Basic measurements in epidemiology

community health nursing I

1. Basic measurements in epidemiology Prepared by Krupa Mathew. M, Assistant professor

2. 2 Define epidemiology The study of the distribution and determinants of health-related states or events in specified population and the application of the study to control of health problems (J.M. Last 1988) Uses of epidemiology Investigation of causation of disease. Study of the natural history and prognosis of diseases. Description of the health status of the populations. It includes proportion with ill Health, change over time, change with age etc Evaluation of the interventions. Planning health services, Public policy and programs.

3. Measurements used in epidemiology Measurement of mortality Measurement of morbidity Measurement of disability Measurement of natality Measurement of disease attributes Measurement of health care services Measurement of the risk factors Measurement of demographic variables

4. Tools of measurement 4 The epidemiologist usually expresses disease magnitude as a rate, ratio, proportion. The basic tools of measurement in epidemiology are Proportion Rate Ratio

5. Proportion 5 A part/share or number considered in comparative relation to a whole. Usually expressed as a percentage %. This is also relation /magnitude between two quantities, and numerator is always part of denominator and expressed as percentage Usually expressed as a percentage % Numerator (which is part of denominator) Denominator Multiplier No time factor

6. Proportion – example 6 -Proportion of female students. -Proportion of anaemic mothers (60% mothers are anaemic) What proportion of the population is suffering from diabetes?

7. R a t e 7 It Measures the occurrence of an event or disease in a given population during a given period (one Year). (Birth rate, growth rate, accident rate). Usually expressed per 100 or per 1000 population. It has a time dimension, whereas a PROPORTION does not. Contains Numerator (which is part of denominator) Denominator Multiplier Time period Usually expressed per 100 / per 1000 population

8. Rate – example 8 Death rate = 𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑖𝑛 𝑜𝑛𝑒 𝑦𝑒𝑎𝑟 𝑇𝑜𝑡𝑎 𝑙 𝑝 op 𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑖𝑛 𝑡ℎ𝑎𝑡 𝑦𝑒𝑎𝑟 X 1000

9. R a tio 9 The value obtained by dividing one quantity by another - X / Y. A ratio often compares two rates. Ratio also expresses relation of size between the two quantities.  Numerator is not part of Denominator. Expressed as X / Y. Examples: Male to female ratio.  Doctor : Population ratio. Male : Female ratio. WBC : RBC ratio

10. MEASUREMENT OF MORTALITY 10

11. Measurement of mortality 11 Disease or injury that initiated the train of morbid events leading directly to death. Crude death rate Specific death rate Proportional mortality rate Case fatality rate Survival rate Adjusted/standardized rates

12. Crude Death Rate 12 𝐶𝐷𝑅 = 𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑟𝑖𝑛𝑔 𝑜𝑛𝑒 𝑦𝑒𝑎𝑟 X 1000 𝑀𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 It is defined as “the number of deaths from all causes per 1000 estimated mid-year population in one year, in a given place”. The simplest measure of mortality is the crude death rate

13. Specific death rate 13 i. Cause specific e.g. Deaths due to cholera ii. Age specific e.g. Infant deaths 𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 due to cholera 𝑑𝑢𝑟𝑖𝑛𝑔 𝑜𝑛𝑒 𝑦𝑒𝑎𝑟 X 1000 𝑀𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑁𝑜.𝑜𝑓 infants 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑟𝑖𝑛𝑔 𝑜𝑛𝑒 𝑦𝑒𝑎𝑟 X 1000 𝑀𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 When analysis planned to throw light on aetiology, it is essential to use specific death rates. The specific death rates may be (i) cause or disease specific eg . TB , cancer (ii) related to specific groups eg . Age-specific, sex specific etc.,

14. Sex specific e.g. Maternal deaths Time specific Weekly deaths 𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 among males 𝑑𝑢𝑟𝑖𝑛𝑔 𝑜𝑛𝑒 𝑦𝑒𝑎𝑟 X 1000 𝑀𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 in week X 52 X 1000 𝑀𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛

15. PROPORTIONAL MORTALITY RATE/RATIO It helps to know what proportion of total deaths are due to a particular cause( eg . cancer ) or what proportion of deaths are occurring in a particular age group ( eg . above the age of 50yrs) It expresses the number of deaths due to a particular cause (or in a specific age group) per 100(or 1000) total deaths.

16. Proportional mortality rate a. Proportional mortality rate from a specific disease 𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑒 𝑡𝑜 𝑎 𝑝𝑎𝑟𝑡𝑖𝑐𝑢𝑙𝑎𝑟 𝑐𝑜𝑛𝑑𝑖𝑡𝑖𝑜𝑛 in a year b. Under five proportionate mortality rate 𝑇𝑜𝑡𝑎𝑙 𝑛𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ 𝑠 from all causes in that year X 100 𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 due to cholera 𝑑𝑢𝑟𝑖𝑛𝑔 𝑜𝑛𝑒 𝑦𝑒𝑎𝑟 X 1000 Total no. of deaths during the same period

