NURSE AND VITAL STATISTICS

Objectives :
At the end of the module , the student will be able to:

1. Define the fundamental concepts of statistics being used in community health

nursing practice.
2. Identify the different types and sources of data.
3. Apply the steps in health statistics.
4. Construct graphs to enhance the presentation of data.
5. Discuss statistics in the Philippine health setting
6.Determine the essential quantitative measurements used in vital statistics
7.Apply vital statistics in describing natality, morbidity and mortality cases.

INTRODUCTION
Knowledge and skills on health statistics are deemed important to the
community health nurse as he performs his roles and functions. Health statistics
are numerically stated facts pertaining or relating to diseases and health in
general. It is based on the results of the output of disease, their numbers
(counts) and rates (measurements) of persons ill (morbidity) and persons who
die (mortality). Moreover, health statistics looks into the delivery of health
services, facilities and personnel resources available directed towards the
improvement of health conditions, hence, health statistics guide in planning,
programming and implementation of health services.

DEFINITIONS
Statistics refers to a systematic approach for obtaining, organizing, and
analyzing numerical facts so that conclusions may be drawn from them.
presents a fact rather than an assumption or a hunch.

Vital statistics in the broad sense refers to the application of statistical

methods and techniques to the study of vital facts such as births, deaths,
populations, illnesses, marriages and divorces. In the narrow sense, the term
refers to births, deaths, and population.

Descriptive Statistics refers to the methods applied in order to summarize and

present data in a form which will make it easier to analyze and interpret. It
includes the methods of tabulation, graphical • presentation, computation of
averages as well as measures of variability (Mendoza, 2000).

Health Statistics are those numbers required in the planning, administration

and evaluation of health programs.

SOURCES OF EPIDEMIOLOGICAL DATA AND STATISTICS

1.Population Statistics - shows the total number of people in a given
community counted at common periodic intervals including information
like: size of population, age composition, sex distribution and birth
registration.
2. Mortality Statistics - number of deaths by: death registration thru the use
of death certificates (most accurate since it is a pre-requisite before burial
of a dead person); and death reports by limited population like insurance
companies.
3. Morbidity Statistics - number of sick persons from: (a) reportable or
notifiable disease records; (b) disease registers of specific diseases like
cancer: (c) reports of absenteeism in school, work, or companies; (d)
medical statistics; and (e) hospital records and reports.

SOURCES OF DATA

 The family record is an excellent source for such statistical information such as age, sex, ethnic
background and specific disease or condition.
 Information from records is used in compiling monthly and annual reports required by the
agency.

Their study method gives direction for collecting, presenting and analyzing
data concerning:
1. The scope of needs identified in patients and families by the public health
nurse.
2. The progress made by families in meeting their own needs for nursing
care.
3. The proportion of persons who obtain needed immunizations and
diagnostic test.
4. The number and kinds of conditions which are brought to medical
attention for diagnosis, periodic medical evaluation, and treatment.
5. The extent to which patients with chronic illness and disability attain self-
care.

 Information from records is used in compiling monthly and annual reports

required by the agency. Such information is used by the local public health agency.

TYPES OF DATA
1.Qualitative data - refers to those variables that describe a quality or
attribute observed in the people or subject being studied. The variables in
qualitative data are referred to as enumerations, classifications and discrete or
counting data.
Example: socio-economic status, health and illness patterns in
the community.

2. Quantitative data - those having measurable values, instead of counts

or enumerations. The variables allow for measurement by recording the amount
of a variable possessed by each person (or thing) being studied. Age in years is
measured by subtracting the birth date. Incubation period for a disease is the
time interval in hours or days between the infection of a susceptible person or
animal and the appearance of signs or symptoms of the disease in question.

STEPS IN HEALTH STATISTICS

There are three major steps done in health statistics before final results are
presented:

1. Collection of numerical data

The kind of data to be collected and the way in which they are collected
depend on the hypothesis or purpose of the study.

A sample - is a portion or a fraction of the population which is to be

investigated.
Sampling - is a method of collecting data on a small number of the
total population under study and then generalizing the findings to the total
population.

There are many types of samples, but the simple random sample is the only one
mentioned here.
 A random sample is a sample from a population, such that very
sample of the same size has the same probability of being chosen.

 The method for collecting data depends on the size, the hypothesis of the
sample, and the variables being studied.

