Scientists in health-related fields focus on phenomena at different levels. For laboratory scientists, the focus is at the molecular, cellular, or organ system level; for clinical scientists, the focus is on the patient; and for public health practitioners, the focus is on the population. Epidemiology is the basic science of public health.
Epidemiology has many subdivisions and offshoots. Often the epidemiology of a disease in a clinical review refers primarily to its frequency and distribution in the population and estimates of its morbidity and mortality. These data are derived by descriptive epidemiology. Case-control, cohort, and cross-sectional studies may seek to identify risk factors and causes of disease and form the core of analytical epidemiology. Evaluations of public health interventions (experimental epidemiology) constitute the third major branch of classic epidemiology. The basic principles of epidemiology have found broad application in many areas, including understanding the public health implications of naturally occurring and synthetic compounds (molecular epidemiology), the complex interactions of genetic and environmental factors in disease (genetic epidemiology), the formulation of better diagnostic and treatment strategies for patients based on available evidence (clinical epidemiology), and the structuring of health care delivery for better outcomes and greater efficiency (health services research). The reader is referred to other sources for a more detailed discussion of various topics in dermatoepidemiology.1–3
Three of the many types of epidemiologic studies are mentioned here because of their prominence in epidemiologic research. The randomized, controlled trial is a particularly rigorous type of study appropriate to the evaluation of public health interventions. In general, the intervention is performed on a random sample of the study population, and the entire study population is then observed for the occurrence of the outcome in question. The random assignment of intervention allows the more rigorous application of many statistical techniques and reduces the potential for bias. Elimination of biases permits these studies to evaluate the efficacy and impact of an intervention more accurately than trials that do not assign the intervention randomly. Standards for reporting have been published4 (http://www.consort-statement.org, accessed Jul 7, 2010) and adopted by leading dermatology journals to improve assessment of their validity and their use in subsequent systematic reviews5 (see Chapter 2).
When evaluating risk factors for disease, it is frequently impossible to assign the risk factor randomly. Hence, inference is based on observational studies. In classical cohort studies, a group with exposure to the risk factor and a group without are chosen and observed over time. Occurrences of the study outcome are counted and compared between groups. Although more vulnerable to bias than randomized trials, cohort studies, in which exposure to the risk factor is known well before the study outcome is knowable, avoid some potentially serious biases. In a cohort study, the incidence of the study outcome can be measured directly in each group, and the relative risk can be measured directly as the ratio of the incidence ...