BASIC

MEASUREMENTS IN
EPIDEMIOLOGY
WHAT IS MEASUREMENT?

Collect from the relevant population the necessary

data on the variables related to the objectives of the
study.
REQUIREMENTS

1. Definition of study units.

2. Definition of what is to be measured:
• Variable
• Attribute
• Circumstances
3. Decision on measurement technique and tool.
TYPES OF MEASUREMENTS

• Measurements of mortality. • Measurements of need and

• Measurements of morbidity. demand for medical care.

• Measurements of disability. • Measurements of use of health

services.
• Measurements of natality.
• Measurements of level of health.
• Measurements of
demographic variables. • Measurements of effectiveness
and efficacy of health services.
TOOLS OF MEASUREMENTS:

• NUMBERS. • RATE.

• RISKS. • RATIO.

• PROPORTION.
RISKS

It measures the chance for an event to occur to an

individual in certain population.
RATES

• The rate measures the occurrence of some particular

events in a population during a given time period.
• The rate indicates the change in some events that
takes place in a population over a period of time.
• Useful for comparison.
RATES CATEGORIES

• Crude rates: general observed rates e.g. death,

birth, etc.
• Specific rates: actual observed rates (cause,
population, period of time)
• Standardised rates: adjustments for purpose of
comparison
RATES COMPONENTS

It comprises these elements :

• Numerator
• Denominator
• Time specification (usually a calendar year.)
• Multiplier
CONCEPT OF NUMERATOR:

• It refers to the number of times an event has

occurred in population ,(e.g. sickness ,death
,episodes of sickness ) during a specific time-
period.
• The numerator is a component of the
denominator.
CONCEPT OF DENOMINATOR

The total no. of population in which the measured

event could occur
The denominator may be:
• Related to the population.
• Related to the event.
RELATED TO THE POPULATION:

 Mid - year population.

Because the population size changes daily due to
birth , death and migration.
It refers to the population estimated as on first of
July an year .
 Population at risk:
The term is applied to those to whom an event
could have happened whether it did or not .
Sometimes it may be necessary to exclude
people because they are not at risk.
 Person - time:
As in cohort study persons may enter the study at
different times in such cases denominator is a
combination of persons and time .
The most frequently used is person-years.
For example if 10 persons remain in the study for 10
years it will be 100persons year.
 PERSON-DISTANCES:
Passenger-mile

 SUBGROUB OF THE POPULATION:

e.g. age ,sex ,occupation , social class ,etc…
RELATED TO TOTAL EVENT

In some instance the denominator may be related

to the total event as in accident the number of
accident per 1000 vehicle will more useful than
total population many of them may be not using
vehicle.
MULTIPLIER

The rate is expressed per 1000 or some other round

figure (10.000,100.000) selected according to
convention to avoid fractions.
DEATH RATE:

Number of deaths in one year x 1000

Mid-year population
RATIO:

• Ratio is expresses a relation in size between two

random quantities .
• The numerator is not component of the
denominator
• The ratio is a result of dividing one quantity by
another.
It expressed in form of: • Male/female ratio.
X:Y OR X/Y
• Child/women ratio
For example:
• Doctor/nurse ratio.
The ratio of WBCs relative • Bed/population ratio.
to the RBCs is 1:600 or
1/600
PROPORTION:

• The proportion is a ratio which indicate the

relation in magnitude of a part of the whole.
• The numerator is always included in the
denominator.
• The proportion is usually expressed as percentage
(multiplier is 100).
For example:
the number of children with scabies at a certain time x100
the total number of children in the village at the same
time
MEASURES OF MORTALITY
SOURCES OF MORTALITY DATA

• Limitations:
• Death certificates
1. Incomplete reporting of death.
• Surveys
2. Lack of accuracy of data.
3. Lack of uniformity of data
collection.
4. Choosing single cause of death.
5. Disease of low fatality.
USES OF MORTALITY DATA

• Explaining trends & differentials in overall mortality,

• Indicating priority for health action and the allocation of
resources,
• Designing intervention programs,
• Assessment & monitoring of public health problems and
programs, and
• Considered as clues for epidemiological research
CRUDE DEATH RATE :

• The number of deaths (from all causes) per 1000

estimated mid year population in one year, in giving
place.
• It measures the rate at which deaths are occurring from
various causes in a given population, during a specified
period.
Number of deaths during the year x1000
Mid year population
Summarizes the effect of tow factors.
A. population composition
B. age - specific death rate (which reflect the
probability of dying)
Age -specific death rates per Crude Populatio
death n
1000 population rate
+56 45-64 8-44 5-7 1-4 0-1

59.7 10.7 1.5 0.4 0.6 13.5 15.2 A

61.1 18.8 3.6 0,5 1.0 22,6 9.9 B
SPECIFIC DEATH RATE:

a - Cause or disease specific e.g., tuberculosis,

cancer, accident.
b- Related to specific groups e.g., age-specific, sex-
specific, age and sex specific, etc.
C- During specific time.
SPECIFIC DEATH RATE:

• Can help us to identify particular groups or

groups "at risk" for preventive action.
• They permit comparisons between different
causes within the same population.
 SPECIFIC DEATH RATE:

Specific death rate due to tuberculosis =

Number of deaths from tuberculosis during a calendar year x1000

Mid-year population

Specific death rate for males =

Number of deaths among males during calendar year x1000

Mid- year population of males
SPECIFIC DEATH RATE:

Specific death rate in group 15-20 years =

No deaths of persons 15-20 yrs in a year x1000
Mid year population of persons aged 15-2
Death rate for January =
Deaths in January x12 x 1000
Mid-year population
Weekly death rate =
Death in the week x 52 x1000
Mid-year population
 CASE FATALITY RATE :

Total number of deaths due to a particular disease x 100

Total number of cases due to the same disease
• Represents the killing power of the disease, it measures
the severity of a disease.
• Used for acute infectious diseases.
• Time interval is not specified
PROPORTIONAL MORTALITY RATE (RATIO):

• Number of deaths due to particular cause (or in a

specific age group) per 100 (or 1000) total deaths.
• Used when population data are not available.
• Can not be used for comparison.
PROPORTIONAL MORTALITY RATE (RATIO):

A-proportional mortality from a specific disease =

No deaths from the specific disease in a year x100
Total deaths from all causes in that year
 PROPORTIONAL MORTALITY RATE (RATIO):

B - Under 5 proportionate mortality rate=

Number of deaths under 5 years of age in the given year x100

Total number of deaths during the same period

C- Proportional mortality rate for aged 50 years and above =

Number of deaths of persons aged 50 years and above x100

Total deaths of all age groups in that year
SURVIVAL RATE:

It is the proportion of survivors in a group, (e.g., of

patients) studied and followed over a period (e.g., a5-year
period).
Total number of patient s alive after 5 years x100
Total number of patients diagnosed or treated
SURVIVAL RATE:

• Used to describe the prognosis.

• To assess the standard of therapy.
ADJUSTED OR STANDARDIZED RATES

• To remove the confounding effect of the different

factors involved in the comparison and give a single
standardized or adjusted rate (age, sex, parity… etc).
• Carried out by two methods; direct or indirect
standardization, both begin with selection of the
population, not the age structure.
MEASURES OF MORBIDITY
MORBIDITY

• Subjective or objective departure from a state of

physiological well being.
• Disease, illness, sickness.
• Measured as:
1. Persons who were ill = No. of people
2. Episodes of illness = No. of attacks
3. Duration of illness = No. of days, weeks
ASPECTS OF MORBIDITY MEASUREMENTS

• Frequency: incidence and prevalence.

• Duration: acute diseases (short duration) and
chronic (long duration)
• Severity: case fatality and disability.
THE VALUE OF MORBIDITY DATA

• Describe the extent and nature of diseases

• Provide more comprehensive and accurate information
for basic researches
• Serve as starting point for etiological studies
• Needed for monitoring and evaluation of disease
control activity.
 INCIDENCE

• The number of new cases occurring in a define population during

specific period of time (incidence cases)
• Incidence rate =
No of new cases of specific D during specific period of time X 1000
Mid year size population at risk during that period
INCIDENCE

Special incidence rate:

• Attack rate
• Secondary attack rate
• Relative risk
• Attributable risk
• Hospital admission rate
USES OF INCIDENCE

health status indicator

To control diseases
For research into etiology, pathogenesis, distribution,
and efficacy of preventive& therapeutic measures
 ATTACK RATE

No. of new cases of a specific disease during a specific period of time interval x 100
Total pop at risk during the same interval

1. It is an incidence expressed is proportion.

2. Used when the pop exposed to a short period risk.
3. It reflects the extent of epidemic.
SECONDARY ATTACK RATE

• The no. of exposed who develop the disease within 1

incubation period from the occurrence of the first case
(primary case)
• It is a number and not a true rate.
 SAR

= no. of exposed who develop the disease within 1 incubation period following
the exposure to primary case x100 total no. of
exposed/ susceptible contacts
Advantages:
Spread of the disease.
To take decision to control measures e.g. isolation.
To determine whether the disease of unknown cause is communicable or not.
RELATIVE RISK

• Ratio between incidence rate among the exposed and

the incidence rate among the non exposed
ATTRIBUTABLE RISK

• Difference I the incidence rates of disease between

exposed group and non exposed group divided by the
incidence rate among the exposed expressed as
percentage.
USES OF INCIDENCE

• To control disease.
• To research in:
1. Aetiology, pathogenesis, distribution of diseases.
2. Efficacy of therapeutic and preventive programs.
PREVALENCE

• Refer to all current cases (old& new) existing at a given

point in time or over a period of time in specific
population
• Types;
• Point prevalence
• Period prevalence
 Point prevalence

No. of all cases of specific disease at a given point in time x100

Estimated pop at risk at the same point in time
Period prevalence

No. of all cases of specific disease during a given

period of time interval x100
Estimated mid interval pop at risk
RELATIONSHIP BETWEEN INCIDENCE &
PREVALENCE

• Prevalence depend on 2 factors incidence and duration of illness

P=IXD
• Incidence is related to occurrence of the disease that means it
reflect etiological factors
• Duration is related to factors affect the course of the disease
(prognostic factors)
USES OF PREVALENCE

• Helps to estimate the magnitude of health

• Useful for planning purposes

 DIFFERENCES BETWEEN I& P
prevalence incidence

Chronic Acute diseases

New & old New cases

Long duration Short incubation period

Endemic epidemics

Cross sectional Cohort study