Unit-V Basic Measurement in Epidemiology

Unit-V
Basic Measurement In Epidemiology

Objectives
At the end of this session the student will be able to:-
• Understand the concept Mortality, Morbidity

• Discuss the Rate, Ratio, Incidence, and Prevalence
• Identify the Maternal and Infant rates in the specific
community
• Discuss Risk Ratio, Odd Ratio and Attributable Risk.
Mortality
• Mortality: is the term used for the number of people
who died within a population
• Mortality rate: , a measure of the number of deaths

in a given population
Morbidity
• Morbidity refers to the state of being diseased or
unhealthy within a population.
OR
• The extent of illness, injury or disability in a defined

population.
• Morbidity rate: a measure of diseases in a given

population, E.g. prevalence rate, incidence rate etc.
Measures of disease
frequency
Summary Measures
• Public health questions are about populations
• Information about population characteristics is often

summarized in an index
• Changes in population characteristics can be

assessed by comparing summary measures
Rates, Ratios, Proportions
• Three general classes of mathematical parameters.
• Often used to relate the number of cases of a disease
[numerator] or health outcome to the size of the
source population [denominator] in which they
occurred.
• Numerator (“case”) has to be defined
• Denominator (“population size”) has to be defined

Ratio
• Obtained by dividing one quantity by another. These
quantities may be related or may be totally independent.
• Usually expressed as: X/Y
• Example: Number of stillbirths per thousand live births.

Number of still births/number of live births x 1000
• “Ratio” is a general term that includes Rates and Proportions.
• Dictionary: “The value obtained by dividing one quantity by

another.” [Porta 2008]
Examples of Ratios: Example 1
• Ratio= Observed cases of AIDS in country A in June/ expected
number of AIDS cases in County A during June
• Example: 40 cases / 20 cases = 2

• No units
Examples of Ratios: Example 2
• R = number of hospitals / (population size)
• R may be multiplied by k = 10,000
• Units = hospitals per 10,000 people
• Suppose R = 4 hospitals/20,000 people = 0.0002 hospitals per

person
• R*k = 0.0002 * 10,000 = 2 hospitals per 10,000 people
• Units = hospitals per 10,000 people
Proportion
• A ratio in which the numerator (x) is included in the
denominator (y)
• Example: The number of fetal deaths out of the total number
of births.
Number of fetal deaths/live births + still birth X 100
• Answer often read as a percent.
• Dictionary: “A type of ratio in which the numerator in included
in the denominator.” [Porta 2008]
Properties of Proportions
• n = the number of individuals in a population
• X = the number of individuals in the same population possess

characteristic C
• p= proportion in the population with characteristic C is equal

to x/n
Properties of Proportions
• p takes on values between 0 and 1 (p is a fraction)
• p has no units
• p may be multiplied by a constant k

− Where k is a number such as 100, 1,000, or 100,00
Example of Proportion
• Proportionate mortality
• In 1995, 53% of all deaths in Africa were children under age

5
• p = 0.53 = 53% = 53 per 100 = 530 per 1,000

Rate
• A measure of how quickly something of interest happens.
• Example: The number of new cases of Parkinson’s disease
which develops per 1,000 person-years of follow-up.
• Time, place and population must be specified for each type of

rate.
• In a rate, numerator may or may not be a subset of the
denominator
• Rate may or may not be a proportion
Properties of Rates
• The calendar time period is the same in both the numerator
and denominator of a rate.
• A rate expresses the relative frequency of an event per unit

time (“risk”)
Examples of Rates in Vital Statistics
• Infant mortality rate (IMR)= number of infant deaths per
1,000 live births during a calendar year
• The IMR is a ratio.
• The IMR is not a proportion because the numerator is not
necessarily part of the denominator (some infants may have
been born during the previous calendar year)
Examples of Rates: Incidence and
Prevalence
Incidence(I): Measures new cases of a disease that develop over
a period of time.
• Very helpful for etiological/causal inference
• Difficult to estimate
• Implies follow-up over time (i.e. cohort design)
Prevalence(P): Measures existing cases of a disease at a
particular point in time or over a period of time.
• Very helpful for quantifying disease burden (e.g. public
health)
• Relatively easy to estimate
• Implies a cross-sectional design
Prevalence
vs. Incidence
• Prevalence can be
viewed as
describing a pool of
disease in a
population.
• Incidence describes
the input flow of
new cases into the
pool.
• Deaths and cures
reflects the output
flow from the pool.
Cumulative Incidence
CI = I/N
• I = # of new cases during follow-up N = # of disease-free
subjects at start of follow-up
• Measures the frequency of addition of new cases of disease
and is always calculated for a given period of time (e.g. annual
incidence)
• Must always state the time period (since time is not
automatically captured in CI)
Person-Time and Rates
Individuals may be exposed to the risk of an event for varying

