Measures of Mortality
&
Mortality in Different
Populations
Dr. Um-e-Habiba
Assistant Professor UIPH
DEMOGRAPHIC INDICATORS
• 1. Measurement of Mortality.
• 2. Measurement of Morbidity.
• 3. Measurement of disability.
• 4. Measurement of natality.
• 5. Measurement of the presence, absence
or distribution of the characteristics or
attributes of the disease.
• 6. Measurement of medical needs, health
care facilities, utilization of health
services and other health related events.
• 7. Measurement of the presence, absence
or distribution of the environmental and
other factors suspected of causing the
disease.
• 8. Measurement of demographic
variables.
Mortality is a term which means
“death” or describes death and
related issues
TOOLS OF MEASUREMENT
• An epidemiologist usually expresses
the health event as RATES, RATIOS
or PROPOTION.
Tools of Measurement
• Counts
• Proportions
• Ratios
• Rates
Case Counts
Measuring disease or health or
health care frequency starts
with counting cases
Simplest and most frequently
gathered measure in
epidemiology
Counts
• Refers to the number of cases of a disease or
other health phenomenon being studied
• Can be useful for allocation of health resources
• Limited usefulness for epidemiologic purposes
without knowing size of the source population
Counts – Limited Interpretation
New Cases
Location of Disease Year Population
City A 20 2008 100
City B 100 2008 1000
Annual Rate of Occurrence
City A: 20 / 100 = 1 / 5
City B: 100 / 1000 = 1 / 10
PROPORTION
• A Proportion is a ratio which indicates
the relation in magnitude of a part of the
whole.
• The numerator is always included in the
denominator.
• A Proportion is usually expressed as
percentage.
Proportions
Persons included in the numerator are always
included in the denominator:
A
Proportion: --------
A+B
Indicates the magnitude of a part, related to
the total. In epidemiology, tells us the
fraction of the population that is affected.
Proportions - Example
A B Total (A + B)
# persons with # persons Total study
hypertension without population
hypertension
1,400 9,650 11,050
P = A / (A + B) = (1,400 / 11,050) = 0.127
Example
The number of children with scabies
at a certain time.
x 100
The total number of children in the
village at the same time
RATIO
• Ratio expresses a relation in size
between two random quantities.
E.g., x : y (or) x/y
Ratios
Like a proportion, is a fraction, BUT without a specified
relationship between the numerator and denominator
Example: Occurrence of Major Depression
Female cases = 240 240
------------------------ = ---- 2:1 female to male
Male cases = 120 120
• The numerator is not a component of
the denominator.
• The numerator and denominator may
involve an interval of time or may be
simultaneous in time.
The number of children with scabies at a
certain time.
The number of children with malnutrition at
a certain time
Rates
In which TIME forms part of the denominator
Epidemiologic rates contain the following
elements:
• Health issue frequency (in the numerator)
• Unit size of population
• Time period during which an event occurs
RATE
• A rate measures the occurrence of some
particular event in a population during a
given period of time period.
• It is the statement of the risk of
developing a condition.
A rate comprises the following elements.
•1. Numerator.
•2. Denominator.
•3. Multiplier.
The time dimension is usually a calendar
year.
The rate is expresses per 1000 or some
round figure (selected according to
convenience or convention to avoid
fraction).
Number of events
Numerator in time period
: xK
Denominator Number at risk
for the event in period
Rates are the basic tool of epidemiologic practice
Why are rates important?
Because they provide more complete information to
describe or assess the impact of a health issue in a
community or population
MEASUREMENTS OF
MORTALITY
• Mortality refers to the number of deaths in a
given time or a place or a proportion of
deaths in relation to a population.
• E.g., : 1. Crude Death Rate
2. Infant Mortality Rate
3. Maternal Mortality Rate
4. Life Expectancy
Demography: the study of life EVENTS.
Individuals are “at risk” of experiencing these
events.
The frequency of events: events happen at rates:
Number of events of a specific type in a given time period
Rate = --------------------------------------------------------------------------
Number of people at risk of experiencing that type of
event in the given time period.
EXAMPLE: CRUDE DEATH RATE
Total number of deaths in a given year and place
CDR =
----------------------------------------------------------------------
Estimated mid year population of the same year and place
EXAMPLE: CRUDE BIRTH RATE
Total number of births in a given year and place
CBR =
--------------------------------------------------------------------------
Estimated mid year population of the same year and place
EXAMPLE: CRUDE BIRTH RATE (per 1,000 pop)
Total number of births in a given year and place
CBR = * 1,000
---------------------------------------------------------------
Estimated mid year population of the same year and place
Total number of births in a given year and place
CBR =
--------------------------------------------------------------
Estimated mid year population of the same year and place
* 1,000
• Early life mortality measures
MATERNAL MORTALITY
Death of a woman while pregnant or
with in 42 days of termination of
pregnancy irrespective of duration &
site of pregnancy from any cause
related to or aggravated by pregnancy
or its management but not from
accidental or incidental causes.