17. Case fatality rate 17 CFR = 𝑁𝑜 .𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑒 𝑡𝑜 a particular disease X 100 𝑇𝑜𝑡𝑎𝑙 𝑛𝑜.𝑜𝑓 𝑐𝑎𝑠𝑒𝑠 due to same disease

18. Survival rate 18 It is the proportion of survivors in a group, studied and followed over a period. It is a method of describing prognosis in certain disease conditions. Used in research studies Like cancer therapy or survival = 𝑇𝑜𝑡𝑎𝑙 𝑛𝑜.𝑜𝑓 𝑝𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑃𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑎𝑙𝑖𝑣𝑒 𝑎𝑡 𝑡ℎ𝑒 𝑒𝑛𝑑 𝑜𝑓 5 𝑦𝑒𝑎𝑟 X 100

19. ADJUSTED OR STANDARDIZED RATES To compare the death rates of two populations with different age – composition, the crude death rate is not the right yardstick. Hence we are using the adjusted or standardized rates The rate is either “age adjustment” or “age standardization” which removes the confounding effect of different age structures and yields a single standardized or adjusted rate, by which the mortality experience can be compared directly . Standardization is carried out by one of the two methods – direct or indirect standardization. Both the methods begin by choosing a standard population not the age-structures of the populations

20. Standardized mortality ratio 20 SMR = Observed deaths Expected deaths X 100

21. Direct standardization 21

22. Indirect standardization 22

23. 37 Total population Total deaths – all causes Cholera deaths CDR Specific DR P MR

24. MEASUREMENT OF MORBIDITY 24

25. Measurements of morbidity Morbidity is defined as “any departure, subjective or objective, from a state of physiological well-being. The term is used equivalent to such terms as sickness, illness, disability etc. WHO Expert committee on Health statistics that morbidity could be measured in terms of 3 aspects (i) persons who were ill (ii) the illness that these persons experienced (iii)the duration of these illnesses

26. 26 Incidence Occurrence of new cases Prevalence Existence of new and old cases Incidence – how many people with the disease are newly diagnosed each year (like video) Prevalence - how many people in a population currently have the disease (like snapshot)

27. Incidence 27 No. of 𝐍𝐄𝐖 cases of a disease Total population at risk during the same time period in a particular time period X 1000 The incidence rate is defined as ‘the number of NEW cases occurring in a defined population during a specified period of time’.

28. Special incidence rates 28 Attack rate : The rate at which acute disease is spreading. It is used during epidemics & expressed in %. Secondary attack rate : % of exposed persons developing disease after primary case exposure.

29. Uses of incidence rate 29 For taking action to control disease More suited for acute or infectious conditions For research

30. Example of use of incidence 30

31. Points to remember about incidence 31 Refers only to new cases Not influenced by duration of disease Refers to a particular time period Denominator is people at risk

32. Prevalence The term disease prevalence refers to specifically to all current cases(old and new) existing at a given point in time, over a period of time in a given population. The total number of all individuals who have an attribute or disease at a particular time divided by the population at risk of having the attribute or disease at this point in time or midway through the period

33. Prevalence 33 = No.of 𝐎𝐋𝐃 𝐚𝐧𝐝 𝐍𝐄𝐖 cases of a disease Total population at risk during the same time period in a particular time point/period X 1000

34. Types of prevalence 34 Point prevalence Number all current cases at any given point of time. 4% TB cases on 1st April. It is defined as number of all current cases (old and new) of a disease at one point of time , in relation to a defined population. The point in a point prevalence, may for all practical purposes consists of a day, several days or even a few weeks depending upon the time it takes to examine the population sample. No of all cases (old & new) of a specified disease existing at a given point in time X 100 Estimated population at the same point in time Period prevalence Number all current cases at a given period of time. A less commonly used measure of prevalence is period prevalence. It measures the frequency of all current cases (old and new) existing during a defined period of time . e.g (Annual Prevalence) expressed in relation to defined population. It includes cases arises before but extending into or through to the year as well as those cases arising during the year. No of all cases (old & new) of a specified disease during a given period of time interval X 100 Estimated mid interval population at risk  

35. Prevalence increases 35 Longer duration of disease Prolongation of life with treatment Increase in incidence Immigration of new cases Better reporting of cases Emigration of healthy people

36. Prevalence decreases 36 Shorter duration of diseases Improved cure rate Decrease in incidence Emigration of new cases Under reporting of cases Immigration of healthy people

37. Uses of prevalence 37 Magnitude of disease problems Identify potential high-risk populations Administrative and planning purposes, e.g., hospital beds, manpower needs, rehabilitation facilities

38. Points to remember about prevalence 38 Refers to new and old cases Influenced by duration of disease Refers to a particular time period Denominator is people at risk

39. Relation between incidence & prevalence 39

40. Relation between incidence & prevalence 40 Prevalence = Incidence X duration Incidence = 10 cases/1000 population/year Mean duration of disease = 5 years Prevalence = 10 x 5 = 50 per 1000 population

41. USES OF MORBIDITY RATES Give important clues for epidemiological research. Assessment of public health problems and programs. Designing intervention programs. Indicating priorities for health action and resource allocation. Explaining trends in overall mortality.