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Epidemilogy Measurment Methods
Epidemilogy Measurment Methods
Health Nursing
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TOOLS OF MEASUREMENT
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Tools of measurement
• Proportion
• Rate
• Ratio
4
Proportion
• Usually expressed as a percentage %
– Numerator (which is part of denominator)
– Denominator
– Multiplier
– No time factor
5
Proportion – ‘real’ example
• What proportion of the population is
suffering from diabetes?
6
Rate
Contains
• Numerator (which is part of denominator)
• Denominator
• Multiplier
• Time period
8
Rate – example
𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑖𝑛 𝑜 𝑛 𝑒
• Death rate = 𝑦 𝑒 𝑎 𝑝𝑟 𝑜 𝑝 𝑢 𝑙 𝑎 𝑡 𝑖 𝑜 𝑛 𝑖𝑛 𝑡ℎ𝑎 𝑡 X 1000
𝑇𝑜𝑡𝑎𝑙
𝑦𝑒𝑎𝑟
9
Ratio
Contains
• Numerator (not part of denominator)
• Denominator
10
Ratio – example
11
Ratio – example
12
Ratio – example
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MEASUREMENT OF MORBIDITY
14
Incidence
Occurrence of new cases
•
Prevalence
Existence of all new & old cases.
Prevalence:-how many people
in a population currently have
the disease (Photograph)
Incidence:-
how many people
are diagnosed each year (Film)
Cure rate
Incidence
Occurrence of new cases
•
Prevalence
Existence of all new & old cases.
Prevalence:-how many people
in a population currently have
the disease (Photograph)
Incidence:-
how many people
are diagnosed each year (Film)
Cure rate
New cases
• The rate at which acute
disease is spreading
Attack rate -- used during
epidemics &
expressed in %.
• Prevalence at a given
Period period of time.
prevalence • Period will be 1year.
Prolongation
of life
Incidence without
cure.
increases.
Longer
duration of
disease
20
Shorter duration of diseases.
Improved cure rate.
Incidence decreases.
Emigration of new cases.
Under reporting of cases.
Improved cure rate.
Short duration of
disease.
Incidence
decreases
Measurement of morbidity
• Incidence
– Occurrence of new cases
• Prevalence
– Existence of new and old cases
27
Incidence
No. of 𝐍𝐄𝐖 cases of a disease
in a particular time period
= Total population at risk during
X 1000
the same time period
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Incidence – example
29
Special incidence rates
• Attack rate
• Secondary attack rate
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Uses of incidence rate
• For taking action to control disease
• More suited for acute or infectious conditions
• For research
31
Example of use of incidence
33
Points to remember about incidence
• Refers only to new cases
• Not influenced by duration of disease
• Refers to a particular time period
• Denominator is people at risk
34
Prevalence
No.of 𝐎𝐋𝐃 𝐚𝐧𝐝 𝐍𝐄𝐖 cases of a disease
in a particular time point/period
= Total population at risk during
X 1000
the same time period
35
Types of prevalence
• Point prevalence
• Period prevalence
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Point prevalence – example
37
Period prevalence – example
38
Prevalence increases
• Longer duration of disease
• Prolongation of life with treatment
• Increase in incidence
• Immigration of new cases
• Better reporting of cases
• Emigration of healthy people
39
Prevalence decreases
• Shorter duration of diseases
• Improved cure rate
• Decrease in incidence
• Emigration of new cases
• Under reporting of cases
• Immigration of healthy people
40
Uses of prevalence
• Magnitude of disease problems
• Identify potential high-risk populations
• Administrative and planning purposes, e.g.,
hospital beds, manpower needs, rehabilitation
facilities
41
Example of use of prevalence
42
Example of use of prevalence
43
Points to remember about prevalence
• Refers to new and old cases
• Influenced by duration of disease
• Refers to a particular time period
• Denominator is people at risk
44
Relation between incidence &
prevalence
45
Relation between incidence &
prevalence
• Prevalence = Incidence X duration
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MEASUREMENT OF MORTALITY
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Crude Death Rate.
