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2001, 18(3):303311
APPLIED MEDICAL RESEARCH ARCHIVES OF HELLENIC MEDICINE 2001, 18(3):303311

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ABSTRACT

The concept of morbidity

L. SPAROS
Laboratory of Clinical Epidemiology,
School of Nursing, University of Athens, Athens, Greece
Archives of Hellenic Medicine 2001, 18(3):303311

Morbidity is an essential concept in the health sciences in totum and in epidemiology particularly. It is a univer-
sal concept that becomes understandable by its operational definition. Morbidity is the occurrence (or fre-
quency) of diseases. With the process of measurement the theoretical concept becomes observable. The rate
measures of occurrence are empirical and theoretical. The empirical measures of disease occurrence are of two
types, namely incidence measures and prevalence measures, corresponding to the two ways in which the health
of a person may be considered. The first observes the number of health-related events or incidents that a per-
son experiences. The second evaluates the person's state of health at a specific point period in time that is what
exists or prevails. The incidence measures are of two types: incidence-proportions and incidence-densities. The
proportion-type incidence rate quantifies the occurrence of an event in association with a series of person-mo-
ments, finite in number, enumerated as the denominator input for the rate, and constituting its referent. The
incidence-density rate quantifies occurrence in a finity amount of population-time accrued as a population
moves over time and comprising an infinite number of person-moments, population-time being the sum of the
members' individual fragments of person-time of follow-up. Given a population-time referent for an empirical
rate, the frequency can be only concerned with the occurrence of an event and not with a state in it, the sec-
ond input to the rate being the number of cases of that event occurring within the population-time. The inci-
dence-density rate, while having these two quantities as inputs, is expressed through the articulation of the unit
 311

and number of these, e.g. 10 cases in 100 person-years is expressed as 0.1 units of (1 year)-1 or 10 units of
(102 years)-1. The case and referent inputs into a density-type incidence rate do not constitute numerator and
denominator inputs, as the ratio is not a common fraction on account of the dimensionality of the referent in-
put. When a state (of health) is at issue the referent is inherently a series of person-moments, and the rate ex-
presses the frequency with which the state was associated with those person-moments, i.e. prevailing at those
person-specific moments. It is a prevalence rate in this definitional sense. The empirical rates may be overall
or specific rates and the overall rates may be crude or standardized. The overall rates are of interest as sub-
stitutes for the respective sets of specific rates on two accounts, simplicity and precision. A theoretical rate has
as its referent or domain an abstract defined category. A theoretical rate of the proportion type represents the
probability that a non-selected instance (person-moments) from the domain of the rate is associated with the
state or event whose frequency in that domain the rate expresses, while a corresponding empirical rate provides
an estimate (point, interval) of this probability. When a theoretical incidence proportion concerns the occur-
rence of an undesirable event, it represents the risk of that event for unselected individuals in the domain of
the rate.

Key words:: Crude rates, Incidence-density, Incidence-proportion, Overal rates, Period prevalence, Point prevalence, Spe-
cific rates, Standardized rates

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Corresponding author:
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Oxford University Press, Oxford, 1994 L. Sparos, 7 Likourgou street, GR-145 62 Kifissia, Greece