CHAPTER 2

HEALTH POPULATION
INDICATORS:
MORBIDITY AND MORTALITY
Prepared by: Monica Joyce S. Sespeñe
CS-BPS FACULTY
 OVERVIEW
As discussed in Chapter 1, Epidemiology is relatively significant to Public
health. Researches and studies are carried out to reveal the speed of
disease occurrence and its effect on the population. Moreover, to essentially
form possible solutions and safety measurements for the control of Public
health. There are several types of population indicators used in
Epidemiology, and Frequency measurement is the most common.

In this learning material, we are about to know the common frequency

measures used to indicate the health status of a specified population. This
includes morbidity and mortality rates measurements and how these
population indicators contribute to public health control.
  identify which chronic, infectious and
degenerative diseases contribute the most
morbidity within and across the populations;

 use the appropriate analytic methods for

LEARNING calculating key measures of morbidity, mortality
OUTCOMES and measures of association; and

 elaborate the significance of population indicators

to the control of disease transmission that affect
the public health.
LESSON
PROPER
 A health indicator is a set-up of public health
surveillance that describes a measure of health such as
the occurrence of disease or other health-related event
HEALTH or factors associated with health such as health status
or other risk factors in a specified population.
INDICATOR
Counting and summarizing cases of diseases in a
specified population is a unique field of Epidemiology.

It is the main component of disease surveillance

and outbreak investigation.
 FREQUENCY measures represent the
summary of measures that capture
applicable information on different health
attributes and dimensions, and the health
system performance. Essentially, these
health indicators attempt to consider and
monitor the health status of a population.
Types of frequency measures:
1. Count
2. Ratio
3. Proportion; and
4. Rate

Ratio, Proportion, Rate = __x x 10n

y
Where, x and y are the two quantities that are being compared and 10 n (10 to the nth power) is a constant multiplier
use to transform the result of the division into a uniform quantity.
Types of frequency measures:

1. Count- simplest and frequently used quantitative measurement of disease frequency. Counts
the number of cases of specific disease.
2. Ratio- the value obtained by dividing one quantity by another. It consists of numerator and
denominator. Types include rate, proportion and percentage. Does not necessarily have a
specified relationship between numerator and denominator.
3. Proportion- a type of ration in which numerator is part of the denominator. It may be expressed
as percentage.
4. Rate- a type of ratio that measures the occurrence of an event in a specified population over a
period. The numerator consist of frequency of a disease over a given period of time and
denominator is the size of the population.
For the 10n values, any values can be used, it depends on the size of the population of the
surveillance and investigation and how the investigators going to interpret the result.

Ratio, Proportion, Rate = __x x 10n

y
Where, x and y are the two quantities that are being compared and 10 n (10 to the nth power) is a constant multiplier
use to transform the result of the division into a uniform quantity.
Frequency measures are used in
Epidemiology to characterize the populations
by age, sex, exposures and other variables.

It is also used to determine the three aspects

of human condition:

1. Morbidity - condition of suffering or

presence of disease or any health related
conditions in a certain population.

2. Mortality- The state of being mortal or

destined to death.

3. Natality- measure the ration of the number

of births to the number of population.
 MORBIDITY
FREQUENCE MEASURES
MORBIDITY FREQUENCY MEASURES is
used to identify the presence of disease or the
probability of its occurrence in a specified
population. Morbidity includes illness, injury or
disability.

What is Morbidity rate? It refers to the

frequency or the number of persons in a certain
population that is affected by a disease or the
number of persons who are ill during a span of
time (Prevalence).

There are two methods of morbidity frequency

measures:

1. Incidence Rate; and

2. Prevalence Rate.
 Incidence Rate
a type of risk measurement that focuses on the frequency of a disease in different population. The
measurement of the disease frequency will be compared to other measurements in different population.

It expresses the probability or risk of illness in a population over a period of time. It measures the
proportion or rate of persons who develop a particular disease during a given period of time.

