Disease Measurement: Shirley I. M

Disease measurement
Shirley I. M.
Measures of Disease Frequency

The most basic measure of disease frequency is a simple count of affected individuals. However, counting is not enough!
Why is a simple count not enough?
3 cases of cancer per year from a city of 1,000 people is very different than 3 cases per year from a city of 100,000 people
So, in epidemiology we must know:
the size of the population from which the affected individuals come, and the time period the information was collected.
Health Measure and indicator
Indicator:
A measurement that, when compared to either a standard or desired level of achievement, provides information regarding a health outcome of a management process.
Outcome Indicator:
reflects changes in maternal mortality, morbidity and other health outcomes

(a) reflects changes in knowledge, attitudes, behaviors, or the availability of necessary services that result from program activities; and (b) specifies the actions needed for program implementation in order to achieve the intended outcomes
Process Indicator:
Basic Measure of Disease Frequency

Rate
an example: Incidence
Rate
basic measure in epidemiology the frequency with which an event occurs in a group of people used to compare the occurrence of disease in different groups
Example: Rates
Rate = Number of events in a specified time period
Average population during the time period
***the measure of time is a critical part of a rate!
Such as, the number of newly diagnosed cases of breast cancer per 100,000 women during 1999.
Common Rates
mortality (death) rate is the number of deaths in a defined group of people during a specified time period. birth rate is the number of live births in a defined group of people over a specified time period.
Incidence
a type of rate
the number of new cases that develop in a group of individuals during a specific time period
We define the incidence rate of the population as the number of new cases of disease (incident number) divided by the person-time over the period: This rate has also been called the person-time rate, incidence density, force of morbidity (or force of mortality in reference to deaths), hazard rate, and disease intensity, although the latter three terms are more commonly used to refer to the theoretical limit approached by an incidence rate as the unit of time measure approaches zero.
Incidence (cont.)
I=
number of new events during a period of time number of persons at risk during this time period
Example: Incidence
If there were 150,00 new cases of lung cancer in the United States during 1997, the incidence rate would be: (150,000/260,000,000) = 0.000058 0.000058 x 100,000 people = 58 cases per 100,000 people, per year
Prevalence
Prevalence:
Prevalence measures the frequency of all current cases of disease (old and new) and is of two types: measures the frequency of all current cases of a disease at a given instant in time measures the frequency of all current cases of disease for a prescribed period of time
1. Point prevalence:
2. Period prevalence:
Measures of Association
How much greater the frequency of disease is in one group compared with another. Often presented in the form of a two-by-two table.
Standardized Mortality Ratios (SMRs)
the ratio of the observed number of deaths to the expected number of deaths a standard group of people is used to determine the expected number of deaths

the standard is often the US population, a state, or a county. serves as the comparison group
SMRs (Continued)
Calculation:
SMR = observed deaths expected deaths
Example: Study of Smoking and Lung Cancer

Our hypothetical study found 58 lung cancer deaths between 1948 and 1963:
based on US population rates, we know that 42.9 cancer deaths were expected in a similar population.
SMR = (58/42.9) =1.35
Example: Study of Smoking and Lung Cancer (cont.)

Our study group had a risk of cancer mortality approximately 35% greater than those in the general population.
Population at Risk
Adalah bagian dari populasi yang rentan terhadap suatu penyakit Dapat ditentukan faktor
demografi lingkungan
Sebagian besar pengukuran penyakit didasarkan pada konsep prevalens dan insidens
Prevalens dan Insidens
Prevalens suatu penyakit adalah jumlah kasus pada suatu populasi tertentu pada suatu waktu tertentu Insiden adalah jumlah kasus baru pada suatu periode waktu tertentu pada suatuy populasi Data prevalens dan insidens menjadi lebih bermanfaat bila dikonversi ke dalam bentuk rate. Rate dihitung dengan membagi jumlah kasus dengan jumlah population at risk dan diekspresikan sebagai kasus per 10n individu
Prevalens rate jumlah individu denga penyakit/keadaan pada suatu waktu tertentu/ jumlah individu pada population at risk pada suatu waktu tertentu Bila data dikumpulkan pada suatu waktu tertentu disebut point prevalence Bila selama suatu waktu tertentu disebut period prevalence, denominatornya population at risk pada pertengahan periode
Faktor yang meningkatkan prevalens

Lamanya penyakit panjang Meningkatkan kasus baru In-migration kasus Out migration dari individu yang sehat In-migration individu yg suseptibel Fasilitas diagnostik lebih baik
Insidens rate
Jumlah individu yang menderita oenyakit pada suatu waktu tertentu/ jumlah lamanya waktu selama setiap individu pada population at risk dalam risiko
Case fatality
Adalah pengukuran beratnya penyakit Case fatality %:
Jumlah kematian karena suatu penyakit/jumlah kasus penyakitnyang sama pada periode yang sama
Mortalitas
Crude death rate/crude mortality rate

Jumlah kematian pada suatu waktu tertentu/ rata-rata total populasi selama periode tersebut
Death rate dapat juga diekspresikan untuk kelompok yang lebih spesifik seperti umur, jenis kelamin, ras
Jumlah kematian yg terjadi pada umur, jenis kel tertentu dari populasi pada suatu wilayah dan waktu tertentu/ Jumlah total populasi pada kelompok umur, jenis kelamin yg sama pada wilayah yg sama dan periode yang sama
Infant mortality death

Jumlah kematian anak kurang dari 1 tahun/ Jumlah lahir hidup dalam tahun yang sama
Maternal mortality rate

Kematian maternal yang berhubungan dengan kehamilan dalam 1 tahun/ Total kelahiran hidup pada tahun yang sama

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Disease measurement

Measures of Disease Frequency

Why is a simple count not enough?

So, in epidemiology we must know:

Health Measure and indicator

reflects changes in maternal mortality, morbidity and other health outcomes

Basic Measure of Disease Frequency

***the measure of time is a critical part of a rate!

Standardized Mortality Ratios (SMRs)

Example: Study of Smoking and Lung Cancer

SMR = (58/42.9) =1.35

Example: Study of Smoking and Lung Cancer (cont.)

Prevalens dan Insidens

Faktor yang meningkatkan prevalens

Crude death rate/crude mortality rate

Infant mortality death

Maternal mortality rate

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