ARBA MINCH UNIVERSITY

SHOOL OF PUBLIC HEALTH

EPIDEMIOLOGY AND BIOSTATISTICS UNIT

Epidemiological Measures

BY MATHEWOS A. (MPH/EPIDEMIOLOGY AND BIOSTATISTICS)

10/08/2020 1
 Learning Objectives

At the end of this session the student is expected to:

List tools in measures of diseases frequency
Discus ratios, proportions and rates

Discus uses of Ratios, Proportions, and Rates

 Epidemiological Measures
• Epidemiology is mainly a quantitative science.
• Measures of disease frequency are the basic tools of the
epidemiological approach.
• Health status of a community is assessed by the collection,
compilation, analysis and interpretation of data on:
– Illness (morbidity),
– Death (mortality),
– Disability and
– Utilization of health services.
Why We Measure Disease Frequency ?

We Measure Disease Frequency:

To know the distribution of disease
To make comparisons.
To Monitor the health status of the population
and
To planning health services.
 Cont…
 Three factors should be considered when disease
occurrences are measured:
(1) The number of people that are affected by the disease,
(2) The size of the population from which the cases of
disease arise, and
(3) The length of time that the population is followed.
 Failure to consider all three components will give a false
impression about the impact of the disease on a population.
Tools in Measures of frequency

Count
Ratio
Proportion
Rate
 Simple Count

• The most basic measure of disease frequency is a simple

count of affected individuals.
• It is number of cases in a defined population

• Such information is useful for:

– public health planners and
– administrators for proper allocation of health care resources in
a particular community.
 Simple Count…

• Can be used to compare disease frequency

between populations if and only if the population
are known to be of similar size.
• Hard to interpret if populations being compared
differ in size – hence counts are sometimes
termed “numerator data”.
 Cont…

• However to investigate distributions and determinants of

an event, it is also necessary to know the size of the source
population which allows comparisons.
• One of the central concerns of epidemiology is to find and
enumerate appropriate denominators in order to describe
and compare groups in a meaningful and useful way.
• Such measures allow direct comparisons of disease
frequencies in two or more groups of individuals.
 Ratio
• A ratio quantifies the magnitude of one
occurrence or condition to another.
• It expresses the relationship between two
numbers in the form of x: y or x/y X k
• The values of x and y may be completely
independent are the two quantities that are being
compared
 Ratio…

• K= 10n is a constant that we use to transform the

result of the division into a uniform quantity.
• The size of nth may equal 1, 10, 100,1000 and so
on depending upon the value of n.
• Ratio, proportion, rate =x /y× 10n
 Ratio…
Commonly used ratios:
 Ratio of female to male
Age dependency ratio
Maternal mortality ratio
The ratio of people with tuberculosis to those
without.
Example: What is the ratio of female to male in your
class ?
 Proportion

• A proportion quantifies occurrences in relation to the

populations in which these occurrences take place.
• It is a specific type of ratio in which the numerator is
included in the denominator and the result is
expressed as a percentage.
• Proportion=x/x+y.100%
 Proportion…
Example: 1 The proportion of all births that was male

Male births x 100

Male + Female births

2. The proportion of female in this class

Number of females x 100
Number of females + number males
 Rate

• Rate is a special form of proportion that

includes time.
• Most commonly used in epidemiology because
it most clearly expresses probability or risk of
disease or other events in a defined population
over a specified period of time.
 Rate…

• Accurate count of all events of interest that

occur in a defined population during a
specified period is essential for the calculation
of rate.
Number of events occuring in a specific time period xK
Population at risk of these events in
the same a specific time period
 Rate…
Notice three important aspects of this formula.

1. The persons in the denominator must reflect the

population from which the cases in the numerator arose.
2. The counts in the numerator and denominator should
cover the same time period.
3. The persons in the denominator must be “at risk” for the
event, that is, it should have been possible for them to
experience the event.
 Types of rates

1. Crude rates
2. Category specific rates
3. Adjusted rates
 Crude rates

Crude rates – are summary measures based on the actual number of

events (births, deaths or diseases) in a general population in a given time
period.

