Vital Statistics

Dr. Tarek Tawfik

 Introduction
 The physician arrives at a diagnosis and
treatment plan for an individual by means
of a case history, physical examination, and
various laboratory and other tests.
 The community may be thought of as a complex living
organism for which the public health team is the
physician. To carry out this role satisfactorily this team
must also make use of the tools and techniques for
evaluating the health status of the community.
 Introduction
 These diagnostic tools and techniques have
consisted of the community’s vital statistics,
which include the counts of births, deaths,
illnesses and the various rates and ratio that
may be computed from them.
 ?Why Vital Statistics
 Community diagnosis.
 Health and health services planning.
 Comparisons over time (trends).
 An essential component to any surveillance system.
 Comparison between different populations and
geographic regions (incidence and prevalence).
 Predictions and projections of health status, fertility
patterns, and diseases into the future.
 : Introduction

Information is a dominant characteristic of

globalization process where each people is both
a provider and consumer
Despite of progress made by some countries in
enhancing their NHSIS “National Health Statistical
Information System” and its computerization , the
Finagle’s law is still describing the situation of
potential users of statistical information
 FINAGLE’S LAW :

“ The information you have is not what you want ;

The information you want is not what you need ;

The information you need is not what you can get ;

The Information you can get costs more than you

want to pay ”
For those people with a limited “ information culture “ ,

the Information ( indicator ) is

“ like a bikini …

It shows every things ,

except the essential ones .”

 DISRAELI `S JOKE

“ There are three kinds of lies :

- the ordinary ( white ) lie ,
- the damned lie and
- the sophisticated lie which is statistics ”
 .Concept; the basic function of data

DATA
specific
context
INFORMATION
general context
KNOWLEDGE

DECISION
 ? INDICATOR
Definitions :
*A variable which helps to measure changes ,
directly or indirectly (WHO,1981) .
* A statistic of direct normative interest which

facilitates concise, comprehensive, and balanced

judgments about conditions of major aspects of the
society (H.E.W/USA,1969).
 Types of Indicators :
Five types

* Count / Number Measure without a denominator

* Proportion ( % ) Numerator is part of denominator

.
* Rate Frequency of occurrence of an event
during a specific time, usually expressed
per “k” population (k=1000,10000,… ).
Rate is used to estimate probability or
risk of occurrence of a disease or to
assess the accessibility or coverage of
health care system .
* Ratio (per k) Measure for which numerator is not

included in denominator ( e.g. : sex

ratio per 100 ; beds population per
1000 ) .
.

* Index Aggregation of measurement of

specific indicators . ( e.g. : Health
development index , summary
measures for Health Population )
 Rates and Ratios

Rate   a 
 b k
 a 

a= the frequency with which an event has

.occurred during some specified time period
a+b = the number of persons exposed to the
.risk of the event during the same time period
K = some number 10, 100, 10000, or 100,000
 Rate and Ratio

Rate: Usually reserved to refer to those calculations

that involve the frequency of the occurrence of some
.event

o Numerator of a rate is a component part of the denominator.

o The multiplier K or the base, used to facilitate calculations
and comprehension of the rate especially if it involves small
numbers.
 Rates and Ratios
Ratio: A ratio is a fraction of the
.form c d k
 Numerator is not a component part K = base
of the denominator (person/doctor C and d refer to
ratio, person-hospital-bed ratio) the frequency
of occurrence of
 The values of K most frequently some event or item
used in ratios are 1 and 100.
 ”Health indicators “vital indices

Mortality Morbidity Fertility

 Death Rates and Ratios 
 Death rates express the relative frequency of the
occurrence of death within some specified interval
of time in a specific population.

