INTRODUCTION TO BIOSTATISTICS HEALTH INDICATORS: Definition

Set of measures that provide a snapshot of health situation of a group

NATURE OF BIOSTATISTICS of people at a particular point in time.
STATISTICS
science which with the collection, HEALTH INDICATORS: Types
• Direct measures: deaths, diseases, use of service
BIOSTATISTICS • Indirect measures: education, poverty, and social
the scientific discipline concerned with the application of statistical development
methods biological (life) problems.
Public health; medicine; ecological & environmental sciences HEALTH INDICATORS: Uses
• Hypothesis formulation and testing
• Program planning and implementation
• Program evaluation and monitoring
• Health policy

HEALTH INDICATORS
• Mortality and burden of disease
• Demographic and socio-economic statistics
• Health service coverage
• Health systems resources
• Risk factors
BRANCHES OF STATISTICS MORTALITY RATES
DESCRIPTIVE STATISTICS CRUDE DEATH RATES
statistical techniques whose main objective is to summarize and present total deaths (all causes) / average population x k
data in a form that will make them easier to analyze and interpret.
• also known as Force of Mortality
• measures of central tendency (mean, median, mode)
• not very useful in comparing health status of communities
• measures of dispersion especially if communities are radically different in their
• measures of location composition
• rates, ratios, proportions
• tables and graphs CRUDE SPECIFIC DEATH RATE
total deaths (particular cause) / average population x k
INFERENTIAL STATISTICS
concerned with making estimates, predictions, generalizations and AGE SPECIFIC DEATH RATE
conclusions about a target population based on information from a total deaths (all causes of particular age grp) / ave. pop'n x k
sample.
• estimation: point & interval (estimating prevalence) SEX SPECIFIC DEATH RATE
• hypothesis testing (e.g., testing vaccine effectiveness) total deaths (all causes of particular age grp) / ave. pop'n x k

