ALLIED HEALTH SCIENCES Basic Community Health

TOOLS OF MEASUREMENT IN EPIDEMIOLOGY

RATES
Dr. N Sivarajah Faculty of Medicine, University of Jaffna September 06, 2012

 Epidemiology is the study of distribution and determinants of disease frequency. Epidemiology mainly focuses on morbidity and mortality in Human populations Morbidity refers to illness Mortality refers to deaths In order to measure and quantify epidemiological data Tools are needed
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Tools used in Epidemiology Prevalence & Incidence

THE PREVALENCE OF A DISEASE IS THE NUMBER OF CASES IN A SPECIFIED POPULATION AT A SPECIFIED POINT OF TIME, WHILE INCIDENCE IS THE NUMBER OF NEW CASES ARISING IN A GIVEN PERIOD IN A SPECIFIED POPULATION

Dr. N Sivarajah

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Incidence & Prevalence The Difference

INCIDENCE New cases appearing PREVALENCE Cases existing old & new cases at a point of time (Point Prevalence) or period (Period Prevalence) Useful indicator for chronic diseases
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Useful indicator for Acute diseases

Dr. N Sivarajah

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Factors influencing observed Prevalence Rate

Increased by
Longer duration of disease Prolongation of life of patients without cure Increase of new cases (Increase in Incidence) In-migration of cases Out migration of Healthy people In-migration of Susceptible people Improved diagnostic facilities (better Reporting, surveillance)

Decreased by
Shorter duration of disease High Case fatality rate from disease Decrease in new cases (Decreased incidence) In-migration of healthy people Out-migration of cases Improved cure rate of cases

Dr. N Sivarajah

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OTHER TOOLS OF MEASUREMENT

RATES RATIOS PROPORTIONS

Dr. N Sivarajah

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RATE
RATES: measure the occurrence of a disease or event in a specified population at a given period at a specified time period No of Births BIRTH RATE = ----------------------------X1000 Mid year Population The numerator is from the Denominator
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Components of a Rate
Rate comprises of A numerator A denominator Time specification usually one year A multiplier usually expressed as per 1000, 10,000, or 100,000 according to convenience or conventions, to avoid fractions
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RATIOS
Ratio is an expression of a relationship in size between two random quantities.
Eg.

Males : Females is 97.9:100 (in 2001) Doctor:Population: 44.8 : 100,000 (in 2001)
Numerator is not a component of the denominator
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PROPORTIONS
Proportion is a Ratio which indicates the relationship in magnitude of a part of the whole. A Proportion is usually expressed as a Percentage Eg.
Number of children with scabies in a village at a given time x 100 Total number of children in the village at the same time

Dr. N Sivarajah

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Common Rates & Ratios

CRUDE BIRTH RATE CRUDE DEATH RATE INFANT MORTALITY RATE MATERNAL MORTALITY RATE CASE FATALITY RATE (Ratio) SURVIVAL RATE

Dr. N Sivarajah

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CRUDE BIRTH RATE

No of live Births during the year CBR = ------------------------------------------------------X1000 Mid year Population

More specific is Fertility Rate

Dr. N Sivarajah

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GENERAL FERTILITY RATE

This is the number of live births per 1000 women in the Reproductive age group (15-49 years) in a given year

Number of live births in an area during the year X 1000 GFR = ---------------------------------------------------------------------------Mid-year Female population aged 15 49 in the same area

Dr. N Sivarajah

Rates AHS CH

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GFR is a better measure of fertility than the CBR because the denominator is restricted to the number of women in the child bearing age, rather than the whole population. The major weakness is that not all women in the denominator are exposed to the risk of pregnancy.

Dr. N Sivarajah

Rates AHS CH

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CRUDE DEATH RATE

Number of deaths during the year CDR = --------------------------------------- X 1000 Mid year population of that year

Dr. N Sivarajah

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Age & Sex specific Death Rates

Number of Deaths in a specific Age / Sex group = -------------------------------------------------------X 1000 Mid-year population in that Age/Sex group

Dr. N Sivarajah

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INFANT MORTALITY RATE

Number of deaths of Infants during the year

IMR = ------------------------------------------------------------X 1000 Number of live births during the year

Note: Infant is a child under one year of Age

Dr. N Sivarajah

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Pregnancy wastage / deaths between conception & one year

All fetuses over 1000 G Or 35 cms. crown to heel Or 28 weeks gestational age

INFANT NEONATE

ABORTION

STILLBIRTH

EARLYNEONATE

LATENEONATE

POST NEONATE

CONCEPTION 28 WEEKS

BIRTH 7 DAYS 28 DAYS PERINATAL PERIOD

1 YEAR

Dr. N Sivarajah

Rates AHS CH

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Maternal Mortality
A maternal death is defined as the death of a women while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy or the management but not from accidental or incidental causes.

Dr. N Sivarajah

Rates AHS CH

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Late Maternal & Pregnancy related deaths

Late maternal death: is the death of a woman from direct or indirect obstetric causes more than 42 days but less tha one year after termination of pregnancy. Pregnancy-related death: This is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death
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MATERNAL MORTALITY RATE

Number of women dying of *maternal causes* X 10,000 MMR= ------------------------------------------------------------------Number of **Total Births

*Maternal

Causes refer to complications of Pregnancy, abortion, delivery & Puerperium (up to 42 days after delivery)

** Total Births includes live births and Stillbirths

Dr. N Sivarajah

Rates AHS CH

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Incidence Rate
Number of persons who start a spell of illnesses = ------------------------------------------------------ X 1000 Population exposed to the risk of getting the illness

Dr. N Sivarajah

Rates AHS CH

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Point Prevalence Rate

Number of persons sick at a given point of time = ------------------------------------------------------ X 1000 Population exposed to risk

Period Prevalence refers to a specified period

Dr. N Sivarajah

Rates AHS CH

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Case Fatality Rate (Ratio)

Total deaths due to a particular disease CFR = -------------------------------------------------X 100 Total cases due to the same disease Expressed as a Percent. CFR represents the killing power of the disease

Dr. N Sivarajah

Rates AHS CH

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Survival Rate
No. of patients alive after 5 years SR = -------------------------------------------------- X 100 Number of patients diagnosed or treated SR is expressed as a percent The SR could be 5 year or 10 year survival rate Especially used in cancer studies.

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ERRORS IN RATES
NUMERATOR ERRORS DIAGNOSTIC INNACCURACY INCOMPLETE IDENTIFICATION OF CASES CHANGES IN RECORDING
CODING CLASSIFICATION DIAGNOSIS

DENOMINATOR ERRORS POPULATION MIGRATION CHANGES IN POPULATION STRUCTURE

PEOPLE HOUSING FERTILITY

CHANGES IN ADMINISTRATIVE BOUNDARIES

Dr. N Sivarajah

Rates AHS CH

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RATES FOR SRI LANKA

CENSUS POPULATION (2001) CRUDE BIRTH RATE CRUDE DEATH RATE INFANT MORTALITY RATE 18,732,256 18.9 per 1000 population 5.9 per 1000 Population 12.2 per 1000 live births

MATERNAL MORTALITY RATE 2.3 per 10.000 Live births

NEONATAL MORTALITY RATE (1996) UNDER 5 MORTALITY RATE (1996) 12.9 per 1000 Live births 4.4 per 1000 under 5 children

Source: Census of Population and Housing.2001 Department of Census & statistics. In Annual Health Bulletin. 2002 . pp ix-xii Dr. N Sivarajah Rates AHS CH 27

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