LECTURE 3

HEALTH STATISTICS AND EPIDEMIOLOGY

TOOLS IN PUBLIC HEALTH:

1. DEMOGRAPHY

 Demography is from the ancient Greek word “demos” meaning “the people”, and -graphy
from the Greek word “grapho” meaning “writing, description or measurement”
 The word was coined by John Graunt in 1662.
 John Graunt (24 April 1620 – 18 April 1674) has
been regarded as the founder of demography.
 Developed early human statistical and census
methods that provided a framework for modern
demography
 It is the statistical study of populations, especially
human beings. As a very general science.
 It analyzes any kind of dynamic living population,
such as one that changes over time and space.
 Demography is the "study of human populations
in relation to the changes brought about by the
interplay of births, deaths, and migration.
 Demography encompasses the study of these populations' size, structure, and
distribution, and spatial or temporal changes in them in response to birth, migration, aging,
and death.
 This is a statistical study of human populations.
 This examines populations' size, structure or composition, distribution, and movements
over space and time.

IMPORTANCE

 The health status of a community depends upon the dynamic relationship between the
number of people, their composition& distribution
 Useful for governments and private businesses to analyze and predict social, cultural,
and economic trends related to population.
 Demographic data provide a basis for predicting future trends and making decisions
 Demographic data are important for the formulation Implementation, and evaluation of
plans, policies, and programs for education housing, health, employment,
transportation, recreational needs, and other forms of social service
 Demographic data can guide policymakers in meeting the needs and of various sectors
of society, such as the young, the adult and aged, the unemployed, the poor, and the
various cultural groups

SOURCES OF DATA

 The term “Demography” is the statistical and mathematical study of the size,
composition, and spatial distribution of the human population, and of changes over time
in these aspects through the operation of five processes of fertility, mortality, marriage,
migration, and social mobility.
 Usually, the demographic data are drawn from various sources:

1. national censuses
2. civil registration systems
3. sample surveys
 1. CENSUS

 Census, is an enumeration of people, houses, firms, or other important items in a

country or region at a particular time.
 It is compiling, evaluating, analyzing and publishing demographic, economic and social
data pertaining, at a specific time, to all persons in a country or in a well-delimited part
of a country.” In other words, the enumeration of the entire population of a country or a
region at a particular time is known as the census.

2. SURVEYS

 A survey is a method of gathering information using relevant questions from a sample of

people with the aim of understanding populations as a whole.
 Data on fertility and mortality from the census are not very reliable and they are also
available only once in ten years.
 In the absence of reliable data from the civil registration system (CRS), the need for
reliable vital statistics at national and state levels is being met through sample surveys
launched from time to time

3. CIVIL REGISTRATION

 A Civil Registration system is used to record statistics on “vital events”, such as births,
deaths, marriages, divorces, and fetal deaths.
 According to the United Nations, civil registration is defined as the continuous
permanent and compulsory recording of the occurrence of vital events, like, live births,
deaths, fetal deaths, marriages, and divorces as well as annulments, judicial
separation, adoptions, legitimations, and recognitions.
 Civil registration is performed under a law, decree, or regulation so as to provide a legal
basis for the records and certificates made from the system, which has several civil
uses in the personal lives of individual citizens.
 Moreover, the information collected through the registration process provides very
useful and important vital statistics on a continuous basis at the national level starting
from the smallest administrative unit
 In fact, obtaining detailed vital statistics on a regular basis is one of the major functions
of the Civil Registration System (CRS) in several countries of the world. Vital records
obtained under CRS have administrative uses in designing and implementing public
health programs and carrying out social, demographic, and historical research
 For an individual, the birth registration records provide legal proof of identity and civil
status, age, nationality, dependency status, etc., on which depend a wide variety of
rights
 Uses of civil registration Civil registration has a dual purpose − legal on the one hand,
and statistical, demographic, and epidemiological on the other.
 For the first purpose, the records generated have importance as legal records
documenting the facts surrounding each registered vital event. In that sense, each vital
record has an intrinsic importance of its own.
 For the second purpose, the records may be aggregated to form a body of vital
statistics which, collectively, convey important information about the persons described
in the statistics in summary form.
 Those two purposes reinforce each other in a number of ways, but it is important to
maintain their distinctiveness in discussing the uses and operation of civil registration