Incidence rate calculating method:

Incidence rate = Number of new cases of disease or injury during specified period X 10n
Number of population at risk during the specified period
Or
Number of population at the middle period of surveillance

An incidence rate is usually expressed per 100, 1000, 10,000, or per 100,000 population. It
depends on the investigator on how it is going to be expressed but it must clearly indicate
which value is being used. For most nationally notifiable disease, a value of 10 5 (100,000) is
used since it comprises a large population.
 EXAMPLE 2.1
In 2019, Rizal Palawan had a record of 3,516 cases of Malaria.
For the first 10 months of this year, 2020, Rizal, Palawan has
reported 300 new cases of Malaria with an estimated mid-year
population of 50,096. Calculate the incidence report using the
base of 10,000 (104)

Solution: Numerator= 300; Denominator= 50,096

Incidence rate =­_300_ x 10,000

50,096
=0.00599 x 10,000
Incidence rate =59.88%
 
There are approximately 59.88 or 60 cases per 10,000
population in 10 months of 2020.

Example 1 Data Source: Manila Bulletin Published October 23, 2020

 ATTACK RATE

It is an alternative form of the incidence rate that is commonly used

when the nature of the disease or population is observed in a short period
of time.

Formula: number of cases affected by a disease x 100 (during a period of time)

total number of population during a specified time

Example: A total of 98 people have attended a holiday dinner and ate a cup of
Buko salad. Among these people, 54 who consumed Buko salad became ill
(continuous diarrhea); the remaining people did not became ill. Calculate the
Attack rate.
Solution: 54/ 98 x 100
= 55.10% or 55 per 100 population
 PROPERTIES AND USES OF Incidence Rate

• Incidence rate describes how fast disease occurs in a population.

• Incidence Rate is like a speed measured in miles per hour (Velocity), it

indicates the speed of disease occurrence and how quickly people became ill
per year.
• In a fast evolving epidemic, like malaria or dengue, daily or weekly
calculations are observed and needed, and monthly incidence is needed
for an Endemic disease.
• Attack rate is not a true rate because the time dimension is not certain or
random.
• At some point, Attack rate is used to measure the incidence of acute
infectious disease epidemics or pandemic.
 Prevalence rate

refers to the number of persons in a population who have a particular disease or condition
at a specified period of time, usually the period of survey. A proportion of persons in a
population who have health conditions during or over the specified time period.
Prevalence includes all cases (new and pre-existing) in a population at a specified time unlike
incidence, it is limited to new cases only.
The value of 10n is usually 1 or 100 for common attributes and 10 3 (1,000), 105 (100,000) or 106
for rare traits and most diseases.

Prevalence rate calculating methods:

•Prevalence of Disease
Prevalence rate = All new cases and pre-existing cases during a specified time x
100%
Number of population on the specified period of time

Source: Dicker, R., et al (2013)

 EXAMPLE 2.2
In a survey at medical center, 85 out of 450 patients
were treated for several nosocomial infections
(infections acquired in hospital) over five months.
Calculate the prevalence of disease.

Solution: Numerator= 85 Denominator= 450

Prevalence rate= ­_85__ x 100

450
= 0.19
= 18.8 or 19%

19% per 100 population were affected by the disease.

 EXAMPLE 2.3
In a survey within 1,150 women who gave birth in
Maine in 2000, a total of 468 reported taking a
multivitamin at least 4 times a week during the month
before becoming pregnant. Calculate the prevalence of
frequent multivitamin use in this group.
 
Solution: Numerator= 468 Denominator= 1,150

Prevalence rate= ­_468__ x 100

1,150
= 0.4069
= 40.7

40.7% per 100 population used a multivitamin

before pregnancy.
TWO CATEGORIES OF PREVALENCE
1. Point prevalence refers to the number of persons who are ill at a particular point in
time. It is the proportion of persons with a particular disease or attribute on a particular
date. 2
 Point prevalence is used to measure how much a specific disease is present in a
certain population at a single or short period of time. The purpose is to form
solutions, stop action with regards to the disease and to release guidelines to the
population at risk.

2. Period prevalence is the proportion of persons with a particular disease or attribute

at any time during the interval.
 It is commonly used to measure how long is the presence of a specific disease in a
certain population for a long period of time. The interval can be a week, months, year
or decade or any specified period of surveillance or investigations.
 EXAMPLE 2.4
Point Prevalence = no. of current cases (new and pre-existing) x at a point of time
Total no. in the group

A Barangay with 41 837 population has been involved in a 2-week tracing of

CoViD-19 cases. On September 1, the first day of tracing, a total of 4 053 cases
were reported as reactive to the CoViD-19 antigen test, and on September 8,
2020 (mid-tracing period), 2 181 new cases were reported. On September 15,
2020, 575 cases were recorded. Assume that there’s no death or recovery of
patients with CoViD-19 during the specified period. Calculate the point
prevalence on September 8, 2020. Express the result by 100.