amounts of time during a total time period of a certain length
due to:
• Entering the time period later
• Leaving the time period earlier
• Experiencing the event of interest
Person-time − Is a calculation combining persons and time
• Is the sum of the individual units of time that people have
been exposed to the risk of an event
• Is used in the denominator of person-time rates
• Is often used in epidemiology and vital statistics
Person Years Of Observation In 10 Year
Heart
Disease Research Project
NO. OF SUBJECTS LENGTH OF
OBSERVATION(YRS)
30 10
10 9
7 8
2 7
1 1
Total : 50
No. of heart attacks observed during 10 yr
period: 5
Incidence Density = ?
Person Years Of Observation In 10 Year
Heart
Disease Research Project
NO. OF SUBJECTS LENGTH OF PERSON YEARS
OBSERVATION(YRS) 300
90
30 10
10 9 56
7 8 14
2 7 1
1 1 Total : 461
Total : 50
No. of heart attacks observed during 10 year period: 5
Incidence Density = ?
Example 1
• In 2003, 44,232 new cases of acquired
immunodeficiency syndrome (AIDS) were reported in
the United States. The population of the U.S. in 2003 at
risk was approximately 290,809,777.Calculate the
incidence rate of AIDS in 2003.
Numerator = 44,232 new cases of AIDS

Denominator = 290,809,777 at risk
10n = 100,000
Incidence rate = (44,232 / 290,809,777) x 100,000
= 15.21 of AIDS per 100,000 population
Dr Waqar Ali, IPH&SS, KMU

Example 2
The diabetes follow-up study included 218 diabetic women and 3,823 non
diabetic women. By the end of the study, 72 of the diabetic women and 511
of the non diabetic women had died. The diabetic women were observed for
a total of 1,862 person years; the non diabetic women were observed for a
total of 36,653 person-years. Calculate the incidence density(rates) of death
for the diabetic and non-diabetic women.
• For diabetic women,
Numerator = 72 And Denominator = 1,862
Person-time Rate = 72 / 1,862
= 0.0386
= 38.6 Per 1,000 Person
For non diabetic women,
• Numerator = 511 And Denominator = 36,653
• Person-time Rate = 511 / 36,653 = 0.0139
• = 13.9 Per 1,000 Person
Dr Waqar Ali, IPH&SS, KMU

Risk
Risk
The likelihood that an individual will contract a

disease.
Odds Ratio
The formula for Odds Ratio is :
Disease/Outcome
ad + -
OR =
Exposure/Cause + a b
bc
- c d
Attributable Proportion
The formula for attributable proportion is :
Risk for exposed group – Risk for unexposed group

AR = X 100%
Risk for exposed group
QUESTION?
References
• Principles of Epidemiology in Public Health Practice,
Third Edition An Introduction to Applied
Epidemiology and Biostatistics
• http://www.cdc.gov/
• Jhonhopkin university epidemiology lectures

Unit-V Basic Measurement in Epidemiology

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Unit-V

Basic Measurement In Epidemiology

At the end of this session the student will be able to:-

• Understand the concept Mortality, Morbidity

• Mortality rate: , a measure of the number of deaths

• The extent of illness, injury or disability in a defined

• Morbidity rate: a measure of diseases in a given

• Information about population characteristics is often

• Changes in population characteristics can be

• Numerator (“case”) has to be defined

• Denominator (“population size”) has to be defined

• Usually expressed as: X/Y

• Example: Number of stillbirths per thousand live births.

• Dictionary: “The value obtained by dividing one quantity by

• Example: 40 cases / 20 cases = 2

• Suppose R = 4 hospitals/20,000 people = 0.0002 hospitals per

• X = the number of individuals in the same population possess

• p= proportion in the population with characteristic C is equal

• p may be multiplied by a constant k

• In 1995, 53% of all deaths in Africa were children under age

• p = 0.53 = 53% = 53 per 100 = 530 per 1,000

• Time, place and population must be specified for each type of

• A rate expresses the relative frequency of an event per unit

Individuals may be exposed to the risk of an event for varying

Numerator = 44,232 new cases of AIDS

Dr Waqar Ali, IPH&SS, KMU

Dr Waqar Ali, IPH&SS, KMU

The likelihood that an individual will contract a

Risk for exposed group – Risk for unexposed group

• Jhonhopkin university epidemiology lectures

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