Module 5

In a hospital
200 patients admitted
50 are diabetic
30 males and 20 females.
10 patients died.
1. Diabetic patients out of 200 =50/200 =0.25 =25%
2. Male : Female =30:20 =3:2
3. Deaths per year =10 per 200 on year.
Rate , Ratio, Proportion
Rate
A rate is a comparison of two quantities where time is involved. It tells
how fast something happens.
𝑁𝑜 𝑜𝑓 𝑒𝑣𝑒𝑛𝑡𝑠
Rate = 𝑋 𝑡𝑖𝑚𝑒
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑡 𝑟𝑖𝑠𝑘
Note:
1. Time is compulsory.
2. Denominator is usually the population at risk.
3. Often multiplied by 1000, 10000 or 100,000
Q. 1. In a village of 10,000 people 50 people developed dengue in 1 year.
50
Rate = 𝑋 1 = 0.005
10000
If multiplied by 1000 = 5 per 1000 in a year.
Example:
a. Birth rate
b. Death rate
c. Incidence rate
d. Mortality rate
Ratio
A ratio is a comparison of two independent quantities. It shows how many
times one quantity is compared to another.
𝑄𝑢𝑎𝑛𝑡𝑖𝑡𝑦 𝐴
Ratio =
𝑄𝑢𝑎𝑛𝑡𝑖𝑡𝑦 𝐵
1. No time component.
2. Numerator is not a part of denominator.
3. Written as A:B or A/B

If a class has 30 boys and 20 girls

Boy: Girl = 30:20 =3:2
Example :
Male female ratio
Risk ratio(Relative risk)
Proportion
A proportion is a type of ratio where the numerator is part of the
denominator.
𝑃𝑎𝑟𝑡
Proportion =
𝑊ℎ𝑜𝑙𝑒
1. No time required
2. Always between 0 and 1.
3. Can be expressed as percentage.
Q.2. Out of 100 students, 40 are females.
Proportion = 40/100 =0.4 or 40%
Example:
1. Prevalence
2. Cure proportion
Q.3. In a village of 1000 people
600 are female
200 females are anemic.
10 maternal deaths occurred in 1 year.
Find
1. Proportion of females?
2. Proportion of anemic among females.
3. Female male ratio
4. Maternal death rate 1000 per year.
Solution:
1.600/1000 = 0.6=60% 3. 600:400 = 3:2
2.200/600 = 0.33 = 33% 4. 10/600 =0.0167 , multiplied by 1000 =16.67
About 17 maternal deaths occur per 1000 females in a year.
Incidence and prevalence
Incidence
Incidence is the no of new cases of a disease occurring in a population
during a specified period of time. It measures risk of developing disease.
𝑁𝑒𝑤 𝑐𝑎𝑠𝑒𝑠 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡𝑖𝑚𝑒 𝑝𝑒𝑟𝑖𝑜𝑑
Incidence =
𝑃𝑜𝑝𝑢𝑎𝑡𝑖𝑜𝑛 𝑟𝑖𝑠𝑘 𝑎𝑡 𝑏𝑖𝑔𝑖𝑛𝑛𝑖𝑛𝑔
1. Count only new cases.
2. Time period is compulsory.
3. Population must be disease free at beginning.
4. Measures risk.
5. Used in cohort studies and RCT.
Q.4. In a village of 1000 healthy people, 50 developed malaria in a year.
Calculate incidence.
Incidence = 50/1000= 0.05 =5%
Risk of malaria in 1 year is 5%.
Q.5 Suppose 200 healthy individuals are followed for 1 year to see
development of Prameha. Calculate incidence.
Prevalence
Prevalence is the total no of existing cases(new+old) of a disease in a
population at a specified time. It measures burden of disease.
𝐴𝑙𝑙 𝑒𝑥𝑖𝑠𝑡𝑖𝑛𝑔 𝑐𝑎𝑠𝑒𝑠(𝑜𝑙𝑑+𝑛𝑒𝑤)
Prevalence =
𝑇𝑜𝑡𝑎𝑙 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑎𝑡 𝑝𝑒𝑟𝑖𝑜𝑑
1. Includes both old and new cases.
2. May or may not be include time ( depends on type)
3. Population may include diseased individuals.
4. measures burden.
Example:
In a population of 2000 people 200 people currently have diabetes.
Prevalence = 200/2000 =0.10 =10%
10% of the population currently have diabetes.
Types of prevalence
1. Point prevalence
2. Period prevalence
Point prevalence
No of existing cases of disease at a particular point of time.
𝐸𝑥𝑖𝑠𝑡𝑖𝑛𝑔 𝑐𝑎𝑠𝑒 𝑎𝑡 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑡𝑖𝑚𝑒9𝑜𝑙𝑑 𝑎𝑛𝑑 𝑛𝑒𝑤)
Point prevalence =
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑡 𝑠𝑎𝑚𝑒 𝑡𝑖𝑚𝑒
Example :
On first January 2026, 100 people in a town of 5000 had TB.
100/5000 =0.02= 2%
This is point prevalence ( Specific time)
Period prevalence
No of people who had disease at any time during a given period.
It includes cases present at beginning plus new cases during that
period.
𝐶𝑎𝑠𝑒𝑠 𝑑𝑢𝑟𝑖𝑛𝑔 𝑝𝑒𝑟𝑖𝑜𝑑(𝑜𝑙𝑑 𝑎𝑛𝑑 𝑛𝑒𝑤)
Period prevalence =
𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑎𝑡 𝑝𝑒𝑟𝑖𝑜𝑑
Example:
In 2025 in a town of 5000 people 100 already have TB at startof year 50
new cases developed during a year.
Period prevalence= 150/5000 = 3
This is period prevalence.
Relation
Prevalence = incidence X Duration
Example:
Incidence of Arthritis is 5per 1000/year. Duration 10 year , calculate
prevalence.
Prevalence = Incidence X Duration
= 5x10 = 50 per 1000

