VITAL HEALTH

STATISTICS and
EPIDEMIOLOGY
Module III

Dr.Regie De Jesus
College of Health Sciences
COMMUNITY HEALTH NURSING I
Epidemiology
• the study of distribution of disease or
physiologic condition among human population
s and the factors affecting such distribution
• the study of the occurrence and distribution of
health conditions such as disease, death,
deformities or disabilities on human populations
• Backbone of the prevention od disease
The Epidemiologic Triangle (Triad)

• shows agent, host, and environment as

having equal influence
The Epidemiologic Triangle (Triad)
Steps in Epidemiological
Investigation:
1. Establish fact of presence of epidemic
2. Establish time and space relationship of
the disease
3. Relate to characteristics of the group in
the community
4. Correlate all data obtained
Role of Nurses in Epidemiology
• Case Finding
• Health Teaching
• Counseling
• Follow up visit
Patterns of Disease Occurrence
Epidemic
• A situation when there is a high incidence of
new cases of a specific disease in excess of
the expected.
• when the proportion of the susceptible are
high compared to the proportion of the
immunes
• E.g. Dengue outbreak during rainy season
Patterns of Disease Occurrence
Epidemic potential
• an area becomes vulnerable to a
disease upsurge due to causal factors such as
climatic changes, ecologic changes, or socio-
economic changes
Patterns of Disease Occurrence
Endemic
• habitual presence of a disease in a given
geographic location accounting for the low
number of both immune and susceptible.
• E.g. Malaria is a disease endemic at Palawan.
• The causative factor of the disease is
constantly available or present to the area.
Patterns of Disease Occurrence
Sporadic
• disease occurs every now and then affecting
only a small number of people relative to the
total population
• Intermittent or “on and off”
Patterns of Disease Occurrence
Pandemic

• global occurrence of a disease

• E.g. COVID-19 in 2020
Vital Statistics / Health Statistics
• Vital statistics are conventionally numerical
records of marriage , birth , sickness and death
by which the health and growth of community
may be studied.
• A tool in estimating the extent or magnitude of
health needs & problems in the community
• Describes the health status of the people which
serves as the basis for developing, implementing,
& evaluating programs & interventions
Purpose of Vital Statistics
• Demographic data and vital statistics are useful
tools in:
• Determining a community’s health status
• Deciding what’s the best way for providing health
services (legislation & policies in CHN)
• Planning a public health program
• Utilization and non utilization of health services
• Evaluating a program’s effectiveness
• Primary tool of research activity.
Demographic Data (Biostatistics)
• Demographic data include those variables
that describe the characteristics of a
population (i.e., population size and how it
changes over time)
• study of population size, composition and
spatial distribution as affected by births,
deaths and migration.
Sources of Vital Statistics &
Demographic Data (Biostatistics)
• Census
• Registration System
• Sample Surveys
Census
• Source of demographic data - complete
enumeration of the population
•

• 2 Ways of Assigning People

• De Jure – People were assigned to the place where
assigned to the place they usually live regardless of
where they are at the time of census.
• De Facto – People were assigned to the place where
they are physically present at are at the time of
census regardless, of their usual place of residence.
Sample Surveys
• Demographic information is collected from
the sample of a given population instead of a
census
• Data obtained from a small number of
people proportionate to the total population,
the result will always be generalized for the
whole population
Registration Systems
• Recording of vital events refers to births,
deaths, marriages, divorces, and the like.
Common Questions
• What agency is in charge of filing the data of the
population and the characteristic such as age and
sex?
• the Philippine Statistics Authority (PSA) under RA
10625
• What agency do we register the births and deaths
of an individual in the city?
• The birth of a child shall be registered within 30
days from the time of birth in the Office of the Local
Civil Registrar ( under PRESIDENTIAL DECREE
No. 651 )
Common Questions
• How about those born and died in a municipality?
• Death shall be registered within 30 days from the time of
death in the Office of the Local Civil Registrar of the
place of occurrence.

• Who does the registration of births?

• Physicians, nurses, midwives and “hilots” or anybody
who attended to the delivery of the child
• For unattended births, the parents or any responsible
person has the duty
Common Questions
• Who does the registration of death?
• the physician who last attended the deceased or
the administrator of the hospital or clinic where
the person died to prepare the certificate of
death

• What law mandates the civil registration?