 The denominator of death rate is referred

to as the population at risk. The numerator
represents only those deaths that occurred
in the population specified by the
denominator.
 Annual Crude Death rate  -1
total number of deaths during year (January 1 to December 31) *
K
total population as of July 1

o The value of K is usually chosen as 1000.

o This indicate the overall health of a community, comparison to other
communities is hazardous unless the many characteristics, other than
health conditions, that influence the death rate (age, sex, race,
socioeconomic status).
o Adjustment is required for that purpose to control the population
difference regarding these variables.
o The same precautions should be exercised when comparing the same
community over years.
 Crude death rate
Community X has a population of 2 millions according to year 2000 census,
?the number of total deaths were 8000, what is the crude death rate

Number of total deaths (8000) * K (1000) =

Population at risk of death (total population) 2,000,000

.The crude death rate for Community X = 4

.The death rate in this community is 4 / 1000
 Annual Specific Death rate  -2
It is more meaningful and enlightening to observe the death rates of small
well defined subgroups of the total population. Rates of this type are
:called specific death rate and are defined as

Total number of deaths in a specific subgroup during a year * K

Total population in the specific subgroup as of July1
.Where K is usually equal 1000
o Subgroups for which specific death rate can be calculated include those
that might be distinguished on the basis of sex, race, age.
o Specific rates may be computed for two or more characteristics
simultaneously (white males: race-sex specific, cause specific death rate.
 Annual specific death rate
The registries of District Y revealed a total deaths of 855 persons due to
Diabetes Mellitus Type II and Coronary Heart Disease, knowing that the
total population at that year was 600,000; compute the cause specific
?death rate for this population

Deaths due to DMII and C.H.D in that year (855 )* K (1000)

Total population at risk (600,000)

.The death specific rate for these diseases = 1.425

.for 1000,or 14 / 100,000 (which is more expressive and comprehensive?) 1.4
 Adjusted or Standardized Death rate  -3

 This method allow to measure the force of mortality in a population while

holding constant one or more of the compositional factors as age, race, or
sex through a single figure which is called an adjusted death rate.

 For adjustment we can use the direct and the indirect methods of
standardization.
The direct method consists of applying to a standard population specific rates
.observed in the population of interest
From the resulting expected numbers we may compute an overall rate that
tells us what the rate of interest would be if that population had the same
.composition as the standard population
 Adjusted death rate (con.)
 This method of adjustment is not restricted to computation of death
rate, we can apply it to other rates (an adjusted birth rate).

 If two or more population can be adjusted, the option of comparison is

valid on the basis of the adjustment factors.

 The standard population used for adjustment is the U.S last decennial
census. For adjustment calculations a population of 1,000,000, reflecting
the composition of the standard population (the standard million) is
frequently used.
 Direct Adjustment method

The 1970 crude death rate for Georgia (a U.S state) was 9.1
deaths/ 1000 population, how to obtain an age adjusted death
rate for Georgia by using the 1970 United States census as the
?standard population
:Data necessary for calculations
 The population of Georgia classified according to age groups.

 The deaths in the Georgians by age groups.

 The age specific death rates for different age groups.

 The standard population by age groups.

 Direct Adjustment Method

Age-specific Deaths Population Age groups

death rates (years)
)per 100,000(
584.8 2,483 424,600 0-4
47.0 449 955,000 5-14
158.6 1,369 863,000 15-24
223.6 1,360 608,100 25-34
442.9 2,296 518,400 35-44
952.3 4,632 486,400 45-54
2,072.1 7,792 384,400 55-64
3,969.1 9,363 235,900 65-74
9,060.9 12,042 132,900 and over 75
41,786 4,608,700 Total
 Adjustment
To obtain the standard population based on 1970 census population:

The total for each age group in the U.S population * 1,000,000

The grand total population (U.S population).

For the age group 0-4 : 17,154,337 * 1,000,000 / 203,211,926 = 84,416.

To obtain the expected number of deaths in the standard population:

Age-specific death rate for each age group * Standard population in

that age group / 1,000,000 = 584.8 * 84,416/1000,000 = 49.4
 Direct Adjustment Method
No. of expected Standard Population U.S population
deaths in population age groups
standard Based on U.S )years(
population population 1970
494 84,416 17,145,337 0-4
94 200,508 40,745,715 5-14
277 174,406 35,441,369 15-24
274
503
122,569
113,614
* 24,907,429
23,087,805
25-34
35-44
1,088 114,265 23,219,957 45-54
1,854 91,480 18,589,812 55-64
2,429 61,195  12,435,456 65-74
3,402 37,547 7,630,046 and over 75
10,415 1,000,000 203,211,926 Total
 Adjustment
The age adjusted death rate is computed in the same manner
:as a crude death rate

total number of expected deaths * 1000

total standard population
10.4 = 1,000,000 / 1000 * 10,415

The death rate in the United States is higher that that found in
Georgia (10.4 – 9.1 = 1.3)
?What that can tell us
 Maternal Mortality rate (ratio) -4

Deaths from all puerperal causes during a year * K

Total live births during that year
.K taken as 1000,or 100,000
 The preferred denominator for this rate is the number of women who

were pregnant during the year which is impossible to determine.