Point Prevalence = __6,234__ x 100

41, 837
= 14%
 EXAMPLE 2.4
Period Prevalence: The rainy season started one
month ago. Rizal Palawan has declared malaria
outbreak because number of new malaria cases
were rising, rapid blood test was performed to
each patient who has malaria symptoms and after a
week (September 5, 2020 to September 11, 2020)
of continuous blood test, 112 new malaria cases
were recorded. Estimated number of population in
the specified week was 50, 096.

Solution: Numerator= 112 Denominator= 50,096

PR= 112 x 1,000

50,096
=2.24%
2.24 or 2 new cases per 1000 people per week.
 PROPERTIES AND USES OF PREVALENCE RATE

• Incidence and Prevalence are frequently confused. Both of these calculates

persons/individuals who have or developed a disease but differ in the numerator as
Prevalence includes all cases (Pre-existing and existing) cases during a given period
of time, while Incidence focuses on the new cases within a specified time.
• The purpose and use of Prevalence is to determine the longevity of the disease. High
prevalence of a disease indicates as high incidence or survival that can be extended
with or without cure. Low prevalence of a disease indicates low incidence, rapid
fatal process or rapid recovery.
• Prevalence provide an indication of the extent of a health problem. The reports may
create implications for the health services needed by the community.
• Prevalence often measures chronic diseases such as diabetes, heart disease,
osteoarthritis, and more. These diseases have long duration.
• It can be expressed as a number, percentage, or number of cases per population size.
 Source: Human Rights Watch
https://www.hrw.org/node/314714/printable/print
 MEASURE OF DISEASE FREQUENCY GRAPH
is a graph that is useful in calculating morbidity frequency
measures.
A single measure of disease graph can be used to calculate
the incidence rate, point prevalence and period prevalence.

COMPONENTS OF GRAPH:
1. HORIZONTAL LINES (---------) represents one person and
the duration of illness.
2. DOWN ARROW - represents the onset of illness.
3. UP ARROW - represents end of illness/ date of recovery.
4. CROSS -represents death or date of death.
MEASURE OF DISEASE FREQUENCY GRAPH

Source: www. Chegg.com

 LET’S TRY TO COMPARE THE INCIDENCE &
PREVALENCE RATE USING THE DISEASE
GRAPH

DISEASE: Meningococcal disease

On Page 24, new cases of Meningococcal disease is presented. In a

population of 20, 10 new cases of illness were recorded, over 15
months of observation period.
New cases of
Meningococcal
disease from
October 1, 2019 to
September 30, 2020.

Graph Source:
Centers for Disease
Control and Prevention
Using the figure presented, calculate the following:

1. Incidence rate from October 1, 2019 to September 30, 2020 using the
midpoint population (the number of persons who are still alive at the mid-
year of the study, April 1, 2020) as the denominator. Express the rate per
100 population.
2. Point prevalence rate on April 1, 2020
3. Period prevalence rate from October 1, 2019 to September 30, 2020
 SOLUTION
1. INCIDENCE RATE from October 1, 2019 to September 30, 2020
IR Numerator = number of new cases between October 1, 2019 to
September 30, 2020
= 4 (6 out of 10 cases had onsets before Oct. 1 and
it’s not considered as new case)
 
IR Denominator = Midpoint population (April 1, 2020)
= 18 (2 persons died before April 1 which means they are
not counted in the population)
Incidence rate = ­_4­­_ x 100
18
Incidence rate = 22

There are 22 new cases per 100 population.

 SOLUTION
2. POINT PREVALENCE RATE
Numerator= 7 (only 7 persons are sick during April 1, 2020; person 2
& 8 died before April 1 and person 3 became ill after April 1)
Denominator = 18

Point prevalence = _7_ x 100 %

18
Point prevalence = 38. 89%
 

38.89% per 100 population is at risk.

 SOLUTION
3. PERIOD PREVALENCE RATE
Numerator= 10
Denominator = 20
Period Prevalence Rate = ­_10_ x100 %
20
Period Prevalence Rate = 50%

50% per 100 population is at risk.

