EPIDEMIOLOGICAL INTERPRETATION OF MEASURES OF MORBIDITY AND MORTALITY

INTRODUCTION: A unique feature of epidemiology is to test aetiological hypotheses and identity the underling causes or risk factors of disease. This requires the use of epidemiological principles and methods. analytical epidemiology. This is the real substance of epidemiology. This aspect of epidemiology is known as, Analytical strategy helps in developing scientifically sound health programmes, interventions and policies. DEFINITION OF EPIDEMIOLOGY: 1.According to John.N.Last 91988): Epidemiology is the study of the distribution and determinants health related states or events in specific population, and the application of this study to the control of health problems. 2.According to WHO (1981): Epidemiology is a study of distribution and determinants of disease and health related events in human population with a view to ensure that health services are planned rationally, disease surveillance is effected and that preventive and control measures are undertaken. AIMS OF EPIDEMIOLOGY: According to the International Epidemiological Association (IEA): a. To describe the distribution and magnitude of health and disease problems in human populations.

b. To identify aetiological factors (risk factors) in the pathogenesis of disease and c. To provide the data essential to the planning. Implementation and evaluation of services for the prevention, control and treatment of disease and to the setting up of priorities among those services. The ultimate aim of epidemiology is to lead to effective action: a. To eliminate or reduce the health problem or its consequences and b. To promote the health and well being of society as a whole. MORBIDITY STATISTICS Definition: A morbidity may be broadly defined as any departure subjective or objective from a state of well being resulting from a disease an injury or an impairment. Mortality statistics serve useful functions in determining the importance of various factors in causing death with reference to sex, different age groups and special groups and causes of death. The analysis of mortality statistics may also be useful in revealing the emergence of new causes of death. It is equally important to study morbidity in a community for a fuller understanding of health condition. Every sickness does not necessarily lead to death and unless morbidity statistics are studied. Morbidity statistics provide information on occurrence of different diseases with reference to age, sex, social class or occupation, locality and other such factors studied in epidemiology.

There are a number of problems peculiar to morbidity statistics as follows: 1. Death is a unique event occurring only once in a person, while illness may occur repeatedly in the same person due to same or different causes. Hence it will have to be decided while calculating illness in a given period of time whether to count the number of persons ill or the number of illnesses because the same person may be ill more than once. 2. Death occurs at only one point of time whereas illness extends over a period of time. It will have to be decided whether to consider new illnesses arising in a period or those present during the period. 3. Death is simply and precisely defined and understood by all whereas illness presents many problems in comparison. Illnesses vary very greatly in the severity, ranging from negligible effects to a condition which is completely incapacitating. In the spectrum of health and disease it is difficult to fix a scale on which to measure the morbidity. 4. Not only with reference to fixing the degree of ill-health or illness existing in a person do problems arise but there is problem of definition itself. The very presence or absence of illness may be difficult to identify. Even in normal healthy state, there is It is considerable variation from person to person and time to time with reference to physiological and biochemical measurements. individual. difficult to fix a limit of normality which is valid for every The opinion of the person himself will have to be accepted in such cases about his illness. On the other hand, there are occasions when the individual feels and thinks himself to be perfectly healthy when in fact examination may reveal that he/she

has latent or incipient disease which, though not recognized by the person affected, is revealed by laboratory or other tests. 5. A distinction may have to be made in manifest disease recognized by the person and recognized by the medical attendant. Further distinction will have to be made of the detection of disease by a medical attendant on clinical examination and on using a diagnostic test like laboratory test, X-ray examination, etc. comparison. 6. Finally, problems of diagnosis also arise commonly. The accuracy of diagnosis depends upon the level of lmedical knowledge, availability of diagnostic facilities and competence of the medical man attending the sick. Common Rates in Morbidity Statistics: Incidence: Incidence denotes the number of instances of illness commencing or of persons falling ill during a given period in a specified population. More generally, it refers to the number of new events. Eg. New cases of a disease in a defined population, within a specified period of time. Prevalence: Prevalence refers to the total number of cases extant or existing (ie. Old and new cases) during a specified period of time in a defined population. Such clear definition of illness and criteria adopted is essential to permit a

Various types of rates can be calculated to describe morbidity statistics: a. The Incidence Rate: It is a measure of the rate at which new events occur in a population. The numerator is the number of illnesses (spells of illness of person ill) beginning in a given period of time. The denominator is the average number of persons at risk during that period. For annual rate, the denominator will be the expected mid year population. The rate is usually expressed per 1,00,000. The illnesses may be acute short term episodes, eg. Diarrhoea or the initial onset of a long term chronic condition such as tuberculosis, leprosy or cancer.
Incidence rate of disease

No.of cases of the sickness starting during the period in an area Average b. No.of persons exposed to risk during that period in the area.

