MEASURES OF

RISK
 INTRODUCTION -
EPIDEMIOLOGIC STUDIES

1 2 3 4
Identify new Identify Identify possible Identify factors or
diseases populations at causative agents behaviors that
risk for a disease of disease increase risk of a
disease
 EPIDEMIOLOGIC STUDIES ALSO:

Determine the relative importance of a factor contributing to a disease

Rule out factors or behaviors as contributing to a disease

Evaluate therapies for a disease

Guide in the development of effective public health measures

Guide in the development of effective preventive strategies

 DEMOGRAPHIC STUDIES -
PURPOSE

• The means by which the epidemiologist can assess the

health status of a population from the perspective of
morbidity and mortality,
• Inexpensive, and the first test of an etiologic hypothesis,
• Can be conducted by using readily available vital and
health statistics
 Philippine Statistics
Authority

N ATIO N A L
D E M O G R A P H IC DOH
D ATA S O U R C ES

Bureau of
Quarantine
E P I D E M I O L O G I C A L D ATA
SOURCES
Department of
Health
 MORTALITY STATISTICS

• Vital events
• Births
• Marriages
• Divorces
• Deaths
 Autopsy records

Financial records (insurance,

pension)
MORTALITY
DATA Hospital records
SOURCES
Occupational records

Death Certificates
 Autopsy data and hospital records
may be more accurate about details,
but may not represent the general
population

Useful for investigating diseases with

AUTOPSIES a high-case fatality

Problem of selection bias - impossible

to correlate an autopsy series with any
well-defined population at risk, or to
estimate the frequency of disease
 M E A S U R E S O F M O RTA LI TY

Elements of mortality rate:

• Specifically defined population group - (denominator)
• A time period
• Number of deaths occurring in that population group
during that time period (numerator)
 ANNUAL DEATH RATE

• Numerator of the rate is the number of deaths that

occurred in the specified population and the
denominator is obtained either from a census or
form estimates of that population;
• The numerator & denominator are related to each
other in that the numerator represents those
individuals who died, and the denominator are those
who were at risk of death.
 “CRUDE” OR UNADJUSTED
DEATH RATE

• In terms of a single year and a population of

1000.
• Unit of time must be specified.
• Can be made explicit for characteristics, i.e., age,
gender, marital status, ethnicity and specific
causes.
 • Proportion of persons who die
from a particular population
(cases)
• Frequently and incorrectly
CASE-
termed a “mortality rate”
FATALITY RATE • Represents the risk of dying
(RATIO)
during a defined period of time
for those who have a particular
disease
• Can be made specific for a
characteristic of interest
 Describes the proportion of
deaths attributable to
inherent causes in a specific
population over a period of
time
P R O P O RT I O N AT E
M O RTA L I T Y
These proportions are not
mortality rates - since the
denominator is all deaths,
NOT the population in
which the deaths occurred
 # in numerator is not necessarily
included in the denominator,
because some of the deaths may
have occurred in person who
developed the disease before the
specified period
DEATH-TO-
CASE RATIO
IT is a RATIO - not a proportion.
A ratio of cause-specific deaths to
cases during a specified time.
 Infant mortality rates are the
commonly used rates for measuring
the risk of dying during the first year
of life.

Most frequently used measure for

INFANT comparing health services among
MORTALITY nations.

Indicator of the level of health in a

community
 There is no system for
gathering information for all
pregnancies - the closest
useful measure is the
number of live births.
MATERNAL
MORTALITY
RATES
Denominator does not
include all pregnancies, but
number of live births
 PU BLI C H E A LT H S U RV EI L LA N C E

A N A LY Z I N G A N D I N TE RP RE TI N G D ATA
 ANALYZING AND INTERPRETING
DATA

After morbidity, mortality, and other relevant data about a

health problem have been gathered and compiled, the data
should be analyzed by time, place, and person

descriptive methods are usually appropriate for analysis

of the majority of surveillance data
 C O MMO N ME T H O D S O F
A NA LYZ IN G S U RV E I L L A N C E
D ATA

• display of frequencies (counts) or rates

of the health problem in simple tables
and graphs
• Rates are useful — and frequently
preferred — for comparing occurrence
of disease for different geographic areas
or periods because they consider the size
of the population from which the cases
came from
One critical step before
calculating a rate is For state- or countywide
constructing a rates, general population
denominator from data are used available in
appropriate population PSA
data.

For other calculations,

an infant mortality rate
the population at risk can
uses the number of live-
dictate an alternative
born infants;
denominator.

rates of surgical wound

infections in a hospital
requires the number of
such procedures
performed
data for diseases that indicate a seasonal
pattern (e.g., influenza and mosquito-borne
diseases) are usually compared with data
for the corresponding season from past
years.
Data for diseases without a seasonal pattern
are commonly compared with data for
previous weeks, months, or years,
depending on the nature of the disease.

Surveillance for chronic diseases typically

requires data covering multiple years.

Data for acute infectious diseases might

only require data covering weeks or
months, although data extending over
multiple years can also be helpful in the
analysis of the natural history of disease.
 space-time
cluster analysis

time series MORE

SOPHISTICATED
analysis, METHODS

computer
mapping
 O T H E R D E M O G RA P H IC
M E A S U R E S : S U RV I VAL A N A LY S IS

• Life Table Analysis

• Studies of survivorship in actuarial
populations for use by insurance
companies to predict survivorship and
set premium charge
• Used to make demographic predictions
and to analyze data in clinical trials
 O TH ER D E M O G R A P H I C M EA S U R E S :
Y EA R S O F PO TEN T I A L L I FE LO ST ( Y P PL )

• Measures the impact of premature mortality on a

population
• The sum of the differences between a determined
end point and the ages of death for those who died
before that end point
• Two most common endpoints are age 65 and average
life expectancy. Gives more weight to early deaths
 Distribution of mortality in
populations

Time: Trend in mortality rates -

secular trends - trends over time
MORTALITY
STUDIES Place: Migrant studies - helps to
establish an environmental
contribution to disease
Person: Age, gender, race &
ethnicity, social class, birth cohort
 Disease control programs

Tax-financed public assistance programs

School & employment records

MORBIDITY
STATISTICS
Insurance data

Special research programs

Morbidity surveys on population samples for

illness in general and for specific diseases
 Focused on identification of
infected individuals, with the goal
of isolation to minimize disease
transmission

Ongoing collection of data by a

M O R BID ITY data center, analysis, dissemination
S TATIS TIC S : and implementation of a response
S U RV E ILL A N C E
S Y S TEM S
based upon analyses

Sentinel Surveillance