LEARNING
CHECK
Number of persons who are affected by food poison after attending a birthday part
Number of population who attended the party

Number of persons who are newly diagnosed with breast cancer from year 2019
Total number of population during 2019 surveillance

_Number of persons who are affected by amoebiasis on June 2, 2019

Number of population who are still alive at the end of the surveillance

Number of women in Brgy. Tanabag newly diagnosed with heart diasese in 2019
Estimated number of women living in Brgy. Tanabag on July 1, 2019

Number of men who suffered from depression in Puerto Princesa, City accdg. to 2019
Estimated number of men living in Puerto Princesa, City in July 1, 2019
MORNING GAME
Scavenger hunt Riddles
 EASY ROUND
1. I have a bark, but I’m not a tree. When you ask, “who’s a good boy?” the answer
is me.

Answer: DOG

2. I’m here to wake you up, but just hit snooze and I’ll shut up

Answer: ALARM CLOCK

3. You can run with the clues, but don’t run with me! Rock beats me
every time.

Answer: SCISSORS

4. One of me per day keeps the doctor away.

Answer: APPLE
Source: https://teambuilding.com/blog/scavenger-hunt-clues
 HARD ROUND
1. I’m full of holes but can still hold water.

Answer: SPONGE
2. I have keys, but no locks and space, and no rooms. You can enter, but
you can’t go outside.

Answer: KEYBOARD

3. I’m tall when I’m young and short when I’m old.

Answer: CANDLE

I’m made of water but will die if you put me in water.

Answer: ICE
 MORTALITY
FREQUENCE MEASURES
MORTALITY FREQUENCY MEASURES is Mortality- The state of being mortal
or destined to death.
used to count the number of death caused
by health event in a specified
population under investigation.

What is Mortality Rate?

It refers to the measurement of
frequency of occurrence of death in a
specific population during a specified
period of time. If morbidity measure
illness, mortality measures death.
 GENERAL FORMULA OF MORTALITY RATE

Formula of Mortality in a specified population, over a specified period of time:

 
Mortality rate= _____Deaths occurring during a given of time x 10n
Size of the population among the deaths occurred
 
When mortality rates is based on vital statistics, the size of the population in the
middle of the time period is used.
 
TYPES OF MORTALITY RATES:

1. Crude mortality rate or crude

death rate
2. Cause-specific death rate
3. Age-specific mortality rate
4. Sex-specific mortality rate
5. Maternal and Infant Mortality
rate
6. Death-to-case ratio
7. Case-fatality rate
8. Proportionate mortality
 TABLE 2.1. MODIFIED SUMMARIZED TABLE OF FORMULAS OF FREQUENCY MEASURES OF
MORTALITY
Measures Numerator Denominator 10n
Total number of deaths 1,000 (103) or 100,000
Crude mortality rate during a given time Mid-interval population (105)
interval

Number of deaths
Cause-specific assigned to a specific Mid-interval population 100,000 (105)
mortality rate cause during a given time
interval

Age-specific mortality Number of deaths in that the number of persons in

rate age group that age group in the 100,000 (105)
population

Number of deaths Number of live births

assigned to pregnancy-
Maternal Mortality rate during the same time 100,000 (105)
related causes during a interval
given time interval

Source: Principles of Epidemiology Third Edition: An introduction to Applied Epidemiology and Biostatistics
 TABLE 1. MODIFIED SUMMARIZED TABLE OF FORMULAS OF FREQUENCY MEASURES OF
MORTALITY

Measures Numerator Denominator 10n

Number of deaths among Number of live births
Infant mortality rate children < 1 year of age during the same time 1,000 (103)
during a given time
interval interval

Number of deaths Number of new cases of

Death-to-case ratio assigned to a specific same disease reported 100 (102)
cause during a given time during the same time
interval interval

Number of deaths from a Number of confirmed

Case fatality rate particular disease cases of disease 100 (102)

Proportionate Number of deaths caused Total number of deaths

mortality Ratio by a specific cause during from all causes during 100 (102) or 1,000 (103)
a given time interval the same time interval

Source: Principles of Epidemiology Third Edition: An introduction to Applied Epidemiology and Biostatistics
 CRUDE-MORTALITY RATE OR CRUDE DEATH RATE
refers to the rate of all causes of death in a population. Rate can be either 1,000 or
100,000. Known as annual death rate.
Crude Mortality Rate in Public Health: Crude Mortality Rate estimates the
portion of the population that dies due to any cause during a specified period. 3

Example 2.6: In the Philippines year 2017, there are 579, 237 total deaths occurred with an
estimated midyear population of 52,600,000 at the half of the year. Calculate the Crude
mortality rate.