X 1000

The Period Prevalence Rate: The period prevalence rate is defined as the number of illnesses (spells of illness or persons ill) existing at any time within a specified period related to the average number of persons exposed to the risk during that period or at its midpoint.
No.of cases of a disease present at any time or Period in the area Average No.of persons exposed to risk during The point of time or the period under consideration

Prevalence

x 1000

c. The Point Prevalence Rate: It is defined as the number of illnesses existing at a specified point of time related to the number of persons exposed to the risk at that point of time (eg. The number of illnesses which were present on a particular day divided by the total number of persons exposed to the risk on that day.

The point prevalence rate

The number of illnesses which were present On a particular day The total number of persons exposed to the risk on that day.

x 1000

d. The average duration of illness: The average duration of illness (and the frequency distribution upon which it is based) may be in terms of the total population exposed to risk in which case it will denote the average duration of illness per person. The average may be in terms of the number of persons ill in which case it will denote the average duration of illness per ill person. The average could also be calculated in terms of the number of illnesses when it will denote the average duration of illness per illness. Sources of morbidity statistics: Morbidity statistics may be available from a large number of sources such as follows: 1. Special morbidity survey general/specific 2. Notification of diseases 3. Hospital statistics (indoor/outdoor), Government/private 4. Health/MCH centre statistics 5. Records of Health Workers 6. Medical Practitioners records 7. Sickness absence records 8. School health service records/absenteeism 9. Disease Registries 10.Industrial sickness benefit records 11.Results of pre employment/pre placement examination 12.Records of health examination for recruitment to Armed Forces or to Government Service. 13.Mass diagnostic camps The data from these different sources vary in the quality, accuracy and completeness. 6

MEASURMENET OF MORTALITY: Traditionally and universally, most epidemiological studies being with mortality data. Mortality data are relatively easy to obtain, and in many countries, reasonably accurate. Mortality data provide the starting point in many epidemiological studies. Limitations of Mortality Data: a. The incomplete reporting of deaths: This is not a problem in developed countries, but in India and other developing countries may be considerable. b. Lack of Accuracy: That is in accuracies in recording of age and cause of death. widespread. c. Lack of Uniformity: There is no form and standardized method of collection of data. d. Choosing a single cause of death: Most countries tabulate mortality data only according to the underlying cause of death. e. Changing: Changing systems and changing fashions in diagnosis may affect the mortality. f. Diseases with low fatality: Lastly, mortality statistics are virtually illness, if the disease is associated with low fatality. The practice of notification of death is not

Comprehensive Community Health Nursing

Mortality Statistics
Crude death rate Age specific death rate Number of deaths from all causes during a X 1000 given year Population estimated at midyear Population Number of deaths for a specified age group X 1000 during a given year Cause-specific rate Maternal mortality Rate Infant mortality rate population estimated at Population midyear for the specified age group death Number of deaths from a specific condition X 100,000 during a given year midyear Number of deaths from puerperal X 100,000 number of Live births complications during a given year live births during the same year Number of deaths under 1 year of age during a X 1000 given year same year Neonatal mortality rate Number of deaths under 28 days of age during X 1000 a given year same year. Fetal mortality rate Number of fetal deaths 20 weeks gestation or X 1000 live more during a given year Number of live births and births and fetal deaths during the same year fetal deaths X 100 Birth-death ratio Case fatality ratio Number of live births in a specified population Number of deaths in a specified population Number of deaths from specified disease or condition Number of reported cases of the specified disease or condition X 100 number of live births during the Live births Number of live births during the Live births Population estimated at Population

CONCLUSION:

In epidemiological study morbidity and mortality data are used to provide a foundation for examining the level of health in a community, crude, or general, death rates assist a community in identifying leading health problems in the total population. BIBLIOGRAPHY: 1. Yashpal Bedi, Hand Book of Social and Preventive Medicine, Anand Publishing Centre, 15th Edition, 1988, Page No.514-517. 2. K.Park, Parks, Text Book of Preventive and Social Medicine, Banarsidas Bhonot Publishers, 15th Edition, 1997, Page No.4650. 3. Mc.Gurine.L. Sandra, Comprehensive Community Health, Mosby Company, 5th Edition 1998, Page No.302-303. 4. A.P.Sathe and P.V.Sathe, Epidemiology and Management for Health Care for All, Popular Prakashan, 2nd Edition, 1991, Page No.260-262. 5. Dr.J.P.Baride and Dr.A.P.Kulkarni, Text Book of Community Medicine, Vora Medical Publications, 2nd Edition, 2002, Page No.131-135.