• the Civil Registry Law (Act No. 3753)
Components of Demographic
1. Population size
Components of Demographic
2. Population Pyramid
• A Population pyramid (also called "Age-Sex
Pyramid") is a graphical representation of the age
and sex of a population

• 3 Types
• Expansive
• Constrictive
• Stationary
Types of Population Pyramid
• Expansive - pyramid with a wide base (larger
percentage of people in younger age groups, indicating
high birth rates and high fertility rates) and narrow top
(high death rate and lower life expectancies). It
suggests a growing population.
• Example: Nigera Population Pyramid
Types of Population Pyramid
• Constrictive - pyramid with a narrow base
(lower percentage of younger people,
indicating declining birth rates with each
succeeding age group getting smaller than
the previous one).
• Example: United States
Types of Population Pyramid
• Stationary - with a somewhat equal
proportion of the population in each age
group. The population is stable, neither
increasing nor decreasing.
Components of Demographic
Population composition
• Age Distribution
• Sex Ratio
• Median age – age below which 50% of
the population falls and above which 50%
of the population falls. The lower the
median age, the younger the population
(high fertility, high death rates).
Components of Demographic
Population
composition
• In 2020, the
median age in the
Philippines is
expected to reach
25.7 years,
increasing to
roughly 35 years of
age by 2050.
Life
Expectancy
Components of Demographic
Population composition
• Other characteristics:
• occupational groups
• economic groups
• educational attainment
• ethnic group
Projection on Population
Components of Demographic
• Urban-Rural – shows the proportion of people
living in urban compared to the rural areas
• Crowding Index – indicates the ease by which
a communicable disease can be transmitted
from 1 host to another susceptible host.
• Population Density – determines congestion
of the place
Philippines Urban-Rural Population
Crowding Index
• indicates the ease by which a communicable
disease can be transmitted from 1 host to another
susceptible host.
• Formula
number of persons in a household
CI = number of rooms used in sleeping
Philippine
Population Den
Types of Vital Statistics Measures
• Percentage
• Ratio
• Rate
Types of Vital Statistics Measures:
Percentages
• Computing by hundredths
• Numerator must be part of denominator
• Example: % of premature babies
= number of premature births X 100
total number of births
• Percentages as summary statistics
• Array of subcategories, using total as denominator
• Can obtain percentage distribution
• All percentages should add up to 100 percent
Types of Vital Statistics Measures:
Ratios
• Used to indicate relative size of one number compared
with another number

• Numerator does NOT have to be part of denominator

• Example: Sex Ratio at Birth

= number of male live births X 100 (or 1,000)
number of female live births
= number of male live births per 100 (or 1,000) female
live births
Types of Vital Statistics Measures:
Rates
• Describes rapidity of occurrence during a
stated period of time
• Example: infant mortality rate
= # deaths under 1 yr during given calendar year X 1,000
# live births during same year

• Two types of rates

• Based on vital statistics only
• Based on vital statistics and population statistics
Types of Vital Statistics Measures:
Rates
• Based on vital statistics only
Infant mortality rate
= # deaths under 1 yr during given calendar year X 1,000
# live births during same year
• Based on vital statistics and population statistics
Age-specific (infant) death rate
= # deaths under 1 yr during given calendar year X 1,000
mid-period total population of children under 1 yr
• Importance of census data
Fertility (Natality) Statistics
• Crude birth rate
• Sex ratio at birth
• Age-specific birth rates
• General fertility rate
Crude Birth Rate
• # resident live births for a specific area during a specified period
• divided by total population for that area (usually mid-year)
• multiplied by 1,000

Total # of livebirths in a given calendar year X

1,000
Estimated population as of July 1 of the same year
ON YOUR OWN: What is the birth rate in this area in 2018?
180,000 live births in 2018 among area residents
12,300,000 estimated population in 2018 for area residents
Crude Birth Rate: Example
180,000 live births in 2018 among area residents

12,300,000 estimated population in 2018 for area residents

180,000 X 1,000 = 14.6

12,300,000

14.6 live births per 1,000 area residents in

2018
• Crude Birth Rate
a measure of one characteristic of the natural growth or
increase of population
Sex Ratio at Birth
• # resident male live births for a specific area during a specified period

• divided by # of resident female live births for that area & period

• multiplied by 100 or 1,000

# of resident male live births X 100 (or 1,000)

# of resident female live births

ON YOUR OWN: What is the sex ratio at birth for the area in 2008?
58,000 = male live births in 2008 to area residents
55,000 = female live births in 2008 to area residents
Sex Ratio at Birth: Example
58,000 = male live births in 2008 to area residents
55,000 = female live births in 2008 to area residents