USES OF CIVIL REGISTRATION RECORDS FOR ADMINISTRATIVE PURPOSES

 Live birth records are the basis for many public health programs for post‐natal care of
mother and child and may be used, when needed, for programs of vaccination and
immunization, premature‐baby care, and assistance to disabled persons.
 Death records are used to provide legal permission for burial or other disposal of
deceased individuals. They can also provide information of epidemiological importance
and indicate the need for preventive control measures. Death records are also
necessary to clear a number of administrative files, such as disease‐case registers,

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 population registers, social security files, military service files, electoral rolls, identity
files, and tax registers

USES OF CIVIL REGISTRATION RECORDS FOR INDIVIDUALS

 For the individual, the birth registration records provide legal proof of identity and civil
status, age, nationality, dependency status etc., on which depend a wide variety of
rights.
 The birth registration record may be required for establishing,

(1) Identity and family relationships for settling inheritance or insurance claims
and arranging transfer of property

(2) Proof of age for admission in schools, entry into services and professions,
obtaining a driving license, exercising voting rights, entering into legal
contracts, inheritance claims, marriage etc.

(3) Nationality or citizenship by birth, to obtain a passport for foreign travel,

qualify for voting privileges, own property

THREE ELEMENTS

1. Change in the size of population (increase or decrease)

2. Structure of population (on the basis of sex or age groups)
3. Geographical distribution of population (on the basis of state or territory)

POPULATION SIZE

 The most fundamental demographic

parameter is the number of individuals within
a population (Lebreton et al. 1992).
 Population size is defined as the number of
individua ls present in a subjectively
designated geographic range

3 DEMOGRAPHIC VALUES AFFECT

THE SIZE OF A POPULATION

a. MORTALITY
b. FERTILITY
c. MIGRATION

MORTALITY

 The frequency of death in a population

FERTILITY

 The product or output of reproduction, rather than the ability to have children. The
physiological ability to have children—that is manifest roughly in the period
between menarche and menopause in women—is termed fecundity

MIGRATION

 Migration is a demographic process that moves people between places,

contributing to population change, fertility, and mortality. Migration is the movement
of individuals, households, and groups between residences or residential locations.

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 COMPONENTS OF DEMOGRAPHY

A. Population size
B. Population Composition
C. Population distribution

A. Population Size

 Refers to the number of people in a given place or area at a given time.

 It involves the analysis of three observable phenomena:

1. changes in population size

2. the composition of the population
3. the distribution of populations in space.

Demographers study five processes:

a. Fertility
b. Mortality
c. Marriage
d. Migration
e. Social mobility.

 These processes determine populations’ size, composition, and distribution

 Not only knowing how large or small the population is but to making comparisons
between population changes in time
 Helps rationalize types of health programs or interventions that will be provided in
the community

Methods of Calculating Population Size

1. Natural increase - the difference between the number of births and the
number of deaths occurring in a population in a specified period of time.

Formula:

1. Natural Increase = No. of Birth (specified year ) − No. of Death (specified

year) (specified year)

Rate of Natural Increase - the difference between the Crude Birth Rate and the
Crude Death Rate occurring in a population in a specified period of
time

Formula:

Rate of Natural Increase = Crude Birth Rate (specified year)−Crude Death Rate (specified year)
(specified year)

2. Relative Increase - the actual difference between the two census counts
expressed in percent relative to the population size made during the earlier
census.

Formula:

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 Relative increase = Pt – Po
Po

Where:

Pt = population size at a later time

Po = population size at an earlier time

B. Population Composition

 population is characterized by its relation to variables such:

a. Age
b. Sex
c. Occupation
d. Educational level

 The nurse uses this data to decide who among the population group merits attention in
terms of health services and programs.

