Lilik Zuhriyah

 Rate, Ratio, Proportion

 Angka Kesakitan (Morbidity Rate)
◦ Prevalensi
◦ Insidensi
◦ Attack Rate
◦ Secondary Attack Rate
 Angka kematian (Mortality Rate)
 1000 kematian 50 kematian

100.000 orang berisiko 1.000 orang berisiko

Angka Fatalitas = 0,01 Angka Fatalitas = 0,05

(1/100) (5/100)
 Mengapa angka (rate) penting ?
 Cukupkah dengan merata-ratakan jumlah
penderita dan yang meninggal untuk
membandingkan kasus tahun ini dan tahun
lalu ?
 Cukupkah dengan membandingkan jumlah
penderita dan yang meninggal antara kota A
dan kota B ?
 Two possible categories of nominal variable :
◦ alive or dead;
◦ case or control;
◦ exposed or unexposed;etc
 These are called dichotomous variables
 The frequency measures which use
dichotomous variables are
◦ ratio,
◦ proportion,
◦ rate.
 Ratio = hubungan dua angka dimana angka
yang satu (x) dibagi dengan angka yang lain
(y)
 X dan y bersifat independen;
 x bisa merupakan bagian dari y
 Contoh :
◦ Sex Ratio = jumlah pria : jumlah wanita
◦ Sex of children attending an immunization clinic :
 Female/ male atau
 female/ all
 Proportion = ratio dimana angka yang satu
dibagi dengan angka yang lain dan numerator
merupakan subset (bagian) dari denominator
 Contoh :
◦ Proporsi kelahiran bayi laki-laki = jumlah
kelahiran bayi laki-laki : jumlah total
seluruh kelahiran bayi
◦ Sex of children attending an immunization
clinic :
 Female/ male → proporsi ? Bukan ! Why?
 female/ all → proporsi ? Ya ! Why ?
  perubahan dari angka yang satu tergantung
pada unit perubahan angka yang lain
 It is often a proportion with an added
dimension
 It measures the occurence of an event in a
population over time
 The basic formula is
number of cases or events occuring during a given time period
Rate  x10 n
populationat risk during the same time periode
Contoh :
 Rate kematian akibat Ca paru per 100.000
populasi per tahun = (40 kematian akibat Ca
paru: 100.000 populasi ) per satu tahun
 To characterize populations by age, sex, race,
exposure, and other variables
 To describe 3 aspects of the human
conditions : morbidity (disease), mortality
(death), and natality (birth)
Incidence Rate
 Definition: the probability or risk of
illness in a population over period of
time
 Measure a risk
 Kenapa tidak pakai raw number for
comparing disease occurence in different
population ?
 Rates adjust for differences in population
sizes
 Higher incidende ≈ Higher risk
 When one population has a higher
incidence of disease than other, we say
that the first population has a higher risk
of developing of disease than the second
 new cases (A) occuring during a given time period
IR  x100
population at risk during the same time period

The same periode = net time

= person-time (PT)

A
IR  x100
PT
1. Numerator =new cases of disease which
occurred or were diagnosed during the
specified period ( not include cases which
occurred or were diagnosed earlier or late
diagnosed )
2. Denominator is the population at risk ≈
person who are able to develop the
disease.
3. Denominator should represent the
population from which the cases in the
numerator arose.
In 2006, 733 new cases of Gonorrhea were reported
among the X civilian population. The 2006 mid-year
population was estimated to be 246,552.
Calculate the 2006 Gonorrhea IR ( per mil) !
1. What does it mean ?
2. Who are person have probability to get the disease
( Gonorrhea) ?
3. Is the denominator representative for the population ?
 A 2
IR  x100  x100  9 cases person  year
PT 22
Prevalence Rate
 persons having a particular disease during gv time p
prevalence  k
population during the same time period

Numerator = all (new & old) cases present

during a given time period
 In a survey of patients at a sexually transmitted disease
(STD) clinic in Malang, 180 of 300 patients stated that
they use condom in the last 2 months before the
interview.

 The period prevalence of condom use in last 2 months

= 180 / 300 X 100 = 60 %

 The prevalence of condom use in the 2 months before

the study was 60% in this population of patiens
 See figure 2-2 (Slide 18)
 Calculate Prevalence Rate (PR) in 1996 !

