Basic Measurements
MS. AFSHAN NAZAR
SENIOR INSTRUCTOR
Objectives
2
By the end of the session, students’ will be able to:
Define basic measurements of epidemiology
Define and calculate:
Mortality rate
Morbidity rate
Calculate and interpret the results of basic
measurements of Epidemiology
Understand the application and use of these measures in
community setting as well as in whole population.
Morbidity
3
Occurrence of any disease is called Morbidity
Morbidity can be measured using rates or proportions
Rates tell us how fast the disease is occurring
Proportions tell us what fraction of the population is affected
Measures of morbidity are:
Incidence rate
Prevalence
Measures of Disease Frequency
4
Measures of disease frequency in mathematics are:
Count
Proportion (percentage)
Rate
Ratio
Measures of disease frequency in epidemiology are:
Incidence
Prevalence
Mortality
5
Mortality rates can serve as measures of disease
severity.
It helps to determine whether the treatment for a
disease has become more effective over time or not.
Numerators and denominators
6
(N/D)
Numerator – the top number of the fraction
Denominator- the bottom number of the fraction
Numerators and denominators
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So 50 people with infections out of 100 people in this room
means half (50/100) of the people in this room have
infections
100 people with infections out of a 1000 in the next room
means only a tenth (100/1000) of the next room have colds
Therefore, we need measures of disease frequency to get
the correct information about population
Count, Proportion, Rate, Ratio
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Counts:
• Simplest & most basic measure
• Count of number
• Cases of a disease
• Absolute number of persons who have disease or
characteristic of interest.
Ratio
9
• Used to compare two quantities e.g. ratio of female to
male births is 1:2
• Ratio: A fraction in which the numerator is not
part of the denominator
𝑎 𝑓𝑒𝑚𝑎𝑙𝑒𝑠
𝑂𝑅
𝑏 𝑚𝑎𝑙𝑒𝑠
• a and b are two mutually exclusive frequency
Example:
• Male and female dengue infection ratio = 70/35 or
• 2 males to one female (2 : 1)
Proportion
10
• A specific type of ratio in which the numerator is part of
denominator, usually presented as a percentage
𝑎 𝑀𝑎𝑙𝑒𝑠
𝑂𝑅 (a=males, b= females)
𝑎+𝑏 𝑇𝑜𝑡𝑎𝑙 𝐵𝑖𝑟𝑡ℎ𝑠
• Often expressed as %
Example: From 7,999 females aged 16 – 45 y, 2,496 use
modern contraceptive methods.
The proportion of those who use modern contraceptive
methods = 2,496 / 7,999 x 100 =
31.2%
Calculation of proportion:
11
Males undergoing bypass surgery at Hospital A
___________________________________________ * 100
Total patients undergoing bypass surgery at Hospital A
352 males undergoing bypass surgery
__________________________________ * 100
539 total patients undergoing bypass surgery
= 65.3%
Rate
12
A proportion with the specification of time in a
specified population.
Example: (deaths in 2015/population in 2015) x
1,000
“Year 2015 has been specified here”
Types of Rate
13
3 major types
Crude rates (birth, death)
Specific rates (age-specific, infant mortality)
Adjusted rates (age adjusted)
Crude rates
14
Crude Death Rate:
deaths in defined period of time x K
population in defined period of time
(k denotes 100’s, 1,000’s etc. and is constant)
Crude rates
15
Example:
Deaths from all causes in Karachi in 2000 = 9981
Total population in Karachi in 2000 = 951,270
Crude rates
16
Crude Birth Rate:
Crude Birth rate (CBR):
the total number of live births / the midyear population x
1000
Total Fertility rate
17
the total number of live births * 1000
women of childbearing age(15-49)
Mortality rate
18
Annual mortality rate for all causes:
Total number of deaths from all causes in one year x 1000
Total mid year population
Mortality rate from all causes is same as Crude
death rate (CDR)
Specific Rates
19
Age-specific, gender-specific, race-specific
Example – infant mortality – deaths within the 1st year of
life
Specific Rates
20
Specific rates
21
Case Fatality Rate:
Specific rates
22
Maternal Mortality Rate:
Deaths of women due to pregnancy complications or within
42 days after delivery in a specified time period X k
Number of live births in a specified time period
23
Dependency ratio
24
Dependency ratio =
Number of people aged 1-14 years and those aged 65 and over * 100
Number of people aged 15- 64 years
Adjusted or Standardized Rates
25
Standardization allows for comparisons when the population
structures differ
Standardized or adjusted rates allow for appropriate
comparisons by taking into account differences in populations
(age, gender, etc.)
Example of use: Population in Arizona is much older than population in
Alaska, so it would be inappropriate to compare mortality rates.
Standardization allows for meaningful comparisons.
Prevalence
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• Number of existing cases of disease (old &
new case)
• Two types:
Point Prevalence
Period Prevalence
Prevalence
27
Point Prevalence:
Proportion of individuals in a population with
disease or condition at a specific point of time
Prevalence
28
Period Prevalence:
measures the frequency of all current events
(old and new) for a prescribed period of time
Prevalence
29
Prevalence depends on two factors:
the incidence
the duration of disease
Thus, a change in disease prevalence may reflect a
change in incidence or duration of disease or both
30
Prevalence
31
* Point prevalence
- 01/01/2009: Case No. 2, 4, 5
- 31/12/2009: Case No. 6, 7, 10
* Period prevalence between 01/01/2009 till 31/12/2009:
Case No. 2, 3, 4, 5, 6, 7, 9, 10
Incidence
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• Measures new cases of disease that develop in a
population during a specified period of time
Incidence = No. of new cases * 100
Total Population at risk
Prevalence vs Incidence
33
34
Reference
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Age Adjusted Rates. Retrieved from
[Link]
html
Gordis, L. (2009) Epidemiology. Fourth Edition