Calculations:

1. Sex composition – computes for sex ratio (compares # of males to # of

females in the population)

Formula:
Sex Ratio = # of males X 100 # of females

2. Age Composition

a. Median Age – this divides the population into two equal parts

Example: If the median age is said to be 19 years old, it means half of the
population belongs to 19 years and above, while the other
half belongs to ages below 19 years old.

b. Dependency Ratio – This compares the number of economically

dependent with economically productive groups in the population.
Dependency ratio represents the number of economically
dependent with economically productive

Economically dependent – 0-14 and 65 and above age groups

Economically independent – 15-64 years old

3. Age and sex composition – can be described using a population pyramid (A

graphical of the age and sex composition of the population)

C. Population Distribution – This shows how people are distributed in a specific geographic
location. This can be described in terms of urban-rural distribution, population density, and
crowding index.

These measures help the nurse decide how resources can be allocated based on the
concentration of the population in a certain place.

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 1. Urban-rural distribution – this illustrates proportion of the people living in urban
compared to rural areas
2. Crowding Index – this describes the ease by which a communicable disease will be
transmitted from one host to another susceptible host.

Crowding index = number of persons in a household, with the number of rooms used for
sleeping
_________________________________________________________
the number of persons in a household with the number of rooms used by
the family for sleeping

3. Population Density – this determines how congested a place is and provides implications
in terms of the adequacy of basic health services present in the community.

Population Density = number of people per land area in terms of square meters or
kilometers
_________________________________________________

the number of people living in a given land area

Tools in Public Health: Vital Statistics

Tools in Identifying Community Health Needs

VITAL STATISTICS

 Refers to the systematic study of vital events such as births, illnesses, marriages,
divorces/separations and deaths.
 A helpful tool in estimating the extent or magnitude of health needs and problems in the
community

Uses of Vital Statistics

1. Serves as an index of the health condition of the people in a community

2. Provides valuable clues to the nature of health services
3. An indispensable tool in planning, implementation, and evaluation of any health program

 Statistics of disease (morbidity) and death (mortality) indicate the state of health of a
community and the success or failure of health work
 Statistics on population (demography) and the characteristics such as age and sex, distribution
are obtained from the NSO, the office charged with registering vital facts in the country.
 BIRTHS AND DEATHS – these are registered in the office of the Local Civil Registrar of the
municipality and are usually headed by the Municipality's Local Registrar or Municipal Health
Officer.

HEALTH INDICATORS

 The commonly used measures of health status reflect disease and mortality, rather than health
itself.
 Mortality rate data are widely used to describe the health status of the population.
 Typically period of life takes are constructed by applying age-specific death rates of a given
population for a given year to a hypothetical cohort of 100,000 newborns.

CRUDE BIRTH RATE

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  This is a measure of one characteristic of the natural growth or increase in population.

CBR = Total number of live births in a given calendar year

-------------------------------------------------------------------- X 1000
Estimated population of the same year

CRUDE DEATH RATE

 A measure of one mortality from all causes which may result in a decrease in population.

CDR = Total number of deaths registered in a given calendar year

--------------------------------------------------------------------------------- X 1000
Estimated population of the same year

INFANT MORTALITY RATE

 This is the measure of the risk of dying during the first year of life. It is a good index of the
general health condition of a community since it reflects the changes in the environment and
medical condition of a community.

IMR = Total number of deaths under 1 year of age registered in a given calendar year
-------------------------------------------------------------------------------------------------------- X 1000
Total number of registered live births of same calendar year

MATERNAL MORTALITY RATE

 This is the measure of the risk of dying from causes related to pregnancy, childbirth, and
puerperium. It is an index of obstetrical care needed and received by women in a community.

MMR =Total number of deaths from maternal causes registered in a given year
---------------------------------------------------------------------------------------------- X 1000
Total number of live births registered in the same year

SPECIFIC RATE OF MORTALITY

 Describe more accurately the risk of exposure of certain classes or groups to particular
diseases. To understand the forces of mortality, the rates should be made specific provided the
data are available for both the population and the event in their specification.

Leading Causes of Mortality

Cause-Specific Death Rate

CSDR = Measures the number of deaths in a specific cause registered in a given year
------------------------------------------------------------------------------------------------------ X 1000
Estimated population as of the same year

LIFE EXPECTANCY

 This is calculated by constructing a life table.