CMR = total number of deaths caused by any health event during a period of time x 100,000
Mid-interval population
= __579, 237 x 100,000
52,600,000
= 1,101.2
  Source: Dicker, R., et al (2013)
Therefore, the crude mortality rate in 2017 is 1,101.2 deaths per 100,000 population.`
 CAUSE-SPECIFIC MORTALITY RATE

refers to the measurement of the mortality rate or death by a specified cause in a

population. It is commonly expressed per 100,000 population. The numerator is the
number of deaths attribute to a specific health event and the denominator is the number
of population at the mid-point of the time period.

Example 2.7: Sars-Cov-2 (cause) specific mortality rate: In the 10 months period of 2020,
there are 7,147 deaths were attributed to Corona Virus.
 
CSMR = total number of deaths attributed to the specific cause in period of time x 100,000
Mid-interval population/ estimated population
= __7,147 x 100,000
52,600,000
= 13.6 or 14 
Therefore, the cause-specific mortality rate is 13.6 deaths per 100,000 population.
Source: Dicker, R., et al (2013)
 AGE-SPECIFIC MORTALITY RATE

is a mortality rate limited to particular age group caused by any health events. The
numerator represents the number of deaths in the specific age group and the
denominator is the total number of person in the specific age group in a population.

Example 2.8: In year 2003 in the United States, a total of 1,651 deaths were reported due to
malignant neoplasms among the age-group 5 to 14 years. There were 40,968,637 individuals in
the same age group during the specified period.

Solution: A-SMR= ___1651___ x 100,000

40,968,637
A-SMR= 4.0 per 100,000.

There are 4 deaths per 100,000 population of age-group 5 to 14 years in 2003.

Source: Johann & Garett Learning

 SEX-SPECIFIC MORTALITY RATE

is a measurement of death limited to genders: Males and Females. The numerator

and denominator limits to one sex/gender.

Example 2.9: In 2018, the population of men in the Philippines reached the count of
56,129, 826. During the same year, there were 10, 624 deaths recorded due to Traffic
accidents, 4,250 of them were identified as men and the remainder are women.
Calculate the Sex-specific mortality rate:

What specific sex mortality should be solved? MEN/MALES

Solution: S-SMR= ___4,250_____ x 100,00
56,129, 826
S-SMR= 7.57 per 100,000 population of Males in 2018.
 MATERNAL MORTALITY RATE
is a ratio used to measures the death rate
associated with Pregnancy. A maternal death
during the pregnancy of the women or within 42
days after the pregnancy regardless of the
duration and area of the pregnancy from any
cause related to or aggravated by the pregnancy
or its management1 ,excluding the accidental or
incidental cause.
It is usually calculated on annual basis and
expressed per 10,000 or 100,000 per live births.

Note: High maternal mortality ratios indicates a

high problem in the health status of women,
gender inequalities, and health services in a
country.
 MATERNAL MORTALITY RATE

FACTORS AFFECTING MATERNAL

MORTALITY RATE:

1. Maternal age
2. Socioeconomic status
3. Nutritional status
4. Healthcare access
5. Complication to health
(puerperium, eclampsia and
hemorrhage)
 MATERNAL MORTALITY RATE

FORMULA:
MMR= Number of deaths assigned to pregnancy-related causes during a given time interval x 100,000
Number of live births during the same time interval

EXAMPLE 2.10:
In 2012, 184 maternal deaths were recorded in Palawan and a total of 130,000
live births.

MMR= __184__ x 100,00

130,000

= 141. 5 or 142 deaths per 100,000 live births in 2012 among the
residents of Palawan
 INFANT MORTALITY RATE
is the measurement of death of an infant before his/her 1st birthday. It is generally
calculated annually and expressed per 1,000 live births.
measurement is accurately obtained by dividing the number of infant deaths in a year
by the number of live births in the same year.

Example 2.11: In 2017, there are 34, 822 infants death were recorded due to all causes of
death and there were 1,700,816 live births reported according to Philippine Statistics
Authority.
 
