Module : Preventive Medicine

1B
(Med 7528)

Title: Sources of Morbidity and

Mortality Data
 Objectives:

1. Define a Rate and a Ratio

2. Review the concept of Incidence and Prevalence
3. Discuss the common statistical data indices in
morbidity, mortality
4. Understand the different formula use in the statistical
data:
a. Morbidity Rate
b. Mortality Rate
c. Maternal Mortality Rate
d. Age specific Death Rate
 Objectives
e. Infant mortality rate
f. Neonatal mortality rate
g. Fetal death rate
h. Toddler mortality rate
i. Sex-specific death rate
j. Case-fatality rate
Epidemiology is a Science of
Rates and Ratios
Death rates
Disability rates
Morbidity rates
Hospitalization rates
Incidence rates
Prevalence rates
 RATIO
Expressions of a relationship between two quantities which can
be related or totally independent of each other
Simplest of all statistical measures and there are no conditions
on their use

Examples:
female female
or
male male + female
 PROPORTION
a ratio in which the numerator is part of the denominator
read as percent (%)

X
Formula: x 100
Y
(X is a part of Y)
Example:
In a community of 500 people, there were 50 malaria-positive persons. Thirty-
two were males and 18 were females.
1. Proportion of malaria-positive persons = 10%
2. Proportion of malaria-positives who are males =64%
3. Proportion of malaria-positives who are females =36%
 RATE
Is the ratio involving a time period

The count or measurement is observed over a period of

time and then divided by its base or population of
observation

Ex:
Total deaths in 2005/ midyear population of 2005
 RATE
formula:

no. of cases occurring during

given time period n
x 10
Population-at-risk
during the same period
 Injury Deaths, Australia, 1992
Male Female

700
600
number of deaths

500
400
300
200
100
0
10-14 20-24 30-34 40-44 50-54 60-64 70-74 80-84
yrs
Age Group
Harrison, 1995
 Injury Death Rates, Australia, 1992
Male Female
200
deaths per 100,000 pop.

150

100

50

0
10-14 20-24 30-34 40-44 50-54 60-64 70-74 80-84
yrs
Age Group
Harrison, 1995
Three common types of rates

Crude rates
Specific rates
Adjusted rates
Three common types of rates
Crude rates
consider the entire population
Specific rates
consider differences among subgroups of the population
Adjusted rates
adjust for differences in population composition
 Concepts of Incidence and
Prevalence
Distinction is important because they have their own
respective uses in planning and evaluation
 Incidence Rate
Also known as attack rate, case rate, sickness rate,
morbidity rate
Refers to NEWLY discovered cases of a particular
disease
Answers the question “HOW FREQUENT DO
CASES OF A PARTICULAR DISEASE OCCUR
DURING A GIVEN PERIOD OF TIME”
Used when dealing with acute conditions or
accidents
A dynamic measurement
The two forms of incidence are:
• Cumulative incidence
• "risk of disease“
• measures the proportion of
persons who develop a disease in a
known span of time
• Incidence rate
• "rate of disease“
• measures the rate of new disease
occurrence over time
 Incidence Rate
Number of cases discovered
during a given period of
time
Incidence = _______________________ X factor
Average population of that
period

The factor means a unit of which may be 100,1,000, 10,000

or 100,000 depending on what is convenient
When computing incidence rate for a year, the average
population is the midyear population
 Prevalence Rate
Useful in dealing with chronic illness or conditions or
disabilities

Answers the question “WHAT PROPORTION OF

THE POPULATION OR OF A GROUP OF
PERSONS ARE ACTUALLY ILL WITH A
PARTICULAR DISEASE AT A POINT IN TIME

A static measurement
 Prevalence Rate
Example : The prevalence of TB cases (all forms, all new
plus old cases) existing at a particular time per 100,000
population

