Chapter 3 Measures of Occurrence – Reduced Content

By Genevieve M. Nangit

This is my reduced version of Chapter 3 of Modern Epidemiology 3rd edition

by KJ Rothman, S Greenland, T Lash. In my opinion, this chapter of the
book is predominantly definitions. I have limited the coverage to 4 measures
of disease occurrence, and excluded the concepts like censor, average age of
death, etc.

Contents

1. Introduction .......................................................................................... 2
2. Incidence Times ................................................................................... 2
3. Incidence Rates .................................................................................... 3
4. Incidence Proportion ............................................................................ 3
5. Prevalence Proportion .......................................................................... 3

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1. Introduction
The objective of epidemiologic research is to obtain a valid and precise
estimate of the effect of a potential cause, often a binary outcome, on the
occurrence of disease. To achieve this objective, an epidemiologist must first
measure the frequency of disease occurrence either in absolute or in relative
terms.

The discussion of disease occurrence is focused on four basic measures:

incidence times, incidence rate, incidence proportion and prevalence.

2. Incidence Times
In an epidemiological study, we measure the span of time before the
outcome of interest occurred relative to a reference event. The reference
event occurs at a time that is unique to each person, as is the case with birth,
but it could also be set to a common value, such as a day chosen from the
calendar. The time of the reference event is called the time origin or zero
time and it facilitates the measuring of the span of time before the outcome
event occurs.

Suppose we are interested on a specific outcome event or “incident”, a

person‟s incidence time for this outcome is defined as the period of time
from zero time to the time at which the outcome event occurs. Synonymous
for incidence time are „event time‟, „failure time‟, and „occurrence time‟. In
other words, incidence time is the point in time starting from a common
reference event at which new cases of disease occur among population
members.

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3. Incidence Rates
In general, incidence rate measures the occurrence of new cases of disease
per unit of person-time, specifically, the number of new cases of disease
(incident number) divided by the total person-time at risk.

There are two formula of incidence rate presented in the chapter and they are
referred as “person-time rate” and “time-weighted average of individual
rates”. The latter type of incidence rate ignores two kinds of individuals in
its numerator – (1) those who are in the population briefly, and (2) those who
are in the population a long time but never got the disease.

Incidence rate have interpretational difficulties because they are often

confused with risks (i.e., probabilities). This arises when the unit used in the
numeric portion is ignored. Thus, it is essential when presenting incidence
rates to give the unit of time used in the computation.

4. Incidence Proportion
Incidence proportion measures the proportion of people who develop new
disease during a specified period of time. When given a fixed interval, the
incident number of cases is equivalent to the size of the population-at-risk.

5. Prevalence Proportion
Prevalence is a measure of status rather than of newly occurring disease, that
is, measuring the proportion of people who have disease at a specific time.
Prevalence focuses on existing health status, unlike incidence measures
which focus on new events or changes in health status.

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