IMR = Number of deaths among children <1 year of age reported during a period of time x 1,000
Number of live births reported during the specified period
= __34, 822 x 1,000
1, 700, 816
= 0.02047 x 1,000
= 20.474 infant deaths per 1,000 live births in 2017
 INFANT MORTALITY RATE

The health of the mother and infant

depends on variety of factors such
as:

1. Prenatal Care
2. Prevalence of prenatal maternal
health behaviors
3. Postnatal care and behaviors
4. Sanitation and infection control.
Infant Mortality Rate in Public Health: Infant mortality rate is an important marker and use
for comparing health status among nations or the overall health of the society. Take a look at
Table .
Table 2. The Philippine Infant Mortality Rate 2017-2020

The current infant mortality rate for Philippines in 2020 is 18.815 deaths per 1000
live births, a 2.2% decline from 2019.

The infant mortality rate for Philippines in 2019 was 19.239 deaths per 1000 live
births, a 2.16% decline from 2018.

The infant mortality rate for Philippines in 2018

was 19.663 deaths per 1000 live births, a 3.96%
decline from 2017.

The infant mortality rate for Philippines in 2017

was 20.474 deaths per 1000 live births, a 3.81%
decline from 2016
Source: macrotrends.com
 DEATH-TO-CASE RATIO
measures the number of deaths attributed to a particular disease during a
specified time period. It is a ratio since it counts the death that might occurred among
who developed disease in an earlier period that is not counted in the denominator.
Example 2.12: During the period of year 2017 to 2018, a total of 289,444 new cases of tuberculosis were
reported in the Philippines. During the span of surveillance, there were 26,250 deaths occurred that were
attributed to tuberculosis. Calculate the death-to-case ratio for 2018 per 100 cases.
 
Death-to-case ratio = number of deaths caused by a particular disease during specified period x 100
Number of new cases of the disease identified during the same period
 
Numerator= 26,250 deaths in year 2017-2018; Denominator= 289,444 new cases in year 2017-2018
 
= __26,520__ x 100
289, 444
Death-to-case ratio = 9.1 death per 100 population
 
Therefore, there were 9.1 or 9 deaths per 100 cases.

Data source: KNOW TB NEWS (https://www.fhi360.org/sites/default/files/media/documents/png-know-tb-newsletter-april-2019.pdf)

 CASE-FATALITY RATES
refers to the proportion of individuals diagnosed with a specific health conditions
(case) who die from that specific condition. It measures the severity of the condition.

 This is likely similar to death-to-case ratio but differ in the value of numerator
which is limited to deaths among people included in the number of incident or
confirmed cases in the denominator.
 Reliability of the Case-fatality rate results are commonly obtained at the end of
an outbreak. It is used to assess the fatality of an outbreak and evaluate public
health measures implemented.
 CASE-FATALITY MORTALITY RATE
Example 2.13: During the dengue season, within the year 2015, 180 people were admitted to the
hospital with a diagnosis of dengue fever. Among 180 patients under two-week observation, 16
dengue patients died as their platelet counts dropped to the lowest, resulting in other health
complications. Calculate the Case-fatality rate.
 
Solution:
Case-fatality rate = Number of deaths caused by a specific disease x 100
Number of confirmed cases of the specified disease
= _16 x 100
180
= 8.88 or 9%

The case-fatality rate is 8.8 or 9 per 100 population. This indicate that the severity of the dengue
fever in a particular population is at low risk.

If the result shows High CFR, it indicates insufficient proper health-care systems. Some factors are
the limited access to proper health care and limited capacity of the surveillance system to give a
timely response for the prevention and safety measures that a population must know.
 PROPORTIONATE MORTALITY RATIO

determines the proportion of deaths in a specified population over a period of

time by different causes. Each causes of death must be expressed as a percentage of all
deaths and the sum of all causes must be 100%. It includes all causes of deaths in a
certain population in a specified period of time.

Formula:
PMR= Number of deaths caused by a specific cause during a given time interval X 100
Total number of deaths from all causes during the same time interval
 PROPORTIONATE MORTALITY SAMPLE EXERCISE
Example 2.14: In Angeles City, Pampanga, there were 68 deaths due to HIV disease during
year 2017, and a total of 360 deaths due to all causes in the same year.