 In countries where maternal mortality ascribed to pregnancy, labor, and

puerperium are small so, K taken as 100,000, while in those countries

with high MMR, taken K as 1000 is more convenient.
 MMR is a good indicator to assess the qualities of medical care and

health facilities in any given community.

 Maternal Mortality rate (ratio)
Limitations of MMR
Fetal deaths are not included in the denominator
(inflation of rate).
A maternal death can be counted only once, although
twins and multiple births may have occurred. The
denominator will be too large, hence a small rate.
Under registration of live births, hence small
denominator and hence too large rate.
Abortion and miscarriage are not included and most
of the times these events are not registered.
 Infant Mortality Rate -5
number of deaths under 1 year of age during a year * K
total number of live births during that year
.Where K is generally taken as 1000
:Limitations
Under registration of the live births which is the
case in many developing countries.
Many of the infants who die in a given calendar
year were born during the previous year.
Many children born in a given calendar year will
die during the following year.
Infant Mortality rate is a good indictor to valuate the qualities of health care
.and health facilities
 Mortality Rates of less than one year -6

:Neonatal Mortality Rate

number of deaths under 28 days of age during a year * K

total number of live births during that year
where K =1000

:Fetal Death Rate

total number of fetal deaths during a year * K
total deliveries during that year
 Mortality Rates of less than one year -6

A fetal death rate is defined as: a product of conception that

.shows no sign of life after complete birth

:Problems in interpretation
Variation regarding the duration of gestation in different
regions.
Some countries reporting only fetal deaths with minimum
required gestational period for reporting.
It does not take into account the extent to which a community
is trying to reproduce (so we use the fetal death ratio).
 Mortality Rates of less than one year -6

:Fetal Death Ratio

total number of fetal deaths during a year * K
total number of live births during that year
.Where K is taken as 100, or 1000

:Perinatal Mortality Rate

K * )infant deaths under 7 days( + )number of fetal deaths of 28 weeks or more(
)number of live births( + )number of fetal deaths of 28 weeks or more(

All the previous indicators are important in the

.evaluation of antenatal care quality
 Cause of Death Ratio -7
:This ratio is defined as
number of deaths due to a specific disease during a year * K
total number of deaths due to all causes during that year
.K = 100
o Used to measure the relative importance of a given
cause of death.
o Should be used with caution in comparing one
community with another.
 Proportional Mortality ratio -8

This index has been suggested as a single measure for comparing

the overall health conditions of different communities:

number of deaths in a particular subgroup * K

total number of deaths
Where K = 100.
Vital Statistics II

Dr. Tarek Tawfik

 Measures of Fertility
Fertility is the actual bearing of children, while
.Fecundity is the capacity to bear children

A knowledge of the rate of childbearing

in a community is important to the
health worker in planning services
and facilities for mothers, infants, and
.children
 Crude Birth Rate -1
:The most widely used of the fertility measures

total number of live births during a year * K

total population as of July 1
.Where k = 1000
 It is a non-specific indicator as the denominator includes all the population, while
those at risk of giving births are females in certain age group (women of age 15- 49
years).
 Even in this age group, the risk is confined to those who actually have the capacity
to be pregnant, and in many communities this is restricted within the frame of
marriage.
 General Fertility Rate -2

number of live births during a year *K

total number of women of childbearing age at that year

.Where K = 1000
.The childbearing age is usually defined as ages 15 through 44 or ages 49

The limitation of that rate is that the pattern of fertility of women is not
constant, it varies with age, the most fertile period (21-25 years) has the
greatest risk compared to other fertile periods.
By including women in the childbearing ages defines and approximates the
number of person who are actually at risk instead of including the whole
population.
 Age-Specific Fertility Rate -3

o Since the rate of fertility is not uniform along the whole period of 15-49
years, a rate that permits the analysis of fertility rates for shorter maternal
age interval is desirable (we classify the childbearing period into intervals
of 5 years duration; 15-19, 20-24, ------, etc.,)

o This classification will permits to compute the different patterns of fertility

in the different age groups. Specific fertility rates can also be computed for
other population subgroup (race, socioeconomic, other demographic
characteristics).
number of live births to women of a certain age (25-29) in a year * K
total number of women of the specified age (25-29)
.Where K = 1000
 Total Fertility Rate -4