Chronic disease – High prevalence

Acute disease – Low prevalence
Difference between point prevalence and period prevalence

Point prevalence Period prevalence

Specific time Duration
Existing cases at that moment Existing + new cases during period
Usually smaller Usually larger
E.g, On 1 Jan 2026 During 2026
Use of incidence in public health
1. Measures risk of disease.
incidence tells probability of developing disease.
Example – if incidence of dengue increases in a district, risk of infection is
increasing.
Used to detect out breaks.
2. Identify causes.
Incidence is essential in cohort studies, clinical trials, Risk factor research.
3. Evaluate preventive programe.
If vaccination program is introduced,
Before vaccination- high incidence.
After vaccine – incidence decrease.
Shows effectiveness of intervention.
Use of prevalence in public health
[Link] disease burden
[Link] in resource allocation.
If prevalence of hypertension is 30%
More BP clinics needed.
More medicines required.
useful for health planning.
3. Monitoring chronic diseases.
Relevance of Odds Ratio, Relative Risk and Risk difference in
Epidemiological Research.
In analytical epidemiology, measures of association are used to quantify
the relationship between an exposure and a disease. The three major
measures are Relative Risk(RR), Odds Ratio(OR), and Risk Difference (RD).
Each has specific importance depending on study design and research
objective.
Example:
In 100 smokers 40 get disease.
1n 100 non- smokers 10 get disease.
1. How many times risk increased – RR- 4times
2. How much extra Risk – RD = 40-10 =30
RR- relative comparison, RD- Real difference, OR – odds comparison.
Relative risk
“Suppose we want to know whether smoking causes lung cancer”
Disease No disease Total
Exposed(smoking) 40 60 100
Not exposed 20 80 100

Risk =Probability of developing disease.

Calculate risk in exposed
Risk(exposed)=40/100
Calculate risk in non – exposed
Risk(non –exposed) =20/100
RR= 0.4/0.2=2
Smokers have 2 times higher risk of disease compared to non- smokers.
Definition
Relative risk is the ratio of risk of disease in exposed group to risk in non-
exposed group. It tells how many times the risk increases or decreases due
to exposure.
D+ D- Total
Exposed a(x1) b (n1-x1) a+b (n1)
Non- Exposed c(x2) d (n2-x2) c+d (n2)
Total a+c b+d

𝑎Τ
𝑎+𝑏
𝑥1Τ
𝑛1 𝑝ො1
RR = = =
𝑐Τ
𝑐+𝑑
𝑥2Τ
𝑛2 𝑝ො2
RR = 1 No association (exposure do not affect risk)
RR>1 Positive association(Exposure increase risk)
RR<1 Negative association(Protective factor, Exposure decrease risk)
Example:
D+ D-
Smokers 40 60
Non smokers 10 90
Risk in smokers 40/100=0.4
Risk in non smokers 10/100 =0.1
RR= 0.4/0.01 =4
Smokers have 4 times higher risk.
Note: RR measures the strength and direction of association and is
commonly used in cohort studies and trials.
RD – Extra risk
RD= Risk in Exposure – Risk in non exposure
= 0.4 -0.2 = 0.2=20%
“Smoking causes 20% extra disease compared to non-smokers”
Definition
Relative difference is the difference in risk between exposed and non
exposed groups. It tells how much extra risk is due to exposure.
RD= 𝑅𝑖𝑠𝑘𝑒𝑥𝑝𝑜𝑠𝑒𝑑 − 𝑅𝑖𝑠𝑘𝑛𝑜𝑛−𝑒𝑥𝑝𝑜𝑠𝑒𝑑
It is also called attributable risk, absolute risk reduction
Definition

