HEALTH FREQUENCY

MEASURES

Siswanto, MD, MSc.

SESSION OBJECTIVES

Demonstrate to
measure morbidity,
mortality, and fertility
rate.
Explain the role of
morbidity, mortality,
and fertility data.
 Sub Topics :
MORTALITY
•Definition
•Mortality Frequency
Measures
MORBIDITY
•Prevalence Rate
•Incidence Rate
FERTILITY
•Fertility Frequency
Measures
•Fertility analysis
•Variabel Antara
 Rate vs Ratio
• A Rate is defined as the number of people
having a disease during a specific time
period, divided by the total number of people
in the population who could develop this
disease.
• A Ratio compares the numerator with the
denominator. For example, sex ratio :
compare males in the nominator with females
in the denominator
 INCIDENCE RATES

• Incidence rates are the most

common way of measuring and
comparing the frequency of
disease in populations.
• Incidence rate expresses the
probability or risk of illness in a
population over period of time
 INCIDENCE RATES

• Since incidence is a measure of

risk, when one population has a
higher incidence of disease than
other , we say that the first
population has a higher risk of
developing of disease than the
second
 The formula for calculating an
IR
new cases occuring during a given time period
IR  100
population at risk during the same time period

NOTICE : 1.The numerator of an

incidence rate should reflect new cases
of disease which occurred or were
diagnosed during the specified period. (
not include cases which occurred or were
diagnosed earlier )
2. The denominator is the population at
risk.This mean that person who are
included in the denominator should be
able to develop the disease.
3. The denominator should represent the
population from which the cases in the
numerator arose.
 EXAMPLE
In 2012, 733 new cases of Tuberculosis were
reported among the Malang civilian
population. The 2012 mid-year population
was estimated to be 246,552.
Calculate the 2012 tuberculosis IR
What does it mean ?
Who are person have probability to get the
disease ( Tuberculosis) ?
Is the denominator representative for the
population ?
 persons having a particular disease during gv time p
prevalence  k
population during the same time period

Example : In a survey of patient at a sexually

transmitted disease clinic in Malang. 180 of 300
patients is interviewed use of a condom at least
during 2 months before the interview.
The periode prevalence of condom use
( 2 months) = 180 / 300 X 100 = 60 %
 Comparison of prevalence and
incidence
• Numerator of Inc = new cases occurring
a given time period
• Numerator of prv = all cases present during
a given time period
Note : The numerator of incidence consists only
of persons whose illness began during a
specified interval. Prevalence includes all
persons ill from a specified interval regardless
of when the illness began. It include not only
new cases but also old cases
The factor that link incidence and prevalence.
Diseases that are short-lived, because they are
rapidly cured or are fatal at an early stage,
will have a relatively low prevalence
compared with their incidence
Diseases with a low mortality and low cure rate,
leaving people with the disabling effect of the
disease will have a high prevalence
compared with their incidence
 EXAMPLE
Two survey were done of the same
community 12 months apart. Of 5000
people surveyed the first time, 25 had
antibodies to histoplasmosis. 12 months
later, 35 had antibodies, including the
original 25.
Prev at the second survey = 35/5000
X1000 = 7/1000
 Cont
Incidence during the 12-month period
= ???
CALCULATE
 ATTACK RATE ( AR)

Number of new cases among the pop during the perd

AR  100
population at risk during the same time period

AR is a variant of an incidence r, applied

to a narrowly define pop observed for a
limited time, such as during an epidemic.
 Example
Of 75 persons who attended a picnic, 46
subsequently developed gastroenteritis.
AR =
 SECUDARY ATTACK RATE
( SAR)
Number of new cases among contact of primary cases
SAR  100
Total number of contacts

SAR is a measure of the frequency of new

cases of a disease among the contacts of
known cases.
 Example
7 cases of hepatitis A occurred among 70
children attending a child care center.
Each infected child came from a
different family. The total number of
persons in the 7 families was 32. One
incubation period later , 5 family
members of the 7 infected children also
developed hepatitis A.
 CONT
Calculate
AR
SAR
• AR = 7/70 X 100 = 10 %
• SAR = 5/25 X 100 = 20 %
 MORTALITY RATES