58,000 X 100 = 105.5

55,000

105.5 male births per 100 female live births among

area residents in 2008
Age-Specific Birth Rate
• # resident live births to women in a specific age group for a specific
area during a specified period
• divided by the total population of women in the same age group for
that area & period
• multiplied by 1,000 to get a rate

# resident live births to women in a specific age group X 1,000

# of women in the same age group
ON YOUR OWN: What is the 2019 area birth rate for women 15-19 yrs?
36,000 = live births in 2019 among resident women 15-19 years old
310,000 = area resident women who are 15-19 years old in 2019
Age-Specific Birth Rate: Example
36,000 = live births in 2019 among area
resident women who are 15-19 years old
310,000 = area resident women who are 15-19
years old in 2019

36,000 X 1,000 = 116.1

310,000
116.1 live births per 1,000 area resident
women who are 15-19 years old in 2019
General Fertility Rate
more specific measure of the increase in population
• # resident live births of women in their reproductive age for a specific area
during a specified period
• divided by the female population age 15-49 years (usually estimated for a
mid-year) for the same area/period
• multiplied by 1,000

# of resident live births X 1,000

# of females aged 15-49
ON YOUR OWN: What is the general fertility rate in the area in 2018?
180,000 = live births in 2008 among area residents
2,700,000 = estimated # of area resident females 15-49 yrs in 2018 (estimated
for 1 July, 2018)
General Fertility Rate: Example
180,000 = live births in 2018 among area residents
2,700,000 = estimated # of area resident females who
are 15-44 years old in 2018 (estimated for 1 July,
2018)

180,000 X 1,000 = 66.7

2,700,000

66.7 live births per 1,000 area resident women who are 15-44
years old in 2018
Total Fertility Rate
Mortality Statistics
• Crude death rate
• Age specific death rate
• Cause specific death rate
• Infant mortality rate
• Maternal mortality rate
• Maternal mortality ratio
• Swaroop’s Index
Crude Death Rate
• # resident deaths for a specific area during a specified period
• divided by the total population (mid-year estimate) for the same
area/period
• multiplied by 1000
•

# of resident deaths in a given year X 1000

Estimated population as of July 1 of the same year

ON YOUR OWN: What is the crude death rate in the area in 2006?
15,231 = total deaths in area during 2006
2,010,787 = estimated 2006 mid-year population for area residents
Crude Death Rate: Example
15,231 = total deaths in area during 2006
2,010,787 = estimated 2006 mid-year population
for area residents

15,231 X 1,000 = 7.57

2,010,787

7.57 resident deaths per 1000 area population in

2006
Age Specific Death Rate
• # resident deaths for a specific age or age group in a specific area
during a specified period
• divided by the population (mid-year estimate) of the same age or age
group in the same area/period
• multiplied by 100,000

# of resident deaths in specified age/group X 100,000

Total population in same specified age/group
ON YOUR OWN: What is the area death rate for children ages 1-14 in 2006?
37 = deaths among area children ages 1 -14 during 2006
381,910 = estimated 2006 mid-year population for area population
aged 1-14
Age Specific Death Rate: Example
37 = deaths among area children ages 1-14
during 2006
381,910 = estimated 2006 mid-year population
for area population aged 1-14

37 X 100,000 = 9.7
381,910

9.7 deaths per 100,000 area population aged

381,910 1-14 in 2006
Cause Specific Death Rate
• # resident deaths from a specified cause in a specific area during a specified
period
• divided by the total population at risk (mid-year estimate) in the same
area/period
• multiplied by 100,000

# of resident deaths from specific cause X 100,000

Total population at risk
ON YOUR OWN: What is the 2006 area death rate for homicide deaths ?
137 = homicide deaths among area residents in 2006
2,010,787 = estimated 2006 mid-year population for area
Cause Specific Death Rate: Example
137 = homicide deaths among area residents in
2006
2,010,787 = estimated 2006 mid-year population
for area
137 X 100,000 = 6.8
2,010,787

6.8 deaths from homicide per 100,000 area

population in 2006
Infant Mortality Rate
SENSITIVE index of the general health condition
• # resident newborns dying under 1 year of age for a specific area
during a specified period
• divided by the number of resident live births for the same
area/period
• multiplied by 1,000

# of resident infant deaths X 1,000

# of resident live births

ON YOUR OWN: What is the area infant mortality rate in 2008?

