Control Studies | 322 | ||
| Conclusion | 323 | ||
| References | 324 | ||
| Review Questions for Chapter 17 | 324 | ||
| 18 The Epidemiologic Approach to Evaluating Screening Programs | 326 | ||
| Learning Objectives | 326 | ||
| The Natural History of Disease | 327 | ||
| The Pattern of Disease Progression | 328 | ||
| Methodologic Issues | 332 | ||
| Selection Biases | 332 | ||
| Referral Bias (Volunteer Bias) | 332 | ||
| Length-Biased Sampling (Prognostic Selection) | 332 | ||
| Lead Time Bias | 334 | ||
| Lead Time and Five-Year Survival | 334 | ||
| Overdiagnosis Bias | 337 | ||
| Study Designs for Evaluating Screening: Nonrandomized and Randomized Studies | 337 | ||
| Nonrandomized Studies | 337 | ||
| Randomized Studies | 338 | ||
| Further Examples of Studies Evaluating Screening | 341 | ||
| Mammography for Women 40 to 49 Years of Age | 341 | ||
| Screening for Cervical Cancer | 343 | ||
| Screening for Neuroblastoma | 344 | ||
| Problems in Assessing the Sensitivity and Specificity of Screening Tests | 345 | ||
| Interpreting Study Results That Show No Benefit of Screening | 346 | ||
| Cost-Benefit Analysis of Screening | 347 | ||
| Conclusion | 347 | ||
| References | 348 | ||
| Review Questions for Chapter 18 | 349 | ||
| 19 Epidemiology and Public Policy | 351 | ||
| Learning Objectives | 351 | ||
| Epidemiology and Prevention | 351 | ||
| Population approaches Versus High-Risk Approaches to Prevention | 353 | ||
| Epidemiology and Clinical Medicine: Hormone Replacement Therapy in Postmenopausal Women | 356 | ||
| Risk Assessment | 357 | ||
| Assessment of Exposure | 359 | ||
| Meta-Analysis | 360 | ||
| Publication Bias | 361 | ||
| Epidemiology in the Courts | 362 | ||
| Sources and Impact of Uncertainty | 362 | ||
| Policy Issues Regarding Risk: What Should the Objectives Be? | 364 | ||
| Conclusion | 365 | ||
| References | 365 | ||
| 20 Ethical and Professional Issues in Epidemiology | 367 | ||
| Learning Objectives | 367 | ||
| Ethical Issues in Epidemiology | 368 | ||
| Investigators’ Obligations to Study Subjects | 369 | ||
| Protecting Privacy and Confidentiality | 370 | ||
| Access to Data | 372 | ||
| Race and Ethnicity in Epidemiologic Studies | 372 | ||
| Conflict of Interest | 374 | ||
| Interpreting Findings | 375 | ||
| Conclusion | 377 | ||
| References | 377 | ||
| Answers to Review Questions | 379 | ||
| Chapter 1 | 379 | ||
| Chapter 2 | 379 | ||
| Chapter 3 | 379 | ||
| Chapter 4 | 379 | ||
| Chapter 5 | 379 | ||
| Chapter 6 | 379 | ||
| Chapters 7 and 8 | 379 | ||
| Chapter 9 | 379 | ||
| Chapter 10 | 379 | ||
| Chapter 11 | 380 | ||
| Chapter 12 | 380 | ||
| Chapter 13 | 380 | ||
| Chapter 14 | 380 | ||
| Chapter 15 | 380 | ||
| Chapter 16 | 380 | ||
| Chapter 17 | 380 | ||
| Chapter 18 | 380 | ||
| Chapters 19 and 20 | 380 | ||
| Index | 381 | ||
| A | 381 | ||
| B | 381 | ||
| C | 382 | ||
| D | 383 | ||
| E | 384 | ||
| F | 385 | ||
| G | 385 | ||
| H | 385 | ||
| I | 386 | ||
| J | 386 | ||
| K | 386 | ||
| L | 386 | ||
| M | 386 | ||
| N | 387 | ||
| O | 388 | ||
| P | 388 | ||
| Q | 389 | ||
| R | 389 | ||
| S | 390 | ||
| T | 391 | ||
| U | 392 | ||
| V | 392 | ||
| W | 392 | ||
| Y | 392 |