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  A life table incorporates data on age-specific death rates for the population in question, which
requires enumeration data for the number of people, and the number of deaths at each age for
the population
 Life expectancy at birth is the total person-years lived beyond the age
 Life expectancy at birth indicates the number of years a newborn infant would live if prevailing
patterns of mortality at the time of its birth were to stay the same throughout its life.
 If a child is born today in a country where the life expectancy is 75, they can expect to live until
they are 75… right?

 Not exactly.
 The statistic “Life expectancy at birth” actually refers to the average number of years a
newborn is expected to live if mortality patterns at the time of its birth remain constant in the
future. In other words, it looks at the number of people of different ages dying that year and
provides a snapshot of these overall “mortality characteristics” that year for the population.

EPIDEMIOLOGY

 From Greek words:

EPOS – which means “upon”
DEMOS - which means people
 It is the systematic, scientific study of the distribution patterns and determinants of health,
diseases, and conditions in a population for the purpose of promoting wellness and
preventing diseases or conditions.

USES OF EPIDEMIOLOGY

1. Study the history of the health population and the rise and fall of diseases and changes in their
character.
2. Diagnose the health of the community and the condition of the people to measure the
distribution and dimension of illness in terms of Incidence, Prevalence, disability, and mortality,
to set problems in perspective to define their relative importance, and to identify groups
needing special attention.
3. Study the work of health services with a view to improving them. Operational research shows
how community expectations can result in the actual provisions of service.
4. Estimate the risk of disease, accidents, and defects, and the chances of avoiding them.
5. Identify syndromes by describing the distribution and association of clinical phenomena in the
population.
6. Complete the clinical picture of chronic disease and describe their natural history
7. Search the causes of health and disease by comparing the experience of groups that are
clearly defined by their composition, inheritance, experience, behavior, and environments

THE EPIDEMIOLOGIC PROCESS

1. Determine the nature, extent and scope of the problem

2. Formulate a tentative hypothesis
3. Collect and analyze data to test the hypothesis
4. Plan for control
5. Implement control plan
6. Make an appropriate report
7. Conduct research

EPIDEMIOLOGIC PROCESS AND THE NURSING PROCESS

 The epidemiologic process is related to the nursing process because it involves:

1. Assessing – data collection to determine the nature of client’s problems

2. Analyzing – Formulation of nursing diagnosis
3. Planning

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 4. Implementing
5. Evaluating
6. Revising or terminating or
7. Research to improve the plan if needed

DETERMINE THE NATURE, EXTENT AND SCOPE OF THE PROBLEM

1. Natura; history of the condition

2. Determinants influencing the condition
3. Distribution patterns
4. Condition frequencies

DETERMINANTS INFLUENCING THE CONDITION

1. Primary Data (essential agent)

a. Parasite
b. Nutritional
c. Psychosocial
2. Contributing Data
a. Agent
b. Host
c. Environment

HOST

 Any organism that harbors and provides nourishment for another organism
 Any species (humans or other animals) capable of being infected

AGENT

 It is the intrinsic property of microorganisms to survive and multiply in the environment to

produce the disease.
 An animate or inanimate factor that must be present or lacking for the disease or condition
to occur.

ENVIRONMENT
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  It affects both the agent and the host.
 It is the sum total of all the external condition and influences the development of an
organism which are:
a. Biological
b. Social
c. Physical

AGENTS OF DISEASE

AGENTS EXAMPLE OF ETIOLOGICAL FACTORS

NUTRITIVE ELEMENTS
Excess Cholesterol
Deficiencies Vitamins , Proteins
CHEMICAL AGENTS
Poisons Carbon monoxide, Drugs
Allergens Pollen, Dust mites
PHYSICAL AGENTS Heat, Lights, Ionizing Radiation
INFECTIOUS AGENTS
Metazoa Hookworms, Schistosomiasis
Protozoa Amoeba, Malaria
Bacteria Pneumonia, Typhoid, Rheumatic fever
Fungi Histoplasmosis, Athlete’s foot
Rickettsia Rocky Mountain Spotted Fever
Viruses Measles, Mumps, chicken pox, Poliomyelitis, Rabies

