EPIDEMIOLOGY

Lecture 3:
Incidence
 What is incidence?
• The rate at which new events occur in a
population.
 Numerator
Multiplier
Number of NEW events in a specified period n
X 10

Denominator

The numerator strictly refers only to first events

of disease.
• Frequency Count
• Rate
• Proportion
 The denominator of an incidence - 1
• Average population exposed to risk during the
period.
– The average size of the population is often the
estimated population size at the midperiod. E.g.,
mid-year population when calculating annual
incidence rates.
 The denominator of an incidence - 2
• A person-time denominator (or other units
such as passenger-miles denominator).
– For each individual in the population, the time of
observation is the period that the person remains
disease-free.
– The denominator used for the calculation of
incidence is therefore the sum of all the disease-
free person-time periods during the period of
observation of the population at risk.
 Example 1
A
B
C
D
E

0 1 2 3 4 5 6 7 8 9 10

Duration (in years)

A 8 years D 4 years
Total p-y = 36
B 9 years E 5 years
Incidence= (4/36)x1000 = 111.11 per 1000 person-years
C 10 years OR 111.11 per 1000 persons per year
 Example 1
A
B
C
D
E

0 1 2 3 4 5 6 7 8 9 10

Duration (in years)

A 5 years D 6 years
Total p-y = 28
B 6 years E 1 year
C 10 years
Incidence= (4/28)x1000 = 142.86 per 1000 person-years
 Example 1
A
B
C
D
E

0 1 2 3 4 5

Duration (in years)

A 5 years D 1 year
Total p-y = 18
B 4 years E 3 years
C 5 years
Incidence= (3/18)x1000 = 166.67 per 1000 person-years
• INCIDENCE DENSITY
• FORCE OF MORBIDITY
 The denominator of an incidence - 3
• Number of people free of the disease in the
population at risk at the beginning of the
period.
• INCIDENCE PROPORTION

• CUMULATIVE INCIDENCE
Cumulative incidence rate
= (274/118539)x1000
= 2.31 cases per 1000 women
When calculating incidence, those having
the disease in the population at the start or
baseline need to be identified and excluded
from the denominator
 Attack rate
• The term “attack rate” is often used instead of
incidence during a disease outbreak in a
narrowly-defined population over a short
period of time.
• The attack rate can be calculated as the
number of people affected divided by the
number exposed.
 Secondary Attack Rate
• The number of cases of an infection that occur
among contacts within the incubation period
following exposure to a primary case in relation to
the total number of exposed contacts; the
denominator is restricted to susceptible contacts
when these can be determined.
• The secondary attack rate is a measure of
contagiousness and is useful in evaluating
control measures.
 Case fatality
• the proportion of cases with a specified
disease or condition who die within a
specified time.

• usually expressed as a percentage.

• Case fatality is a measure of disease severity

 The relationship between incidence
and prevalence

PREVALENCE = INCIDENCE X Average DURATION of disease

If prevalence is low and does not vary significantly with time.

Jan 1, Dec 31,
2013 2013
Population at risk =200
(on 1st July, 2013)
A cohort of 100 people at risk of a disease was followed
from 2012 to 2014. Following information is available.
Case no Disease start date Disease end date
1 Nov 2012 Feb 2013
2 Mar 2013 Dec 2013
3 Oct 2013 Feb 2014
4 Aug 2013 Nov 2013
5 Sep 2013 Dec 2013
6 Jan 2013 June 2013
7 Oct 2013 Mar 2014
8 Oct 2012 Dec 2012
9 Feb 2013 Sep 2013
10 Mar 2013 May 2104

Calculate the incidence rate for the period Jan 2013 to Dec 2013.