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Bathtub shape has important connotations in public health and the concept could be reflected
in two novel ways: (1) engineering (2) epidemiological model. Typical bath‑tub curve is a
combination of three failure rates, that is, decreasing, constant, and increasing failure rate,
and different techniques are utilized to reduce these failures. This brief study highlights the
concept of bath‑tub, related theory, application, and how data modeling could be undertaken
considering bath‑tub failure rate.

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180]

Nidhi Dwivedi, Sandeep Sachdeva, Anika Sulania

Department of Community

Medicine, North DMC Medical

College and Hindu Rao

Hospital, NewDelhi, India

Address for correspondence:

Dr.Sandeep Sachdeva,

Department of Community

Medicine, North DMC

Medical College and

Hindu Rao Hospital,

NewDelhi110007, India.

Email:sachdevadr@yahoo.in

Abstract

Bathtub shape has important connotations in public health and the concept could be reflected

in two novel ways:(1) engineering(2) epidemiological model. Typical bathtub curve is a

combination of three failure rates, that is, decreasing, constant, and increasing failure rate,

and different techniques are utilized to reduce these failures. This brief study highlights the

concept of bathtub, related theory, application, and how data modeling could be undertaken

considering bathtub failure rate.

Key Words: Demography, epidemiology, failure rate, hazard, injury, quality control,

mortality, survival

Introduction

Bathtub is known to be linked with human culture,

lifestyle, and socioeconomic flamboyance since historical

era. However, in modern context more so in the

developed world, it is also one of the top sites of

occurrence of injuries among adults. The typical

bathtub has important connotations in public health

and the concept could be reflected in two novel ways:

1. Engineering(hazard rate or bathtub curve)

2. Epidemiological model.

High rate of death is noticed during early course of

human life due to risk of birth and fragility and as the

age advances, natural risk of death declines to a steady

state until a period upon which body starts to wear

out. Health(including medical) science has contributed

immensely to extend human lives in last century and a

similar phenomenon is noticed for engineering goods,

electronic components, and assemblies. Most reliability

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www.ijournalhs.org

human life, that is, hazard rate or risks of failure over

time.[1]

The rate at which failure occurs at a certain time interval

say t1, t2 is called failure rate during that interval. It is

defined as the probability that a failure per unit time

occurs in an interval given that failure has not occurred

prior to the interval t1 whereas hazard rate(or hazard

function) is defined as the limit of failure rate as the

length of interval(t1, t2) approaches to zero.[2] Thus, it

is considered as instantaneous failure rate or literally

speaking hazard rate is a subcomponent of failure rate.

Hazard rate indicates the change in failure rate over the

lifetime of a population.[3]

In many situations, factors or covariates affecting an

individuals lifespan vary over time and are referred

as timevarying or timedependent covariates, for

example, in research studies involving age at which

smoker develops chronic disease(s) is dependent upon

type and level of smoking which itself can vary over

This is an open access article distributed under the terms of the Creative

Commons AttributionNonCommercialShareAlike 3.0 License, which allows

others to remix, tweak, and build upon the work noncommercially, as long as the

author is credited and the new creations are licensed under the identical terms.

For reprints contact: reprints@medknow.com

DOI:

10.4103/2349-5006.183689

Bathtub concept in health sciences: A comment. Indian j health

sci 2016;9:117-20.

117

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of children or couples employment status, both of

which can change over time. Astatement showing

lifetime relationship to covariates is incomplete without

considering covariate history, that is, values the

covariate takes over time; a generally useful approach

is to consider hazard function at time t conditional on

previous covariate values. The hazard function can take a

shape of increasing, decreasing, constant, humpshaped,

bathtub, or some other characteristic that describes

failure mechanism.[4] A typical bathtub curve is shown

in Figure1 and considered an important graphical

shape among nonmonotone shapes of the hazard rate

function.[5,6] The other shape, that is, monotone shape

reflects a constantly rising or declining nature of graph.