 Persons who are under observation in 1996 =

A, C, D, F (n=4)
 Person who is affected = A (1 person)
 PR = 1 : 4 = 0,25 = 25%
 Incidence Rate Prevalence Rate
What is measured % of Pop with Rapidity of disease
disease occurance
Numerator New case All (new & old) cases
Denominator Population at risk All population
Transmisi penyakit Bisa diketahui Tidak bisa diketahui
Kondisi saat ini Bisa digambarkan Tidak bisa
digambarkan
Short lived disease high Low
(rapidly cured or are
fatal at an early stage)
Long lived disease low high
(low mortality & cure
rate)
Two surveys were done of the same community
12 months apart. Of 5000 people surveyed at
the first time, 25 had antibodies to
histoplasmosis. 12 months later, 35 had
antibodies, including the original 25.
CALCULATE !

1. Prevalence at the second survey !

2. Incidence during the 12-month period!

Answers :

1. (35/5000)x1000 = 7/1000

2. ((35-25)/(5000-25)) x 100 = 2 per 1000

Attack Rate
 Number of new cases among the pop during the perd
AR  100
population at risk during the same time period

AR is a variant of an incidence rate, applied to a

narrowly define population observed for a limited
time, such as during an epidemic.
Of 75 persons who attended a picnic, 46
subsequently developed gastroenteritis.
AR = ?
 Number of new cases among contact of primary cases
SAR  x100
Total number of contacts

SAR is a measure of the frequency of new cases of a

disease among the contacts of known cases.
7 cases of hepatitis A occurred among 70
children attending a child care center. Each
infected child came from a different family.
The total number of persons in the 7 families
was 32. One incubation period later, 5 family
members of the 7 infected children also
developed hepatitis A.
1. AR
2. SAR

Answers :
1. AR = 7/70 X 100 = 10 %
2. SAR = 5/(32-7) X 100 = 20 %
Crude Mortality Rate
 Number of death in a specified period
CMR  x100
Average total pop. during that period

NOTICE : Death are usually accurately

measured compared with morbidity
data.
 the mortality rate from all causes of death for a
population.

 no account of the fact that the chance of dying

varies according to age, sex, race,
socioeconomic class and other factors.

 not appropriate to use CMR for comparing

different time periods different geographic
areas.
 The death rate of people living in a new
housing estate with many young families will
be very much lower than that in a old housing
estate where many retired people choose to
live.
Infant Mortality Rate (IMR)
 Number of deaths of infants  1 year
IMR  x1000
Number of live births in year

NOTICE :
IMR is often used as a measure of overall
health status when comparing different
countries. ( Why ?? )
 The numerator is the number of deaths
among children under 1 year of age
reported during a given time period, usually
calendar year.
 The denominator is the number of live
births reported during the same time
period.
 The infant mortality rate is usually
expressed per 1,000 live births.
 as Indicator health status of a community
 East Java ( 2003) IMR = 42 /1000 LB
 Indonesia ( 2001) IMR = 50/ 1000 LB
 Is the IMR rate a proportion ? No , it is a ratio
but not a proportion.
 Relate to the socioeconomic status of an area
or country ( Poverty )
Case Fatality Rate (CFR)
 Number of cause - specific deaths
among the incident cases
CFR  x100
Number of incident cases

NOTICE : CFR is a measure of the

severity of a disease, in term deaths.
Cause Spesific Mortality Rate
 the mortality rate from a specified cause for a
population.
 The numerator is the number of deaths
attributed to a specific cause.
 The denominator remains the size of the
population at the midpoint of the time
period.
 Crude Mortality Rate
◦ =(number of death / total population) x 100000
◦ = (2.123.323 / 243.401.000) x 100.000
◦ = 872,4 deaths per 100.000 population