Maternal Mortality Ratio
Number of maternal deaths associated with
pregnancy, delivery & puerperium during
certain year and place
x 100,000
----------------------------------------------
Number of live births in the same year
and place
Example:
There is town which has 1,000 people.
Eleven women in the town become pregnant.
One baby miscarries.
Ten women give birth to ten live babies.
One of the women who gave birth dies due to
complications in the pregnancy.
The maternal mortality ratio is 1 out of 10. It is
10%
Maternal Mortality Rate
Number of maternal deaths associated with
pregnancy, delivery & puerperium during certain
year and place
---------------------------------------------- x 100,000
Women of Reproductive age in the same year
and place
Example:
There is a town which has 1,000 people.
500 are women.
400 are women of reproductive age.
Last year, ten women gave birth to ten live
babies.
One of the women died due to complications in
the pregnancy.
The maternal mortality rate is 1 out of 400: it is
0.25%
Maternal Mortality Rates
(deaths 100,000 live births)
Industrialized Countries 13
South America 210
Central America/Caribbean 140
East Asia/Pacific 190
South Asia 560
Middle East/North Africa 100
Sub-Saharan Africa 980
0 200 400 600 800 1000 1200
Still Birth Rate
Number of still births during specific
year and place
-------------------------------------------- x 1000
Total births during that year and place
Still Birth Ratio
Number of fetal deaths of 28 weeks of
gestation or more in certain year and place
---------------------------------------------- x 1000
Number of live births in the same year and place
Neonatal Mortality Rate
Number of deaths below 28 days of life
during certain year and place
------------------------------------------------- x 1000
Total number of live births in the same
year and place
Post neonatal mortality rate
Number of deaths 28 days to one year
of life during certain year and place
--------------------------------------------- x 1000
Total number of live births in the same
year and place
Neonatal Mortality Relative to
Infant Mortality
110
Deaths per 1,000 Live Births
100
90
80
70
60
Post- Neonatal Deaths
50
Neonatal Deaths
40
30
20
10 Source: Demographic
Health Surveys
0
Bangladesh Ethiopia (2000) Haiti (2000) I ndia (1998/ 99) Nigeria (2003)
(1999/ 2000)
Country
Infant Mortality Rate
Number of deaths of children < one year
in a given year and place.
------------------------------------------------ x 1000
Total number of live births at the same
year and place
Infant Mortality Rates
Causes of infant mortality
Birth defects have been the leading cause of
infant mortality.
Prematurity/low birth weight (LBW) was
the second leading cause of infant mortality.
Sudden infant death syndrome.
Maternal pregnancy complications.
Respiratory distress syndrome
Under-five Mortality Rate
Number of deaths of children 1- 4 year
in a given year and place.
------------------------------------------------ x 1000
Total number of live births at the same
year and place
Main Causes of Death
Disease or Condition Proportion of Under-
five Deaths
Neonatal Illnesses 33%
Diarrhea 22%
Pneumonia 21%
Malaria 9%
AIDS 3%
Measles 1%
Other 9%
Malnutrition is an underlying cause of 53% of all
child deaths
Source: The Lancet.
Vol.361, June 28, 2003
~11 Million Children Die/year
(70% From 5 Major Causes)
Malaria
7% ARI
29%
Other
Malnutritio
31% n 56%
Birth Trauma
Measles
Neonatal Deaths 8%
Tetanus
Fever
Low Birth Weight
Diarrhea
25%
Child Mortality Rates
(deaths of children under age five per 1,000 live births)
Industrialized Countries 11
South America 54
Central America/Caribbean 48
East Asia/Pacific 57
South Asia 13
Middle East/North Africa 86
Sub-Saharan Africa 183
0 50 100 150 200
Current Situation
Each year nearly 11 million children die before the age of
five.
30,000 die everyday, largely from preventable causes.
41% of these deaths occur in Africa, which has only 10 %
of the world’s under-five population.
33% of all child deaths occur in the first month of life.
Cause Specific Death Rate
Number of deaths due to specific
disease in specific year and place
--------------------------------------------- x 1000
Estimated mid year population of the
same year and place
Proportionate Mortality Rate
Number of deaths due to a particular
cause during certain year and place
-------------------------------------------- x 100
Total number of deaths due to all causes
in the same year and place
MEASUREMENTS OF
MORBIDITY
• It refers to diseases and illness, injuries and
disabilities in a population.
• Data on the frequency and distribution of a
disease helps in controlling its spread, and in
some cases it may lead to the identification
of cases.
Example
1. Case Rate :
The case rate is the number of reported cases of a
specific disease or illness per 100,000
population during a given year.
2. Case Fatality Rate: The Case Fatality Rate is
the proportion of persons contacting a disease
who die of that disease during a specified time
period.
Case Fatality Rate
Number of deaths due to a particular disease
--------------------------------------------------- x 100
Total number of cases of that disease
THANK YOU!