Epidemiology
HUNG-EN SUNG and CASSANDRA RAMDATH
City University of New York, USA
Epidemiology is the study of the distri-
bution of disease as well as the study of
its determinants and its consequences for
human populations (Rothman 2012). It uses
empirical methods and conceptual models to
answer questions such as how much disease
there is, what speciic factors put individuals
at risk, and how severe the outcomes of dis-
ease are for patient populations, in order to
inform public health policymaking. he term
“disease” encompasses not only physical or
mental illnesses but also behavioral patterns
with negative health consequences, such as
substance abuse or violence.
he measurement of disease occurrence
begins with the estimation of incidence and
prevalence. Disease incidence is the num-
ber of new cases in a population within a
speciic period of time. First-ever incidence
picks up only irst-ever onsets; by 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 that would experience the onset
over a speciic time period.
Prevalence is the number of people in
a population with a speciic 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 who contracted the disease dur-
ing their lives or between two speciic time
points. he nature of the disease itself deter-
mines the appropriate choice of measure. For
he Wiley Blackwell Encyclopedia of Race, Ethnicity, and Nationalism, First Edition.
Edited by John Stone, Rutledge M. Dennis, Polly S. Rizova, Anthony D. Smith, and Xiaoshuo Hou.
© 2016 John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd.
DOI: 10.1002/9781118663202.wberen666
example, for single-episode conditions with
a clearly deined onset such as chickenpox,
irst-ever and cumulative incidence rates are
most useful, but, for recurrent conditions
with ill-deined onsets such as allergy, period
and cumulative prevalence rates are most
oten 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, exposure to single
risk factors is usually neither a suicient nor
a necessary cause of disease. Consequently,
eforts are devoted to quantifying the level
of increased risk when one is exposed to a
particular risk factor. Risk is normally mea-
sured as either the 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 identifying disease outcomes
with the goal to control the damage done to
patients.
Disparities in health and health care
across racial, ethnic, and socioeconomic
backgrounds in the United States and other
countries are well documented (Barr 2008;
Lenard and Straehle 2012). Social disadvan-
tages and failures routinely translate into
higher rates of morbidity, disability, and mor-
tality as well as into lower rates of medical
service utilization. Unfortunately, the lack
of individually speciic data undermines
the establishment of reliable baseline and
trend analyses of health, health-care access,
cost, and quality by group characteristics.
A better understanding of the causes of
these diferences requires the availability
of quality data on race, ethnicity, socio-
economic status (SES), acculturation and
language, and sociopolitical capital—for