USES OF STATISTICS Note: these specific death rates can be combined

✦ A data reduction technique
✦ A tool for objective appraisal and evaluation PROPORTIONATE MORTALITY RATE (PMR)
✦ A tool in the decision-making process
PMR (cause) = total deaths, particular cause/total deaths, all causes x k
ROLE OF STATISTICS IN PUBLIC HEALTH
I. Health Care Planning PMR (age grp) = total deaths, all causes, particular age group x k
• age-sex composition total deaths, all causes
• population distribution
• population projection Swaroop's Index= total deaths, all causes, among 50y/o & above x k
• health status (morbidity & mortality) total deaths, all causes
• factors affecting health
II. Evaluation of programs PROPORTIONATE MORTALITY RATE (PMR)
III. Administration (health care resources & health service needs) • PMR are useful in describing the relative importance of
different fatal diseases in the population of different ages,
PHENOMENON OF VARIATION sexes, occupations, etc.
The tendency of a measurable characteristic to change • Not useful when there is an epidemic due to a certain disease
• from one individual or one setting to another; or since the total deaths may increase producing a decrease in
• within the same individual or setting at different periods of the PMR (due to a specific cause) even if there is no decrease
time in the deaths due to that specific cause.
Statistics is necessary to analyze variability • The higher the Swaroop's index, the better the health status
of the community since it implies that many people are
RATES AND RATIOS reaching that age group.
RATIO
a comparison of two numbers INFANT MORTALITY RATES
no. of deaths less than 1 year old / total no. of livebirths x k
PROPORTION • This is one of the most sensitive indicator of a health status
a comparison of two numbers where the numerator is a part of the of a community
denominator • It reflects adequacy of immunization programs, infant
nutrition, pre-natal and post-natal services
RATE • It also a reflection of satisfactory environmental sanitation,
a comparison of two numbers where the denominator represents the potable water supply, housing facilities, etc.
population at risk or exposed to a certain factor (at a given time)
NEONATAL MORTALITY RATES
USES no. of deaths below 28 days old / total no. of livebirths x k
• Indicators for measuring health status of the community
• Basis for planning health programs POST NEONATAL MORTALITY RATES
• Monitoring the program no. of deaths from 28 days old to less than 1 yr old/total no. of LB x k
• For disease surveillance (rates and ratios)
FETAL DEATH RATIO
fetal deaths 28 weeks & over of gestation x k
total number of livebirths
• Since, fetal deaths are seldom reported especially if early
fetal deaths, WHO has recommended only the total
livebirths as the denominator.
MATERNAL MORTALITY RATE (deaths among women directly due to
pregnancy, labor and puerperium
total number of deaths x k total number of livebirths
• The ideal denominator should have been those women at
risk for dying from maternal causes, that is usually unknown,
hence they are replaced by the number of livebirths
CRUDE FATALITY RATE
number of deaths from a particular disease x k
number of cases of the same disease
• The ideal denominator should have been those women at
risk for dying from maternal causes, that is usually unknown,
hence they are replaced by the number of livebirths
FERTILITY RATES
CRUDE BIRTH RATE
number of livebirths in a year x k
average population
• Note that this does not take into account the variations in
the population such as sex, age, etc.
GENERAL FERTILITY RATE
number of live births in a year xk
number of women 15-44 years old
• It is assumed that the age group 15-44 years old are the one
at risk of giving birth
MORBIDITY MEASURES
PREVALENCE RATES: Point vs Period Prevalence
Point Prevalence = existing cases of a disease at a point in time x k
total population at that point in time
Period Prevalence = existing cases of a disease at a point in time x k
average population during the period
Note: the average population is usually the midyear population
INCIDENCE RATES: Cumulative Incidence vs Incidence Density
Cl = no. of cases who DEVELOP the disease during a period x k
no. of individuals FREE of the disease at the beginning of the period
ID= no. of NEW cases developing during the interval x k
total person time* of observation
*person time - sum of individual observation periods for each subjects
the pop'n
Statistics is the science dealing with the collection, organization, analysis
and interpretation of numerical data. All these processes should be
present if we are to employ statistics in any given set of numerical data.
As we may be dealing with voluminous amount of information, statistics
can assist anyone in decision-making process as well as formulation of
good judgement.
In the clinical setting, statistics can guide physicians in prescribing
treatment to their patients. In the case, the doctor will inquire from the
patient his main problem and symptoms of his conditions or illness. He
then proceeds to examine him physically. In this manner, the doctor is
actually collecting information. It is followed by organization and
analysis of data that has been collected by comparing his findings with
medical knowledge. In turn, this will lead the physician in the diagnosis
of the patient’s condition hence, interpreting data that has been
collected, organized and analyzed. All these four processes of collection,
organization, analysis and interpretation were utilized and ultimately
lead the physician to decide the appropriate treatment for his patient.
Here is another example of how statistics can serve as a tool in the
decision making process. Suppose the Department of Health wish to
know the current prevalence rate of Dengue Fever cases in the country
and compare with it last year. DOH then collected a sample of hospitals
in the country and determine the number of cases of Dengue Fever
admitted in the hospital. A statistical test can be used to check if the
current prevalence rate has significantly increased from the last year’s
value, i.e. we may have a hypothesis that states no difference in the
prevalence rate of Dengue Fever between last year and the current year.
Through the statistical test, we may have to make a decision of rejecting
or not rejecting this hypothesis. If we happen to reject this hypothesis,
DOH may then embark on a massive education campaign for the general
public regarding Dengue Prevention and Early Protection as well as
additional procurement of necessary medicines for the patients. If there
was really a significant increase, then we make a correct decision and
the education campaign is indeed a worthy project. However, if in
reality, there was no increase in the prevalence rate, then we made a
wrong decision of rejecting the hypothesis when it is really true.
Therefore, the educational campaign as well as procurement of
medicines may be not necessary. The statistical test can be made to
minimize the probability of these errors.
Subdivision of Statistics
1. Descriptive statistics – this refers to branch of statistics aiming to
“describe” the data that has been collected, summarizing it to provide
informative description of the data set. This may entail the use of
descriptive measures such as mean or average, percentages or
percentiles, mode, standard deviation or through the use of tables or
graphs.
2. Inferential statistics – this refers to the branch of statistics that with
making estimates or conclusions about the target population based on
the information taken from a sample or subset of the target population.
These may be done by making point estimates or interval estimates of
measure (say the mean) of a population or using a statistical test to
reject or not to reject a hypothesis.
Why do we need statistics?
The primary reason why we have to employ statistics is because of
phenomenon in variation. This refers to the characteristics property of
one measure to change from one individual to another or from one
instant of time to another instant in the same person. Example: height,
weight are measureable characteristics different from person to person.
Body temperature likewise is different in the morning, noon, evening
within the same individual.
Variable – this refers to a measure or a characteristic whose outcome
cannot be predicted with certainty.
RATES and RATIOS
Ratio – a comparison of two numbers
- it is of the form a/b x k
- example: sex ratio; dependency ratio
Proportion - a comparison of two numbers where the numerator is a
part of the denominator
- it is of the form a/a+b x k
- example: the proportion of males
- if k = 100, the proportion becomes percentage
Rate - a comparison of two numbers where the denominator represents
the population at risk or exposed to a certain factor (at a given time)
- frequency of events / pop’n at risk (exposed) x k
- example: morbidity rate; mortality rate
Uses:
1. Indicators for measuring health status of the community; generally,
the lower morbidity or mortality rates means the better health status of
the community.
2. Basis for planning health programs; if indeed there is a high morbidity
or mortality rates, then it is necessary to institute intervention programs
that is aimed to eradicate or lower the prevalence of a certain health
problem.
3. After instituting a program, then it is necessary to monitor that
program to assess its impact on the health status of a community.
4. Rates and ratios are also used for disease surveillance. Aside from the
usual birth death rates to measure the health status of the community,
there are also other rates which are used to check for the occurrence of
a certain disease, e.g. for the period of June to August, the prevalence
rate of dengue increased to 30% compared last year.
Types of Health Status Indicators:
1. Mortality rates
2. Morbidity rates
3. Fertility rates
4. Crude rates
5. Specific rates

MORTALITY RATES
1. Crude Death Rate
2. Cause Specific Death Rate / Age Specific Death Rate / Sex Specific
Death Rate
3. Proportionate Mortality Rate (Swaroop’s Index)
4. Infant Mortality Rates
5. Neonatal Mortality Rates
6. Post-Neonatal Mortality Rate
7. Fetal Death Ratio
8. Maternal Mortality Rate
9. Case Fatality Rate

FERTILITY RATES
1. Crude Birth Rate
2. General Fertility Rate

MORBIDITY MEASURES
1. Prevalence Rate (Point vs Period Prevalence)
2. Incidence Rate (Cumulative Incidence vs Incidence Density)