Bathtub curve is a composite of several failure

distributions and has three fairly distinct periods:

decreasing failure rate for infant mortality; constant

failure rate for useful life; and increasing failure rate for

wearout period.[7]

Decreasing failure rate(infant mortality period)

failure rate of a single item, but describes relative failure

rate of an entire population of products over time. If the

slope is followed from start to where it begins to flatten out

can be considered the first period, that is, characterized by

a decreasing failure rate. The weaker units die off leaving

a population that is more rigorous and the items become

less likely to fail as their survival time increases. Most of

the failures during this period are results of identifiable

causes such as a problem in design, manufacture, use of

substandard component, misapplication, or poor quality

control. As such there are four methods to reduce failures

during this period, that is, burnin testing or debugging

acceptance testing.[8] Process control charts are used to

detect potential problems with a view to detect and prevent

the occurrence of failure.

The constant failure rate period

constant failure rate known as useful life wherein failure

occurs purely by chance and, therefore, considered most

common time frame for making reliability predictions.

The time when a chance failure will occur cannot be

predicted, additionally, as the failure rate is constant,

this is the only phase in which exponential distribution

can be valid and, therefore, the time between failures

is exponentially distributed. It is pertinent to notice

how the amplitude on the bathtub curve is at its lowest

during this time. The failures of this period results

from the inherent limitations of design and accidents

that occur due to usage or random unforeseen reasons.

Good control on operation and maintenance is the key

to eliminate accidents/failures; however, basic reduction

of failure rate requires a fundamental redesign.[9] It is

worthy of attention that decrease in failure rate during

this period does not result in a proportional increase in

reliability(probability of survival).

Increasing failure rate(wearout period)

increasing failure rate with time. In a device with a

large population of components, the third and final

failure period is characterized by(a) rising failure

rate above that of the constant failure period and(b)

deterioration that causes components to reach the end

of designated useful lives. This stage is a reflection

of old age and to reduce failures it is necessary

to undertake preventive maintenance along with

replacement of dying components. Different statistical

distributions can be used to characterize each phase, for

example, infant mortality period might be represented

by gamma or Weibull, the useful life period by the

exponential, and the wearout period by gamma or

normal distribution.

118

several fields including:

1. Reliability and quality control: Hazard curve is used

in risk identification, risk assessment, analysis and

evaluation of risk associated with exposure and its

control

[Downloaded free from http://www.ijournalhs.org on Wednesday, June 08, 2016, IP: 106.79.54.180]

to calculate model age at death, life expectancy and

compression of mortality etc

3. Survival analysis: Hazard curve helps in making

prediction about risk of future infectious disease;

gives idea about the quality of clinical treatment as it

indicates survival of patient after treatment; it is also

helpful in ascertaining usefulness of new method and/

or supremacy over current techniques

4. Health and Hospital Management/Disaster

Management: Concept is applicable in emergency

department of a hospital and also in situation of

disaster

5. Actuarial sciences: Hazard curve is used to decide

payment and policy-administration systems and assist

in death classification system.

Modeling

In public health, some of the known popular models

that easily capture our attention are primary care

model, DOTS(tuberculosis) model, and more recently

AIIMS(Delhi) like model which have definitive

strengths and known weakness/limitations, but overall

found to be useful and hence stands replicated in country.

In contrast, modeling in statistical essence highlights

the entire process involved from goal definition, study

design, and data collection to scientific use. In any field

be it medical, social science, or engineering, researcher

always deals with data and seeks to draw a general

conclusion from a sample of observation with an eye

on population rather than the sample itself.

A statement in mathematical terms representing a

relationship between a dependent and nondependent/

predictor variable(s) is referred to as a model. It is

basically a description of data generating mechanism,

a simplification of complex reality, and refers to

the construction of hypothesis. Statistics is largely

considered a part of mathematics with a slight

difference notably that mathematical model is based

on deterministic distribution whereas statistical model

are probabilistic in nature. For illustration, all the

factors affecting the survival of cancer patients are

listed according to their importance and weightage

contribution with certain assumptions. The survival

may depend upon primary factors such as age, stage/

extent of disease and rate of cell cloning. These

factors are called as parameters, and statistical model

could very well predict the probability of survival at a

particular time for a set of parameters. The statistical

model not only reveals relationship of parameters with

the parameters.