Number of death in a specified period

CMR  100
Average total population during that p

NOTICE : Death are usually accurately

measured compared with morbidity data.
• Disadvantage of a CMR is that it takes
no account of the fact that the chance of
dying varies according to age, sex,
race, socioeconomic class and other
factors. It is usually not appropriate to
use CMR for comparing different time
periods different geographic areas.
 example
• The death rate of people living in a new
housing estate with many young
families will be very much lower than
that in a old housing estate where many
retired people chose to live.
 INFANT MORTALITY RATE

Number of deaths of infants less than 1 y

IMR  1000
Number of live births in year

NOTICE : IMR is often used as a measure

of overall health status when comparing
different countries. ( Why ?? )
( Indicator health status of a community)
East Java ( 2003) IMR = 42 /1000 LB
Indonesia ( 2001) IMR = 50/ 1000 LB
• Is the IMR rate a proportion ? No , it is a
ratio but not a proportion.
• Relate to the socioeconomic status of
an area or country ( Poverty )
 Case Fatality Rate
Number of cause - specific deaths
among the incident cases
CFR  100
Number of incident cases

NOTICE : CFR is a measure of the

severity of a disease, in term deaths.
 CRUDE MORTALITY RATE
• The crude mortality rate is the mortality
rate from all causes of death for a
population.
 CAUSE – SPESIFIC
MORTALITY RATE
• The cause-specific mortality rate is the
mortality rate from a specified cause for
a population. The numerator is the
number of deaths attributed to a specific
cause. The denominator remains the
size of the population at the midpoint of
the time period.
 AGE-SPECIFIC MORTALITY
RATE
• An age-specific mortality rate is a
mortality rate limited to a particular age
group. The numerator is the number of
deaths in that age group; the
denominator is the number of persons
in that age group in the population.
Some specific types of age-specific
mortality rate are neonatal, post
neonatal, and infant mortality rates.
 INFANT MORTALITY RATE
• The infant is mortality rate is one of the most
commonly used measures for comparing
health services among nations. The
numerator is the number of deaths among
children under 1 year of age reported during
a given time period, usually calendar year.
The denominator is the number of live births
reported during the same time period. The
infant mortality rate is usually expressed per
1,000 live births.
 NEONATAL MORTALITY RATE
• The neonatal period is defined as the period
from birth up to but not including 28 days.
The numerator of the neonatal mortality rate
therefore is the number deaths among
children under 28 days of age during a given
time period. The denominator of the neonatal
mortality rate, like that of the infant mortality
rate, is the number of live births reported
during the same time period.
 POSTNEONATAL MORTALITY
RATE
• The post neonatal period is defined period
from 28 days of age up to but not including 1
year of age. The numerator of the post
neonatal mortality rate therefore is the
number of deaths among children from 28
days up to but not including 1 year of age
during a given time period. The denominator
is the number of live births reported during
the same time period.
MATERNAL MORTALITY RATE

• The maternal mortality rate is really a

ratio used to measure mortality
associated with pregnancy. The
numerator is the number of death
assigned to cause related to pregnancy
during a given time period. The
denominator is the number of live births
reported during same time period.
 SEX-SPECIFIC MORTALITY
RATE
• A sex-specific mortality rate is a
mortality rate among either males or
females. Both numerator and
denominator are limited to the one sex.
 RACE-SPECIFIC MORTALITY
RATE
• A race-specific mortality rate is a
mortality rate limited to a specified racial
group. Both numerator and denominator
are limited to the specific race.
 COMBINATIONS OF SPECIFIC
MORTALITY RATE
• Mortality rates can be further refined to
combinations that are cause-specific, age-
specific, sex-specific, and/or race-specific.
For example, the mortality rate attributed to
HIV among 25 – to 44- year-olds in the united
states in 1987 was 9,820 deaths among 77.6
million 25- to 44-year-olds, or 12.7 per
100,000. This is a cause- and age-specific
mortality rate, because it is limited to one
cause (HIV infection) and one age group (25
to 44 years).
 The factors that influence
mortality
• Sex
• Marriage status
• Health services status
• Age
• Urban or rural
• Socioeconomic status
• Education level