1,300 = infant deaths in area during 2008
Infant Mortality Rate: Example
1,300 = infant deaths in area during 2008
150,000 = live births in 2008 to area residents

1,300 X 1,000 = 8.7

150,000
8.7 infant deaths per 1,000 live births among area residents
in 2008

Note: Fetal- (death before complete expulsion)/ Neonatal

(death under 28 days old) -mortality rates are calculated
in a similar way- with the specific populations at risk
Infant Mortality Rate
Maternal Mortality
Maternal Mortality Rate
• # resident maternal deaths within 42 days of pregnancy termination due to
complications of pregnancy, childbirth, and the puerperium in a specific area
during a specified period
• divided by the total population (mid-year estimate) for the same area/period
• multiplied by 1,000

# of resident maternal deaths __________ X

1000
Estimated population as of July 1 of the same year

ON YOUR OWN: What is the 2008 area maternal mortality ratio?

84 = maternal deaths in area during 2008
145,000 = estimated 2008 mid-year population for area residents
Maternal Mortality Rate: Example
84 = maternal deaths in area during 2008
145,000 = estimated 2008 mid-year population
for area residents

84 X 1000 = 0.579
145,000

0.579 maternal deaths per 1000 area

population in 2008
Maternal Mortality Ratio
•# resident maternal deaths within 42 days of pregnancy termination due to
complications of pregnancy, childbirth, and the puerperium in a specific
area during a specified period
•divided by total resident live births for the same area/period
•multiplied by 1000

# of resident maternal deaths X 1000

# of resident live births

ON YOUR OWN: What is the 2008 area maternal mortality ratio?

84 = maternal deaths in area during 2008
13,000 = live births in 2008 to area residents
Maternal Mortality Ratio: Example
84 = maternal deaths in area during 2008
13,000 = live births in 2008 to area residents

84 X 1000 = 6.46
13,000

6.46 maternal deaths per 1000 live births

among area residents in 2008
Swaroop’s Index
measures the LIFE EXPECTANCY of the population
• # resident deaths among 50 years old and above during a specified
period
• divided by the total deaths in a given population
• multiplied by 100
•

# of resident deaths (> 50 years old) X 100

# total deaths in a given population (all causes)

ON YOUR OWN: What is the Swaroop’s Index in the area in 2006?

512 = total deaths among >50 years old during 2006
15,231= total death in the given population
Swaroop’s Index: Example
512 = total deaths among >50 years old during 2006
15,231 = total death in the given population
512 X 100 = 3.36
15,231

3.36 % died at 50 years old or above

Note: the HIGHER the Swaroop’s Index the

BETTER
Morbidity Statistics
• Prevalence rate
• Incidence rate
• Case Fatality Rate
• Attack Rate
Prevalence Rate
• Measures the proportion of population which exhibits a particular
disease at a particular time
• NEW and OLD cases

# of new & old cases in a given year X 100

Estimated population of the same year

ON YOUR OWN: What is the prevalence rate of HIV among men in

2006?
843 = number of men with HIV during 2006
12,431= total population men in 2006
Prevalence Rate: Example
843 = number of men with HIV during 2006
12,431= total population men in 2006

843 X 100 = 6.78

12,431

6.78 % have HIV infection in 2006

Incidence Rate Sample
• Measures the frequency of a given phenomenon
during a given period of time
• NEW cases
# of new cases in a given year X 100
Estimated population of the same year
ON YOUR OWN: What is the incidence rate of HIV
among men in 2006?
621 = new cases of men with HIV during 2006
12,431= total population of men in 2006
Incidence Rate: Example
621 = new cases of men with HIV during
2006
12,431= total population of men in 2006

621 X 100 = 4.99

12,431

4.99% have recently acquired HIV infection

Case Fatality Ratio
• Index of a killing power of a disease which is often
influenced by incomplete reporting and poor morbidity data

# of deaths from a specific cause X 100

# of registered cases of same disease

ON YOUR OWN: What is the case fatality ration of COVID-

19 in the Philippines as of Sept 28?
5,381 = number of deaths from COVID-19
307, 288= total registered cases of COVID 19
Case Fatality Ratio: Example
5,381 = number of deaths from COVID-19
307, 288= total registered cases of COVID 19

5,381 X 100 = 1.75

307,288

1.75% die from COVID 19

Attack Rate
• Measures the risk of exposure
• It is the risk of getting the disease during a
specified period, such as the duration of an
outbreak.

# of person acquiring a disease in a year X F

# of persons exposed to same disease, same year
Attack Rate: Example
• An attack rate is defined as the proportion of
those who became ill after a specified exposure.
• For example, in an outbreak of gastroenteritis
with 50 cases among a population at risk of
2500, the attack rate of disease is
• 50/2500 = 0.02, or
= 2/100, or
= 20/1000
Module Requirement
• Please answer activity in 3rd Module folder
in Schoology