Specific death rate.
Case fatality rate.
Proportional mortality rate.
Survival rate.
Standardized death rate.
Number of deaths from all causes, per 1000
estimated mid year population in one year in
a given place.
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No. of deaths in Madurai in 2018
51
CDR in Madurai in 2018
52
Cause Specific death rate like
disease death rate, Road accident…
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No. of deaths in Madurai in 2018
55
Cause of death – cholera
56
Cholera specific death rate in Madurai
in 2018
57
Proportion or % of deaths due to
particular cause out of total deaths.
It
measures the disease
burden.
Under 5, No of deaths below 5 years
proportional = -------------------- X 100
mortality rate Total No all of deaths
Total population in Madurai in 2015
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No. of deaths in Madurai in 2015
60
Total deaths
61
Cause of death – cholera
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Proportional mortality rate of cholera
63
CDR
Total population (MYP)
37
Cholera deaths PMR
Percentage of particular cases dying
during particular disease epidemic.
66
No. of people died due to cholera
67
Total no. of cholera cases
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Percentage of the treated patients remaining
alive at the end of 5 years treatment.
pts alive at the end of 5 yrs
Surviva = ---------------------- X 100
l Rate Total No of pts treated
What is standardization?
70
What is standardization?
73
Direct standardization
74
Crude rates
Madurai Population Death Death rate
s per 1000
0-64 53,500 8.3
446
75
Age specific rates
Madurai Population Death Death rate
s per 1000
0-24 21,500 5.7
25-64 32,000 123 10.0
323
Chennai Population Death Death rate
s per 1000
0-24 32,000 4.6
25-64 60,000 150 11.6
700
76
Standard population
Standard Population
0-24 156,000
25-64 45,000
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Standardization for Madurai
Standard Population Madura Expected
i deaths
0-24 156,000 rates
889
25-64 45,000 5.7
450
Total 201,000 10.0
1,339
80
Indirect standardization
81
Standardized mortality ratio
Age National death rate
per 1000
25-34 3
35-44 5
45-54 8
55-64 25
82
Standardized mortality ratio
Age Doctor Observed
population deaths
25-34 300 *
35-44 400 *
45-54 200 *
55-64 100 *
Total 1000 9.0
84
Standardized mortality ratio
Observed deaths
SMR = X 100
Expected deaths
86
Summary
• Incidence and prevalence are finer
measurements health as compared to
of
death rates
• They help us to measure the effectiveness
of disease control measures
87
Take home messages
• Proportion, rate and ratio – basic tools
• CDR is a simple measure of death/health
• Standardization is needed for comparability
• Incidence reflects new cases only
• Prevalence reflects new and old cases
• Incidence and prevalence are related
• Mortality measures are important, morbidity
measures give a better idea of health
88
Review 1
• It was reported that the incidence of dengue
was increasing every year in Madurai. This
could mean all EXCEPT,
a) Incidence of DM is increasing
b) Reporting of diabetes has increased
c) Diabetic patients are surviving longer due to
better treatment
d) Public awareness on diabetes has increased
e) None of the above
90
Review 3
• Examples of a disease with high incidence but
low prevalence include (multiple options)
91
Review 4
• Examples of a disease with low incidence but
high prevalence include (multiple options)
92
Review 5
• A new diabetes control programme was
introduced in Madurai. After 1 year, the
incidence and prevalence of Diabetes
increased. This means
a) Simple measure
b) Influenced by the age composition
c) Not comparable between countries
d) All of the above
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Review 7
• Proportional mortality is useful for all EXCEPT
95
Review 8
• Standardized rates can be calculated for
a) Age
b) Sex
c) Race
d) Literacy rate
e) All the above
96
Review 9
• Standardized mortality ratio requires all
EXCEPT
97
Review 10
• A patient with Atherosclerotic heart disease for 7
years developed Acute myocardial infarction last
week and died today as a result of myocardial
rupture. What is the immediate cause of death?
98
Review 11
• Mid year population is not the denominator
for (multiple options)
99
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