Disease Measurement

Dr. Shirley I. M. dr. MKes

 Measures of
Disease Frequency

The most basic measure of disease frequency is a simple

count of affected individuals
a simple count not enough, ex.:

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
In epidemiology we must know:

the size of the population from which the

affected individuals come, and
the time period the information was
collected.
 Basic Measure of Disease Frequency
A rate is a number of events (births, cases of
disease, or death) in a given population over a
given period or a given point in time
Rate
an example: Incidence
Population at Risk : Part of the population that
susceptible to a disease
Three general categories of rates:
Birth rates
Morbidity(sickness) rates
mortality or fatalityu rates
 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
 Incidence (cont.)

I= number of new events during a period of time

number of persons at risk during this time period
 Incidence Rates
A special type of proportion that includes a specific time period
and population-at-risk

Numerator = the number of newly affected individuals occurring

over a specified time period

Denominator = the population-at-risk over the same time period

There are two types of incidence rates..

 Cumulative Incidence Rate

(CIR)
A measure of average risk
CIR answers the question: what is the probability or chance that an
individual develops the outcome over time

Also referred to as the risk or event rate

Common risks or CIRs

5-year breast cancer survival rate
94% (for local stage), 18% (for distant stage)
Case-fatality rate
23% of neonates with bloody D and fever die (e.g., Africa)
In-hospital case-fatality (mortality) rate
5% of hospitalized patients die at hospital X.
Attack rate
25% of passengers on a cruise ship got V&D Mathew J. Reeves, Dept. of
Epidemiology, Mich State
Univ.
 Incidence Density Rate (IDR)
Defn: the speed at which a defined at-risk group or population develops a new clinical
condition or outcome over a given time period.

IDR = Number of newly disease individuals

Sum of time periods for all disease-free indv.-at-risk

denominator is "person-time" or "population time

a measure of the instantaneous force or speed of disease

IDR ranges from 0 to infinity (it is not a proportion!)

The Concept of person-time
the sum of the disease-free time experience for individuals at risk in the population

Concept: 100 people followed for 6 months have same person-time

experience as 50 people followed for a year.
100 x 0.5 = 50 person-years
50 x 1.0 = 50 person-years

How to calculate? (add up disease-free time)

100 subjects followed for 6 months
1 new case develops on day 1 of each successive month (i.e., 2 thru 6):
Person time is the sum of disease free-time for each month (1 thru 6)
= 100 + 99 + 98 + 97 + 96 + 95 = 585 months
IDR = 5/585 person-months or 8.54 per 1,000 person months

Person time can be measured with whatever scale that makes the most sense i.e.,
person-days, person-weeks, person-months, person-years (PY)
Incidence Density Rate (IDR)
A measure of the speed that disease is occurring
IDR answers the question: At what rate are new cases of disease
occurring in the population

Common IDRs
Mortality rate (Vital Statistics)
Lung CA mortality rate = 50 per 100,000 PY
Breast CA mortality rate = 15 per 100,000 PY

Disease Incidence Rates

IDR of neonatal diarrhea = 280 per 1,000 child weeks

Disease specific IDR rates

Calculated for specific sub-sets defined by age, gender or race
Black Men: Lung CA incidence rate = 122 per 100,000 PY
Wh. Female: Lung CA incidence rate = 43 per 100,000 PY
Mathew J. Reeves, Dept. of
Epidemiology, Mich State
Univ.
 Concept of the Prevalence
Pool
New cases
(Incidence)

Recovery
Death
rate
rate

Mathew J. Reeves, Dept. of

Epidemiology, Mich State
Univ.
 Relationship between Prevalence and Incidence

Prevalence is a function of:

the incidence of the condition, and
the average duration of the condition
duration is influenced in turn by the recovery rate and mortality rate

Prev ~ Incidence x Duration

This relationship explains why.

Arthritis is common (prevalent) in the elderly
Rabies is rare.
Influenza is only common during epidemics.

Mathew J. Reeves, Dept. of

Epidemiology, Mich State
Univ.
 Example: Incidence
If there were 150,000 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
Definition: the proportion of a defined group or population that has a clinical condition or
outcome at a given point in time

Prev = Number of cases observed at time t

Total number of individuals at time t

ranges from 0 to 1 (its a proportion), but usually referred to as a rate

and is often shown as a %

Example:
Of 100 patients hospitalized with stroke, 18 had ICH
Prevalence of ICH among hospitalized stroke patients = 18%

The prevalence rate answers the question:

what fraction of the group is affected at this moment in time?
 Factors that affect prevalence
Prolong disease
Increased new cases
In-migration of cases
Out migration of healthy individual
In-migration of susceptible individuals
Better diagnostic facilities
 Case fatality
Measurement of disease severity
Case fatality rate:
Jumlah kematian karena suatu
penyakit/jumlah kasus penyakitnyang
sama pada periode yang sama
 Mortality
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 rate
Number of children less than 1 year death
Jumlah lahir hidup dalam tahun yang
sama
Maternal mortality rate
Kematian maternal yang berhubungan
dengan kehamilan sampai dengan 42
hari post partum/
Total kelahiran hidup pada tahun yang
sama