Measures of Morbidity

Measures of Morbidity
Prof. Dr.
Maha AL-Nuaimi
Learning Objectives
At the end of this lecture, you will understand
the following:
⚫ Measures of disease frequency Prevalence
&Incidence.
⚫ The relationship between incidence &
prevalence
⚫ Distinguish types of attack rates.
⚫ The principles in epidemiology??
⚫ What is “Measurement”?
Measures of Disease Frequency:
City A has 500 DM cases

City B has 50 DM cases
In which city the DM is the biggest

problem?
But if you know that:
But if we know that:

City A has 500 000 Population.
City B has 10 000 Population.
So City A: 500 / 500 000 × K → 1/1000

City B: 50 / 10 000 × K → 5/1000
Then.. In which city the DM is the
biggest problem?
But if we mentioned that the 500 cases (A) were
collected in one year and the 50 cases (B) were
collected in 5 years, this will lead to:-
City A … 1/1000 × 5 years = 5/1000.

In which city the DM is the biggest
problem?
What does this mean?
⚫ The mere No. is …..

⚫ The importance of measurements:
- To describe distribution accurately…
- To predict disease occurrence …
- To compare the variations ….
- For interventional program or measure.
Measurements in epidemiology:
Tools of measurement of all related heath

problems?
⚫ Rates: N is part of D, Specification of time is a
provision. Rate =
N
 K
D
⚫ Proportion: Time not a provision, expressed
in % or decimals. (20%, 1/5th)
⚫ Ratio ….
Measures of morbidity
⚫ Incidence
⚫ Attack rates
⚫ Prevalence
INCIDENCE:
⚫ Measures the No. of new cases of any

health related phenomenon that occur
during a specified period of time in a
population at risk.
INCIDENCE Rate
- Is like velocity. It indicates how quickly people

become ill per time.
- It imply a change over time. (year, or any interval).
- i.e., what proportion of the population will develop

illness during the specified time period.
“It measure the probability or “risk” of disease

occurrence”
Incidence rate =
No. of new events occurring during a

given period of time
‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬x K
Total population at risk of getting that
event
Characteristics of incidence
⚫ Address the question HOW FAR the condition
are?
⚫ A measure of RISK of disease for a specific
time period.
⚫ Express the Risk of disease for the population
not for single person
⚫ Population should be free of disease at
beginning of study (At risk)
Denominator in Incidence
“POP at Risk”??
⚫ Free from disease.
⚫ susceptible
⚫ Exist and exposed
⚫ Everyone in denominator must have the
potential to be part of the numerator.
⚫ SO .. we exclude the individuals not at risk.

Notes in Inc. Calculation:
⚫ Risk of bronchogenic CA, if we say the

incidence in the year 2021, we must
exclude the cases that came at 2020.
⚫ Incidence is also called: risk, absolute
risk, or hazard.
Uses of incidence:
1. Describes the risk of disease

occurrence overtime.
2. Since the incidence rates are affected by
any factor. detect the RISK factors.
3. Compare the risk of disease between
two or more populations.
4. In planning & Evaluation of resources &
prevention…...
Attack rate
⚫ Is a variant of an incidence rate applied to a

narrowly defined population over a limited
time and place.
⚫ mainly used in “outbreak” of infectious
disease or food poisoning
⚫ Same formula as incidence rate.
⚫ Expressed in %.
⚫ Types of attack rate:

“Primary Attack Rate":
The frequency of cases in an outbreak among susceptible individuals
exposed to a risk in a small cluster of place and time .
No. persons getting the disease during a specific time and place
Primary Attack rate = ‫ ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬x
100
Total population at risk of getting the disease
“ Secondary Attack Rate":
A measure of the frequency of new cases among contact of “primary
cases”, develop the disease within IP
Cases among contacts of primary cases during the period

secondary Attack rate = ‫ ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬x
100
Total No. of contacts at risk
Secondary attack rate:
⚫ It measures the contagiousness of the

disease.
⚫ Are often calculated for contacts or
households.
⚫ To calculate the (denominator), subtract
the number of primary cases from the
total number of contact or households.
Prevalence
⚫ Measures the number of cases (new

and old) of any health-related
phenomenon at a specific time in a given
population.
No. of new and old events occurring

at a specific time
Prevalence rate = ‫ ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬x K
Total population at that time
types of prevalence:
1. Point prevalence: no. of events that are present at a
SPECIFIC point in time of an “old & new cases” in a pop.

at a point of time
Point Prevalence rate = ‫ ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬x K
e.g: survey on retinopathy in geriatric ……

2. period prevalence: the no. of cases of the disease
of an old & new that are present within a period of time
( usually a calendar year) in a pop.

during a period of time
Period Prevalence rate = ‫ ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬x K
i.e. in measuring the prevalence of smoking in

2022 among specific student population ???
Characteristics of prevalence
⚫ It address the question HOW MUCH

⚫ Describes the burden of a disease in the
community at a point or period of time ..
⚫ estimates the probability of disease
encumbrance at any time.
Uses of prevalence:
⚫ Is used primarily to measure the amount of

illness in a community.
⚫ To determine the health care needs of that
community and the resource available for
this purposes.
⚫ In international comparisons.
⚫ Does it used for studying disease etiology?

The relation between the incidence and prevalence:
Which type of diseases contribute much to the prevalence??
Incidence
Prevalence = incidence x duration of disease
Prevalence
If the incidence of disease, fatality

and recovery rate, are relatively
stable. The prevalence is affected by .Death
duration of disease. .Recovery
Prolonged duration of disease? ?
Factors increase prevalence:
❑ long duration
❑ prolongation of life
❑ increase in new cases
❑ In-migration of cases
❑ Out-migration of non-cases
❑ in-migration of susceptible people
❑ Better reporting, improved diagnostic
facilities
Factors Decrease prevalence
⚫ Shorter duration of the disease

⚫ Higher case-fatality rate of disease
⚫ Decrease in new cases
⚫ In-migration of non-cases
⚫ Out-migration of cases
⚫ Out-migration of susceptible people
⚫ Improved cure rate of cases.
⚫Reference :
Epidemiology in Medicine by: CHARLES
H. HENNEKENS & JULIE E. BURING
Thanks
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Measures of Morbidity

City A has 500 DM cases

In which city the DM is the biggest

But if we know that:

So City A: 500 / 500 000 × K → 1/1000

City A … 1/1000 × 5 years = 5/1000.

⚫ The mere No. is …..

Tools of measurement of all related heath

⚫ Measures the No. of new cases of any

- Is like velocity. It indicates how quickly people

- i.e., what proportion of the population will develop

“It measure the probability or “risk” of disease

No. of new events occurring during a

⚫ SO .. we exclude the individuals not at risk.

⚫ Risk of bronchogenic CA, if we say the

1. Describes the risk of disease

⚫ Is a variant of an incidence rate applied to a

⚫ Types of attack rate:

Cases among contacts of primary cases during the period

⚫ It measures the contagiousness of the

⚫ Measures the number of cases (new

No. of new and old events occurring

No. of new and old events occurring

e.g: survey on retinopathy in geriatric ……

No. of new and old events occurring

i.e. in measuring the prevalence of smoking in

⚫ It address the question HOW MUCH

⚫ Is used primarily to measure the amount of

⚫ Does it used for studying disease etiology?

Which type of diseases contribute much to the prevalence??

Prevalence = incidence x duration of disease

If the incidence of disease, fatality

⚫ Shorter duration of the disease

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