 HIV (cause) spesific mortality rate for the

entire population
◦ = (number of HIV death/ population) x 100000
◦ = (13.468/243.401.000) x 100.000
◦ = 5,5 HIV related deaths per 100.000 population
 HIV related mortality rate among 35 – 44
years olds (Cause spesific and age spesific
mortality rate)
◦ =(number of HIV deaths in 35-44 years old /
population of 35-44 years old) x 100.000
◦ = (4.794 / 34.305.000) x 100.000
◦ =14,0 HIV related deaths per 100.000 35 – 44 years
olds
 HIV related mortality rate among 35-44 years
old black males (cause, age, race, and sex
spesific mortality rate)
◦ = (number of HIV deaths in 35-44 years olds black
males / population of 35-44 year old black males)
x 100.000
◦ = (1.212 / 1.663.000) x 100.000
◦ = 72,9 HIV related deaths per 100.000 35-44 years
old black males
Age Spesific Mortality Rate
 a mortality rate limited to a particular age group.
 the numerator is the number of deaths in that
age group;
 the denominator is the number of persons in that
age group in the population.
 Some specific types of age-specific mortality rate
are neonatal, post neonatal, and infant mortality
rates.
 The neonatal period is defined as the period
from birth up to but not including 28 days.
 The numerator is the number deaths
among children under 28 days of age
during a given time period.
 The denominator is the number of live
births reported during the same time
period.
 The post neonatal period is defined period
from 28 days of age up to but not
including 1 year of age.
 The numerator is the number of deaths
among children from 28 days up to but not
including 1 year of age during a given time
period.
 The denominator is the number of live
births reported during the same time
period.
 The maternal mortality rate is really a ratio
used to measure mortality associated with
pregnancy.
 The numerator is the number of death
assigned to cause related to pregnancy
during a given time period.
 The denominator is the number of live births
reported during same time period.
 A sex-specific mortality rate is a mortality
rate among either males or females.
 Both numerator and denominator are limited
to the one sex.
 A race-specific mortality rate is a mortality
rate limited to a specified racial group.
 Both numerator and denominator are limited
to the specific race.
 Mortality rates can be further refined to
combinations that are cause-specific, age-
specific, sex-specific, and/or race-specific.
 For example, the mortality rate attributed to
HIV among 25 – to 44- year-olds in the
united states in 1987 was 9,820 deaths
among 77.6 million 25- to 44-year-olds, or
12.7 per 100,000.
 This is a cause- and age-specific mortality
rate, because it is limited to one cause (HIV
infection) and one age group (25 to 44
years).
 to compare the mortality experience of different
populations.
 mortality rates increase with age, a higher mortality
rate in one population than in another may simply
reflect that the firs population is older than the
second.
 Statistical techniques are used to adjust or
standardize the rate in the populations to be
compared which eliminates the effect of different
age distributions in the different populations.
 Mortality rates computed with these techniques are
called age-adjusted or age-standardized mortality
rates.
 Sex
 Marriage status
 Health services status
 Age
 Urban or rural
 Socioeconomic status
 Education level
 Direct Method
•Use other town’s population as the standard
population
•Expected death in town A or B = Ʃ population
in the same age group from standard
population x death rate per 1000 from town
A or B
 Indirect Method
•Use other town’s standard death rate as the
standard death rate
•Expected death in town A or B = Ʃ population
in the same age group from town A x
standard death rate per 1000 from
population standard
Measure Numerator (x) Denominator (y) Expressed per
Number at Risk
(10n)
Crude Birth Rate Ʃ live births Estimated total 1000
reported during a population at
given time interval mid interval
Crude Fertility Ʃ live births Estimated 1000
Rate reported during a number of
given time interval women age 15-
44 years at mid
interval
Low Birth Weight Ʃ live births under Ʃ live births 1000
Ratio 2500 grams during reported during the
a given time same time interval
interval
Based on 2 pictures before, calculate :
a. Incidence rate in Oct 1, 1990 to Sept 30,
1991 !
b. Point Prevalence on October 1, 1990
c. Period Prevalence , Oct 1, 1990 to Sept 30,
1991 !
In a particular community 115 persons in a
population of 4.399 became ill with a disease
of unknown etiology. The 115 cases occured in
77 households. The total number of persons
living in these 77 householdswas 424
a. Calculate the overall attack rate in the
community !
b. Calculate Secondary attack rate in the
affected housholds, assuming that only one
case per household was a primary
(community acquired) case !
In 1987, a total of 12.088 HIV related deaths
occured in males and 1.380 HIV related deaths
occured in females. The estimated 1987
midyear population for males and females was
118.531.000 and 124.869.000 respectively
a. Calculate the HIV- related death rate for
male and females
b. What type of mortality rates did you
calculate in step a ?
c. Calculate the HIV mortality rate ratio for
males versus females !
 Lwanga, SK., Tye, Cho- Yook., Ayeni, O.
1999. Teaching Health Statistics Lesson and
Seminar Outline. Second Edition. WHO