These models are particularly useful when investigator

by intuitive means cannot see the relationship between two

or more facts of data set. The models, thus, constructed

are put through graphical and numerical checks before

acceptance and subsequently parameters are estimated

using data in hand across various levels. The estimated

model is useful to elucidate new understanding, derive

new predictions/forecasts(e.g.weather) or optimum

therapeutic solutions, to test hypothesis, to derive

confidence interval, lead to causal inference, and so on. To

sumup, statistical models are useful in data analysis:(1) as

a summary;(2) as a predictor; and(3) as a simulator, etc.

The hazard function is an important characteristic

of a lifetime distribution and is of interest in most

applications indicating the way risk of failure varies

with age or time. Prior information about the shape

of hazard function can help to guide model selection.

Finally, if factors affecting an individuals lifespan

vary over time, it is often essential to approach

modeling through hazard function, for example,

survival/life time data. Various statistical models

used for analyzing survival data are exponential

distribution, Weibull distribution, gamma, lognormal,

inverseGaussian distribution, etc. In the field of

health sciences, exponential and Weibull distributions

are frequently used.

The Weibull distribution could be written as

f (x| , ) = x ( -1) exp x x > 0, > 0, > 0

distribution. If <1, distribution provides decreasing

hazard rate shape whereas >1 indicates increasing

behavior and = 1 reduces the model to wellknown

constant hazard rate exponential family. [10] Thus,

Weibull distribution accommodates all three shapes of

hazard rate in the form of bathtub.

119

[Downloaded free from http://www.ijournalhs.org on Wednesday, June 08, 2016, IP: 106.79.54.180]

References

as being related to a bathtub[Figure2], the incidence

would be represented by water flowing into the tub and

the prevalence by the water in the tub(pool of cases).

The prevalence pool is affected by individuals leaving the

population(e.g.death), which can be viewed as the drainage

from the tub. The water supply itself would be individuals

coming into the population(e.g.births). The usefulness of

incidence and prevalence rate as a health status indicator

is welldocumented(WHO). These indicators are public

health management tools useful in reflecting situation with

regard to magnitude, distribution, and control of diseases;

identifications of potential highrisk population; efficacy

of preventive and therapeutic interventions; planning,

budgeting, and administration; and research purpose.

1.

Nil.

Conflicts of interest

120

2nded. NewYork: John Wiley and Sons; 1982.

2. Mann NR, Schaffer RE, Singpurwala ND. Methods for Statistical

Analysis of Reliability and Life Data. NewYork: John Wiley and

Sons; 1974.

3. MartzHF, WallerRA. Bayesian Reliability Analysis. NewYork: John

Wiley and Sons; 1982.

4. KleinJP, MoeschbergerML. Survival Analysis: Techniques for

Censored and Truncated Data. NewYork: Springer; 1997.

5. UpadhyaySK, GuptaA, DeyDK. Bayesian modelling of bathtub

shaped hazard rate using various Weibull extensions and related

issues of model selection. Indian J Stat 2012;74:1543.

6. Bath

tub

curve.

Available

from:

http://www.

cleantechnotes.org/2013/02/22/fraunhofersphotovoltaic

durabilityinitiativereducinginvestmentrisks/. [Last accessed on

2015Jun 01].

7. Cheng Tan. ACritical Discussion on Bathtub Curve. Available from:

http://www.bm.nsysu.edu.tw/tutorial/iylu/conferance%20paper/

B035.pdf. [Last accessed on 2015 Apr 15].

8. EbelingCE. An Introduction to Reliability and Maintainability

Engineering. International edition. NewYork: McGrawHill Inc.;

1997.

9. JuranJM. Quality Control Handbook. 4thed. London: McGrawHill

Inc.; 1988.

10. NelsonW. Applied Life Data Analysis. General Electric Company

Corporate Research and Development. NewYork: John Wiley and

Sons; 1982.

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