D+ D- Total
Exposed a(x1) b(n1-x1) a+b (n1)
Non-Exposed C(x2) d(n2-x2) c+d(n2)

𝑎 𝑐 𝑥1 𝑥2 𝑥1 𝑥2
RD= - = - = 𝑝1
Ƹ - 𝑝2,
Ƹ = 𝑝1,
Ƹ = 𝑝2
Ƹ
𝑎+𝑏 𝑐+𝑑 𝑛1 𝑛2 𝑛1 𝑛2
-1<RD<1
RD=0 both group have identical effect with no difference in causing Risk
RD>0 Exposure increase risk.
RD<0 Exposure is protective.
Odds ratio- Odds comparison
Odds
Odds is the ratio of the probability that an event will occur to the probability
that it will not occur.
Odds – compare the event vs non-event.
Risk - compares event vs total.
𝑁𝑜.𝑜𝑓 𝑒𝑣𝑒𝑛𝑡𝑠
Odds =
𝑁𝑜 𝑜𝑓 𝑛𝑜𝑛−𝑒𝑣𝑒𝑛𝑡𝑠
𝑝
If probability of risk =p, then Odds=
1−𝑝
Example: Suppose in 100 people 20 have disease 80 do not have disease.
Risk or probability = 20/100=0.2 =20%
Odds = 20/80=1/4
calculation of Odds ratio

Disease No disease Total

Exposed(smok 40 60 100
ing)
Not exposed 20 80 100
If 40 diseased 60 not
Odds(exposed) =40/60
20 diseased 80 not diseased.
Odds(non – exposed) =20/80
Odds(exposed) 40/60
OR = = = 2.67
Odds(non – exposed) 20/80
Definition
Odds ratio is the ratio of odds of exposure among cases to odds of
exposure among controls.

D+ D-
Exposed a b
Non-exposed c d

𝑎Τ 𝑎∗𝑑
𝑏
OR = 𝑐Τ =
𝑑 𝑏∗𝑐
Note:
1. Used in case control studies.
2. Used in logistic regression.
3. Approximate RR when disease is rare – OR ≈ RR
OR=1 - No association(Exposure has no effect on disease)
OR>1 - Exposure increase odds of disease.(exposure is risk factor)
OR<1 - Exposure decrease odds of disease(Exposure is protective)
Q.1.A study was conducted to find the association between Smokng
and lung disease.
Lung disease No lung disease
Smokers 60 40
Non- Smokers 30 70
Calculate
[Link] ratio
[Link]
[Link]
Solution:
𝑅𝑖𝑠𝑘 𝑖𝑛 𝑒𝑥𝑝𝑜𝑠𝑠𝑒𝑑 6/100
RR= = =0.6/0.3 =2
𝑅𝑖𝑠𝑘 𝑖𝑛 𝑢𝑛𝑒𝑥𝑝𝑜𝑠𝑠𝑒𝑑 30/100
Smokers have 2 times higher risk of lung disease.
RD = Risk in exposed – Risk in unexposed
=0.6-0.3=0.3 =30%
Smoking causes 30% extra cases.
𝑎Τ 𝑎𝑑
𝑏
OR= 𝑐Τ = = 60*70/40*30=4200/1200 = 3.5
𝑑 𝑏𝑐
Odds of lung disease are 3.5 time higher among smokers.
Q.2. Association of alcohol consumption and liver disease. Calculate
RR,RD,OR.
Liver disease No disease
Alcohol users 50 50
Non-users 20 80
Solution:
50/100
RR= =2.5 Alcohol users have 2.5 times higher risk of liver
20/100
disease
RD = 0.5-0.2=0.3 Alcohol consumption causes 30% additional cases.
OR = 4 Odds of liver disease are 4 times higher among alcohol users.
Q.3. Association between high fat diet and obesity. Calculate OR,RR,RD.

Obesity No obesity
High fat diet 40 60
Normal diet 10 90