No. of new + old cases

of a particular disease
at a particular point in time
Prevalence Rate = ____________________X factor
Population at that time
 Incidence and Prevalence -
Differences
Incidence Prevalence
number of new cases of disease number of existing cases of disease at a
Numerator
during a specified period of time given period of time
Denominator population-at-risk population-at-risk
• whether the event is a new • presence or absence of a disease
Focus case • time period is arbitrary; rather a
• time of onset of the disease “snapshot” in time
• expresses the risk of becoming • estimates the probability of the
ill population being ill at the period of
• the main measure of acute time being studied.
Uses diseases or conditions, but also • useful in the study of the burden of
used for chronic diseases diseases and implication for health
• more useful for studies of services
causation
Note: If incident cases are not resolved, but continue over time,
then they become existing (prevalent) cases.
In this sense, prevalence = incidence × duration.
 Indices of Fertility
The crude birth rate (CBR)
Total Live Births in a Year
CBR = X 1,000
Midyear population

Example: The crude birth rate of Province A in 2016

7,113
CBR = X 1,000
241,882
CBR = 29.41 per 1,000 population
 Indices of Fertility
Crude Birth Rate (CBR) is called crude because:

1.) only live-births are counted

2.) the denominator is the total population which includes

children, old people and males
Indices of Mortality and Morbidity
Health workers have not come up with indices that
positively measure health status
Most utilize negative indicators such as sickness or
death
Do not reflect one’s state of physical or mental health
and social well being (if this is our definition of health)
 Morbidity
Morbidity is the technical term for sickness and is
measured by either incidence or prevalence
Meaningful data if it describes:
Extent of impairment of bodily functions
Threat to life
Extent of impairment of mobility
Cost of care of the sickness
Amount of discomfort/pain it brings
 Morbidity
Specific Morbidity
Rate Example

TB cases aged 1-4 X 1000

Cause-age-specific
Pop of 1- 4

TB cases among females X 1000

Cause-sex-specific
Population of females

Cause-age-sex- TB cases among females 1-4 yrs X 1000

specific Population of females 1-4 yrs

Cause-treatment- TB cases among BCG vaccinated individuals x 1000

specific BCG vaccinated population

Cause-age-sex- TB among females 1-4 with BCG

treatment specific Population of females 1-4 with BCG
Sources of Morbidity Statistics
Clinical and hospital
Managed care
Registries
Vital statistics
Surveys
Disease reporting
Insurance and pre-paid med. care plans
Absenteeism records
Mortality: is one of the major measures
of disease in the population
information available from death
certificates (required by law)
Number of deaths
in time period
=
Death rate: Number at risk
of dying
 Mortality Rates
Deaths from diseases

Proportional mortality by cause

Age-specific death rate

Infant Mortality Rate (IMR)
Neonatal mortality rate
Fetal death rate
Perinatal death rate
Toddler mortality rate
 Mortality Rates
Commonly used mortality indicators
Crude death rate (CDR)
Death rate from a particular cause (cause – specific)
Age-specific death rate
Sex-specific death rate
Case-fatality rate
 Crude Death Rate
Total Deaths from all Causes
in a Year
CDR = X 1,000
Midyear population

Example: The crude death rate of City A in 2016

1,148
CDR = X 1,000
155,511
CDR = 7.38 per 1,000 population
Cause Specific Mortality Rate
 Deaths From a Particular Cause

Example:
Deaths due to TB in 2016
X 100,000
Population in 2016
 Maternal Mortality Rate
(MMR)
Deaths among Women due to
Maternal Cause
MMR = X 1,000
Total Live Births during
the Year

The ideal denominator should be the total number of

pregnant women, but this data is difficult to retrieve
This rate is both sex- and cause-specific and in a way
age-specific because maternal deaths occur in the
reproductive age group of 15 – 44
The rate measures risk of dying due to the process of
pregnancy, childbirth and puerpuerium
 Infant Mortality Rate
Total Infant Deaths in a
Calendar Year
IMR = X 1,000
Total Live Births during
the Year

Measures the risk of dying in infancy under 1 year of age

may be used to measure the adequacy of health services
administered (since infant deaths are preventable)
Note that not all infants who die during the year were
born on that same year
Can artificially be decreased by increasing the
denominator by better reporting of live births
 Case Fatality Ratio

# of Deaths from diagnosed

Case Fatality Rate (%) = cases in a given period X 100
# of diagnosed cases of the
disease in the same period
Thank You.
 References:
Mendoza, O. et.al Foundations of Statistical Analysis for
the Health Sciences. 2010