CR= Total no. of cases of the outcome in the popn. x10n

Total no. of individuals in that pon. in a specified time p.

Examples of crude rates: CDR, CBR

• No distinction is made for different categories or ages and no adjustment

has been made for any factors such as age.
 Crude rates…

• Advantages of crude rates

• Calculable from minimum information,

• widely used despite limitations

• Disadvantages of crude rates

• Difficult to interpret due to variation in composition (e.g.

age)
• Obscures significant differences in risk between subgroups.
 Category specific rates
Apply to specific subgroups in the population.
– Calculation of factor specific disease frequency
measures such as:
 Cause specific rates
 Age specific incidence rates
 Age specific death rate
 Sex-specific death rates
 Race-specific rates
 Category specific rates …

• Advantages of specific rates

– apply to homogenous subgroups,

– detailed and useful for epidemiological and public
heath purposes

• Disadvantage of specific rates

– Cumbersome/bulky to compare many subgroups
 Example

• During the first 9 months of national surveillance for

eosinophilia-myalgia syndrome (EMS),CDC received
1,068 case reports which specified sex; 893 cases were
in females, 175 in males.
• Calculate:

1. Female-to-male ratio for EMS

2. Proportion of EMS cases that are male
 Solution
1. Female-to-male ratio for EMS

A. Define x and y: x = cases in females

y = cases in males

B. Identify x and y: x = 893

y = 175

C. Set up the ratio x/y: 893/175

D. Reduce the fraction so that either

• x or y equals 1: 893/175 = 5.1 to 1

5 female EMS patients for each male EMS patient reported to CDC.
 Solution…
2. Proportion of EMS cases that are male
A. Define x and y: x = cases in males
y = all cases
B. Identify x and y: x = 175
y = 1,068
C. Set up the ratio x/y: 175/1,068
4. Reduce the fraction so that either
• x or y equals 1: 175/1,068 .100%=16%
 Cont…
Note that:
 Ratios, proportions, and rates are not three distinctly
different kinds of frequency measures.
 They are all ratios:
 Proportions are a particular type ratio,
 Rates are a particular type of proportion.
 Ratio, we usually mean a non proportional ratio;
 Proportion, we usually mean a proportional ratio that
doesn’t measure an event over time, and
 Rate, we frequently refer to a proportional ratio that
does measure an event in a population over time.
 Uses of Ratios, Proportions, and Rates

 To characterize populations by age, sex, race,

exposures, and other variables.
 To describe three aspects of the human condition:
morbidity (disease), mortality (death) and natality
(birth).
 Cont…
Condition Ratios Proportions Rates

Morbidity Risk ratio Attributable Incidence rate

(Disease) (Relative risk) proportion Attack rate
Rate ratio Point prevalence Secondary attack rate
Odds ratio Person-time rate
Period prevalence
Mortality Death-to-case ratio Proportionate Crude mortality rate
(Death) Maternal mortality rate mortality Cause-specific mortality
Proportionate mortality Case-fatality rate rate
ratio Age-specific mortality rate
Post neonatal mortality Sex-specific mortality rate
rate Race-specific mortality rate
Age-adjusted mortality rate
Neonatal mortality rate
Infant mortality rate
Years of potential life lost rate
Natality Low birth Crude birth rate
(Birth) weight ratio Crude fertility rate
Crude rate of natural
increase
 Example
• In County A, with a population of 50,000, 100 new cases of
breast cancer occurred over a one year period.
• In County B, with a population of 5000, 75 new cases occurred
over a three year period.
• Which county has a higher frequency of new breast cancer cases?
• In order to make a meaningful comparison between the two
counties, it is necessary to convert the data into the same
population size and time period.
THANK YOU
VERY MUCH

10/08/2020 30