If the 7 age-specific fertility rates are added

and multiplied by the interval which the
ages were grouped (5 years interval), the
result is called the total fertility rate.
The resulting figure is an estimate of the number of
children a cohort of 1000 women would have if,
during their reproductive years, they reproduced at
the rates represented by the age-specific fertility
rates from which the total fertility rate is computed.
 How to calculate fertility measures
Cumulative Expected Standard Age-specific Number of Number of Age of
fertility rate Births population based birth rate births to women in women
on U.S population per 1000 women of population )years(
1970 women specified age

495.0 19,182 193,762 99.0 21,790 220,100 15-19

1,379.5 30,707 173,583 176.9 37,051 209,500 20-24
2,030.0 18,313 140,764 130.1 22,135 170,100 25-29
2,362.5 7,967 119,804 66.5 9,246 139,100 30-34
2,500.5 3,227 116,925 27.6 3,739 135,400 35-39
2,540.5 1,021 225,162 4.0 1,044 261,700 40-49
80,417 1,000,000 95,005 1,135,900 Total

Crude birth rate = total births / total population

21.0 = )1000()4,608,900 / 95,005( =
GFR= (95,005/ 1,135,900)(1000) = 84.1
Age specific fertility rate= 99.0(5) + 176.5 (5) + etc= 2,540.5 (total fertility)
.Cumulative fertility rate= age-specific rate for each group * interval width
Standardized general fertility rate = (80,417/ 1,000,000)(1000)= 80.4
 Measures of Morbidity
 Another area that concerns the health worker who is analyzing the
health of a community is morbidity.
 The word morbidity refers to the community’s status with respect
to disease. Data for the study of morbidity of a community are
not, as a rule available and complete as are the data on births and
deaths because of incompleteness of reporting and differences
among regions, and countries with regard laws that requiring
diseases reporting and notification.
 The two rates most frequently used in the study of diseases in a
community are the incidence and the prevalence rates.
 Incidence Rate -1
:Defined as
total number of NEW cases of a specific disease during a year * K
total population at risk as of July1

The value of K depends on the magnitude of the numerator. A base of 1000 is used
when convenient, but 100 can be used for the more common diseases, and
.10,000 or 100,000 for the less common or rare

The incidence rate measures the degree to which new cases are occurring
in the community, is useful in helping determine the need for initiation
of preventive measures, the trends of diseases occurrence, the emergence
of an epidemic, and the type of diseases that occurring whether acute or
.chronic in nature, and the relative weight of each in the community
 Prevalence Rate -2
:The prevalence rate is really a ratio, since it is computed as

total number of cases, NEW or OLD, existing at a point in time * K

total population at risk at this point in time

.Where the value of K is selected by the same criteria as for the incidence rate

This rate is specially useful in study of chronic diseases

.to study the diseases burden and magnitudes
 Case Fatality Rate -3
This ratio is useful in determining how well the treatment programs for a certain
.disease is efficient

total number of deaths due to a disease * K

total number of cases due to the disease

Where K = 100. the period of time is arbitrary, depending on the nature of the disease, and
.it may cover several years for an endemic disease
This ratio can be interpreted as the probability of dying following
contraction of the disease in question.
This ratio reveals the seriousness of the disease in question.
 Immaturity Ratio -4

:This ratio is defined as

number of live births under 2500 grams during a year * K

total number of live births during that year

.Where K = 100
This ratio measures the magnitude of immaturity and
premature deliveries in the given community and directly
used in the evaluation of the quality of health care provided
.to women in the childbearing period
 Secondary Attack Rate -5

This rate measures the occurrence of an infectious disease among susceptible

.persons who have been exposed to a primary (index) case

number of additional cases among contacts of a

primary case within the maximum incubation period * K
total number of susceptible contacts
.Where K = 100

This rate is used to measure the spread of infection and is usually

applied to closed groups such as a household, classroom,
where it can be assumed that all members were in contact with
.the index case
Thank you