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Epidemiology is the study of patterns of disease, illness, and health that occur in populations according to variables of interest such as gender, age, race, and ethnicity. It is an interdisciplinary field that combines medical science, social and behavioral science, and biostatistics. Epidemio-logical research has provided an understanding of the progression of many illnesses and diseases from inception to end, or the natural history of a disease. This knowledge is useful in the design of health intervention and disease prevention programs, policy recommendations, and to highlight areas in need of change in the nation's health care system.

A guiding principle is that risks or exposures to diseases are unequally distributed among a continuum in a population, and this distribution is influenced by social forces, a relationship best examined at the population level. A defining feature that sets epidemiology apart from much of clinical medicine is its population-level focus, versus examination of the individual. A population is a group of people who share a common characteristic(s) of interest, such as geographical region, gender, or religion. This approach enables the identification of different patterns of health and illness across a population.

The Development of Epidemiology

Scientific observations regarding the fact that some groups of people seemed more susceptible to a particular disease or illness have been made for hundreds of years. Often negative health outcomes were associated with an economic force, such as occupation. Early studies include Sir Percivall Pott's study of high testicular cancer among chimney sweeps and John Snow's findings that a cholera outbreak was traceable to a contaminated drinking water source. Based on their findings, both men were able to make recommendations to improve the public's health. Emile Durkheim's observations that suicide rates in Europe were related to social integration also provided an early framework.

Social epidemiology developed in the 20th century as a means to better focus on social and biological determinants of disease. Work by a number of different researchers put forth and advanced the idea that stressors in the environment can have adverse physiological effects on the body. A landmark article by Saxon Graham detailed the manners through which membership in a social group (such as an ethnic group) can start a chain of events that begins with behavior patterns, risk, and exposures that affect disease and health outcomes. Social epidemiology has been and continues to be a major contributor in the identification of health disparities, or that some groups disproportionately suffer more from a disease or illness than another.

Methods, Data, and the U.S. Census

Epidemiology relies heavily on quantitative data in order to track cases of diseases, illnesses, or health outcomes and examine the distribution across person, place, and time variables. Such data are instrumental in the documentation of racial and ethnic health disparities. The U.S. Census provides a wealth of population-level information on economic, social, and demographic characteristics. Data such as average household income for geographic regions and ethnic and racial group population sizes are invaluable for examining social forces on patterns of health and illness. Of particular interest to epidemiologists are census tracts and metropolitan statistical areas (MSAs), as some disease and illness patterns are correlated with urban and rural life, types of residence, and proximity to industrial plants. Other sources of epidemiologic data include the Framingham Heart Study, the oldest continuing running study of coronary heart disease risk, the National Vital Statistics System, the Behavioral Risk Factor Surveillance System, and the National Health and Nutrition Examination Survey.

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