Chapter 3

Measures of Disease
Occurrence
 Cont…
• We want to measure the frequency of health
related events in a certain population,
• Measure of disease frequency is used to determine
how often the disease or other health outcome of
interest occurs in various subgroups of interest.
• Disease frequency can be measured through:
– Ratio
– Proportion
– Rates
Ratio: the value of x and y may be completely
independent, or x may be included in y.
Example:
– Male to female ratio
– Doctor to population ratio
• Proportion: is a ratio (expressed as a percent)
in which x is included in y.
Example:
– Proportion of male in a community
– Proportion of HIV infected female students in DBU
 Cont…
• Rates: measure the occurrence of an event in
a population over time.
• Rates must include :
1) Persons in the denominator who reflect the
population from which the cases in the
numerator arose;
2) Counts in the numerator which are for the same
time period as those from the denominator; and,
3) Only persons in the denominator who are "at
risk" for the event.
 Cont…
• Example:
Measles cases in under five in 2007/Under five
children in 2007.
 Cont…
• By observing the occurrence of diseases in populations
over time we may be able to estimate disease frequency.
• There are two general types of measures of disease
frequency:
– Incidence and
– Prevalence
• Incidence measures the number of new cases that develop
over a period of time.
• Prevalence measures the number of total existing cases of
a disease at a particular point in time or over a period of
time.
 Incidence rate
• Measures the rapidity with which newly
diagnosed patients develop over time.
• It is the most common way of measuring and
comparing the frequency of disease in
populations.
• The period of time for the rate must be
specified.
• It is useful for identifying risk factors and
assessing disease aetiology.
 Cont…
• Has two types:
– Cumulative Incidence = total number of new cases
occurring during a specific time period/total
population at risk during the same observation
time period

– Incidence Rate = Number of new cases during

observation period/Person-time observed
 Cont…
Example:
• Look at the following graph of hypothetical
follow-up experience for 13 advanced
Alzheimer's patients being cared for at home
during January 1990 - December 1993 and
followed until December 31, 1994 for
admittance to a nursing home, in order by
study entrance date.
 Cont…
• Based on the above data calculate
A. Cumulative incidence
B. Incidence density of admission to nursing care
unit within the follow up period
• Solution
A. CI = # new cases/Total population at risk
= 6/13 x 100 = 46.2%
Therefore, 46.2% of the Alzheimer’s patients were
admitted to nursing care unit during the four
year follow up period time
B. ID = # of new cases/person-time
 How to calculate person-time
• If individuals are being followed over time, so
that the period of disease-free observation is
known for each person, we simply add up the
disease-free time for all persons:
population-time = Σ (disease-free time for each
person)
Cont…
• Therefore, ID = 6/30 person-years
= 0.20 patients admitted per year
 Prevalence rate
• The amount of disease that is present already
in a population.
• Indicates the number of existing cases in a
population.
• Prevalence measures are most useful in health
care planning.
• Has two types:
– Point prevalence
– Period prevalence
 Cont…
• Point prevalence: measures the existing cases
at a point in time.
Example, under five nutrition survey in Debre
Birhan at January 30, 2008 to estimate the
prevalence of acute malnutrition.
 Cont…
• Period prevalence: measures the existing
cases over a period of time.
Example, monthly report, quarterly report,
annual report, etc.
 Cont…
• Example, In January, 3 new cases of trachoma
were detected in a village. There were already
10 people in the village who had the disease,
but two successfully completed a course of
therapy during the month and were cured. The
population of the village was 2600. Calculate
the incidence, the period and point prevalence
 Cont…
• the incidence rate is
(3/2600-8) x 1000 or 1.2 per 1000 or 0.12%
• the period prevalence rate is
(3+10)/2600) x 1000 or 5 per 1000 or 0.5%
• the point prevalence rate as of 31 January is
((3+10-2)/2600) x 1000 or 4.2 per 1000 or
0.42%.
 Factors affecting the incidence and
prevalence
• Incidence increases with
– Increase in new cases (increase in incidence)
– In-migration of cases
– Out-migration of healthy people
– In-migration of susceptible people
– Improved diagnostic facilities (better reporting)
 Cont…
• Incidence decreases with
– Decrease in new cases (decrease in incidence)
– In-migration of healthy people
– Prevention activities
• Prevalence increases with:
– Longer duration of the disease
– Prolongation of life of patients without cure
– Increase in new cases (increase in incidence)
– In-migration of cases
– Out-migration of healthy people
– In-migration of susceptible people
– Improved diagnostic facilities (better reporting)
 Cont…
• Prevalence decreases with:
– Shorter duration of the disease
– High case-fatality rate from disease
– Decrease in new cases (decrease in incidence)
– In-migration of healthy people
– Out-migration of cases
– Improved cure rate of cases
• HIV/AIDS incidence in 2007 E.C.
– Incidence
– Prevalence
Relationship between prevalence and incidence
• Prevalence = Incidence x Duration
• Example
 Other types of rates
• See your handout
 Standardization
• The occurrence of most diseases are
associated with age and sex.
• There are two methods of age
standardization:
1. Direct method
2. Indirect method
Cont…
 Direct method
• Steps:
1. Identify the standard population
2. Multiply the standard population in each age
categories by the age-specific mortality rates of
each group being compared to find the expected
number of deaths in each age group
3. Add the expected number of deaths of all age
categories
4. Divide it by the total size of the standard
population
Cont…