Given
Numerator: 68 (no. of death caused by HIV disease)
Denominator: 360 (no. of death caused by different disease/all causes)

Solution:
PMR= ___68___ x 100
360
PMR= 18.8 OR 19% of the population.
More examples of
MORTALITY RATES
TABLE 2.2 Pneumonia and All-cause Mortality and Estimated population by Age Group
for both genders and for Females alone, Philippines, January-December 2017
Both sexes Females Only
Age All Pneumonia Estimated All Pneumonia Estimated
group causes Population causes population of
(Mid-year Females
population)

0-4 28,824 2,972 11,401,600 12,435 1,336 5,541,200

5-14 9,882 268 21,323,700 4,334 312 10,382,300

15-24 18,959 827 19,991,900 6,072 335 9,736,600

25-34 27,706 1,174 16,498,500 8,790 421 8,140,000

 Both sexes Females Only
Age All causes Pneumonia Estimated All causes Pneumonia Estimated
group Population population of
(Mid-year Females
population)
35-44 41, 940 1,657 13,083,60 14,150 659 6,464,000
0
45-54 70,298 2,827 10,313,40 24,547 1,020 5,124,100
0
55-64 103, 734 5,819 6,973,100 36,969 2,119 3,557,700
65 + 289,221 40,857 5,335,600 145,593 20,745 3, 048,100
Not 145 414 0 30 50 0
stated
Total 590, 709 56, 815 104 252, 920 24, 878 51, 994, 000
(all 921,400
Ages)

Source: The 2017 & 2018 Philippine Health Statistics (Epidemiology Bureau Department of Health)
EXAMPLES 2.15: Table 3 provides the number of deaths from all causes and from
Pneumonia by age group in the Philippines in 2018. Calculate the following using the
data presented in table 3 and determine which type of mortality rate is used.

A. Pneumonia-specific Mortality Rate for the entire population

B. All-cause Mortality Rate for 55-64 years old.
C. All-cause Mortality among Females
D. Pneumonia-specific mortality among 25- to 34-year-old females.
 SOLUTIONS

A. Type of Mortality Rate: Cause-specific Mortality Rate

CSMR= total number of deaths caused by Pneumonia in the entire population x 100,000
Mid-interval population/ estimated population
= __56,815 x 100,000
104, 921, 400
CSMR = 54%

Conclusion: There are 54 pneumonia deaths per 100,000 population in the

Philippines for year 2018.
 
 SOLUTIONS

B. Type of Mortality Rate: Age-specific Mortality Rate

ASMR= total number of deaths from all causes among 55-64 years old x 100,000
Estimated midyear population of 55-64 years old
= 103,734 x 100,000
6,973,100

ASMR = 1,487.6

Therefore, there are 1,487.6 deaths per 100,000 population of 55-64 years old.
 SOLUTIONS

C. Type of Mortality Rate: Sex-specific Mortality Rate

 
SSMR = total number of deaths from all causes among females x 100,000
Estimated midyear population of males
= __252,920 x 100,000
51,994,000
= 486

There are 486 deaths per 100,000 population of females in 2018.

 SOLUTIONS

D. Type of Mortality Rate: Age-Specific, Sex-specific and Cause-specific mortality rate

 
CSMR= total number of deaths caused by Pneumonia among 25-34 yr. old females x 100,000
Estimated midyear population of females

= __ 421 x 100,000
8,140,000
= 5.17 %

Therefore, there are 5.17 or 5 deaths caused by Pneumonia per 100,000

population of 25-34 years old female.
 
 SUMMARY

Morbidity and mortality are two types of retrospective

information that allows for continuous evaluation of the
efficacy of either a specific health care system or an
implemented intervention in place. For example, the use of
maternal morbidity and mortality to gauge the risks of
pregnancy and childbirth, as well as the efficacy of the health
care they receive, are of vital importance.
 THANK YOU!

Don’t forget to visit the

Google classroom for your
activities and evaluation.
 References
BOOK REFERENCES

1. Merrill, R. M. (2016). Introduction to Epidemiology (7th ed.). Jones & Bartlett Learning.

2. Dicker, R., Coronado, F., Koo, D., & Parrish, R. G. (2021). Principles of Epidemiology in
Public Health Practice, 3rd Edition (3rd ed.). CDC (Centers for Disease Control and
Prevention).

3. Jekel’s Epidemiology, Biostatistics, Preventive Medicine, and Public Health. (2020).

Elsevier.
4. Baird, J.K, et al., (2002). Epidemiologic Measures of Risk of Malaria. Public Health
Resources. pg 385. https://core.ac.uk/download/pdf/188100131.pdf

4. Johann and Barrett Learning. Measures of Morbidity and Mortality used in Epidemiology.
http://samples.jbpub.com/9781284103717/9781449651589_CH03_Friis.pdf