HOST FACTORS (Intrinsic Factors)

GENETIC Sickle cell anemia

AGE
SEX
ETHNIC GROUP
PHYSILOGIC Fatigue, pregnancy, puberty, stress
IMMUNOLOGIC EXPEREINCE Hypersensitivity
Active Prior to infection, immunization
Passive Maternal antibodies, gammaglobulin
INTER-CURRENT OR PRE-
EXISTING DISEASE
HUMAN BEHAVIOR Personal hygiene, Food handling

ENVIRONMENTAL FACTORS (Extrinsic factors)

PHYSICAL ENVIRONMENT Geology, Climate

BIOLOGICAL ENVIRONMENT
Human Population Density
Flora Sources of food, influences on vertebrates and
arthropods as source of agent
SOCIO-ECONOMIC
ENVIRONMENT
Occupation Exposure to chemical agents
Urbanization Urban crowding, tension and pressures
Disruption Wars, Disasters

DISTRIBUTION PATTERNS IN ANALYZING EPIDEMOLOGICAL DATA

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 1. Person – refers to the characteristics of the individual who were exposed and who
contacted the infection or the disease.
2. Place – refers to the features, factors, or condition which existed in or described the
environment in which the disease occurred.
3. Time – refers both to the period during which the cases of the disease being studied were
exposed to the source of infection and the period during which the illness occurred.

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 PATTERN OF OCCURRENCE AND DISTRIBUTION

SPORADIC OCCURRENCE

 Intermittent occurrence of a few isolated and unrelated cases in a given locality

 The cases are few and scattered, so that there is no apparent relationship between
them
 They occur on and off intermittently through a period of time
 Example:
RABIES In the Philippines, there are few cases during certain weeks of the year.
Cases are scattered throughout the country so that the cases are not related at
all to the cases in other areas.

ENDEMIC OCCURENCES

 Continuous occurrence throughout a period of time, of the usual number of cases in

a given locality
 The disease is always occurring in the locality and the level of occurrence is more or
less constant over a period of time.
 It is in a way identified in the locality itself, it may be high endemic or low endemic
when the given level is continuously maintained.
 Example:
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 Schistosomiasis is endemic in Samar and Leyte
Filariasis is endemic in Sorsogon

EPIDEMIC OCCURRENCE

 Usually large number of occurrences in a relatively short period of time

 There is a disproportionate relationship between the number of cases and the period
of occurrence. The more acute is the disproportion, the more urgent and serious is
the problem.
 The number of cases is not in itself necessarily big or large, but such a number of
cases when compared with the usual number of cases may constitute an endemic in
a given locality, as long as that number is so much more than the usual number in
that locality.
 Example:
Bird Flu, there have been no cases of bird flu, so the occurrence of a few cases in a
given area at a given time would constitute a bird flu epidemic.

PANDEMIC OCCURRENCE

 It is a simultaneous occurrence of an epidemic of the same disease in several

countries.
 It is another pattern of occurrence from an international perspective.
 Example:
COVID-19

What makes epidemics among the most interesting and meaningful among the pattern of
occurrences of disease?

 It demands immediate effective action

 The immediate action includes epidemiological investigation – emergency
epidemiology as well as control

FACTORS CONTRIBUTING TO EPIDEMIC OCCURRENCE

1. Agent factor
 The result of the introduction of the new disease agent into the population
 It may result from changes in the number of living organisms in the immediate
environment or from their growth in some favorable culture medium.
2. Host factor
 They are related to lowered host resistance as a result of exposure to elements
during a flood or other disaster, to relaxed supervision of water and milk supply
or sewage disposal, or to changes habit of eating.
 It may be related to a change in immunity and susceptibility to population
density and movement, crowing, sexual habits, personal hygiene or to change in
motivation as a result of health education.
3. Environmental factor
 Changes in the physical environment: temperature, humidity, rainfall may directly
or indirectly influence equilibrium of agent and host.

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