 A few sources for data are records are from the public health nursing agency, clinic, school, or
industry; employment records; birth and death certificates; census reports; morbidity and
mortality, reports from the local, national, or international agencies.

Procedures used for the collection of health statistics

(a) registration of vital events like births and deaths:
(b) notification or reporting of illnesses;
(c) case records for individual illnesses and deaths
(d) health surveys for community diseases and health problems; and
(e) census for population data.

2. Summation of the collected data

-The voluminous statistical data collected are subjected to systematic

Organization, this includes:
A. Scrutinizing data, especially with regards to accuracy
B. Sorting and classifying the data into exclusive categories of classes and groups
C. Identifying pertinent statistical constant like rates and ratios
D. Presenting the data in tabular and/or graphical forms.

3. Analysis, interpretation and generalization of the summarized data

-Statistics are dependable only to the extent the data upon which they are
based are accurate and reliable.
-The nature and limitations of data must be recognized, and sources of error must be noted, accounted
for and controlled if possible.

*The following precepts must guide and govern in the analysis,

interpretation and generalization of data:
A. Being unbiased or having no preconceived ideas;
B. Rejecting contrary values, eliminating possible errors, and facing the facts as they are.
C. Noting all possible causes, testing and controlling them
D. Comparing data that are comparable. Data from unlike sources may lead to false
interpretations.

TABULATING THE DATA

 Tables are the most common way of presenting observations in a systematic

Arrangement- they show the interrelationship among the variables

 The simplest form of table is a two column frequency table which may be used for
quantitative or qualitative data. The first column gives the classes into which
data are grouped, and the second column lists the frequencies for each classification or group.

GRAPHICAL PRESENTATION OF DATA

Graphical presentations of data are useful in simplifying the presentation and
enhancing the comprehension of data.

Types of Graphs
1. Line graph
- is primarily intended to portray trends, and changes
indicating population growth, birth rates, morbidity and mortality rates

2.Bar graph
used to portray absolute or relative frequencies,
population rates or other numerical measurements across the categories
of qualitative variable or discrete quantitative (discontinuous) variable.

3. Histogram - is a graph that uses bars to present frequency distributions

of quantitative and continuous data. It is a series of adjacent rectangles
of which the frequency is equal to the class of all intervals and are of the
same width.
4. Frequency polygon - is a graph that uses dots connected with straight
lines to represent the frequency distribution of a continuous quantitative
variable or measurement.

5.Pie chart - is used to show how the whole is divided into its component
parts through the use of wedge or slice proportional to the relative
contribution of the component to the whole pie.

6.Scatter graph
- used to show the relationship between two quantitative variables, giving a rough estimate of the type
and degree of correlation between the variables.

For example: if you were plotting a child's height at various times, the height would depend upon the
time and so the height is the dependent variable and goes on the y-axis, whereas time does not depend
on anything and so is the independent variable and goes on the x-axis.

FREQUENTLY USED VITAL STATISTICS

Morbidity Rates - measures the frequency of illness within specific populations.
Time and place must always be specified. The most commonly used are:

1. Incidence Rate (new cases of a disease in a population over a period of time)

IR = no. of new cases of specific disease x 1000

estimated population

2. Prevalence Proportion Rate (old and new cases of a specified disease existing at a given period)

PR= no. of cases present at a given time x 1000

estimated population at that time

*measures the number of people who are actually suffering of the disease.
gives the existing cases at a point of time.

3. Attack Rate (cases as percent of exposed population)

AR= no. of persons acquiring a disease registered in a given year x 1.000

no. exposed to the same disease in same year

Mortality Rates these rates measures the probability of dying only if they satisfy
the previously mentioned conditions kinds:
1. Crude Death Rate - measures the decrease of population due to death. The force of mortality or
the probability of dying.
*Summarizes age specific death rate.
2. Cause of Death Rate - most causes of death rates are computed on total population which is
affected by the population composition, completeness of death registration and the disease
ascertainment level in the community.

3. Specific Death Rates - are necessary to study in detail the mortality conditions in a community. It
can be made more specific according to age, sex, occupation, education, exposure to risk factors, or
combinations of these factors.

4. Proportionate Mortality Rate - maybe due to cause, age, sex, occupation; for describing the
relative importance of different total decreases in the population of different age, sex and
occupation.
5. Infant Mortality Rate (common, conventional) - one of the most sensitive indices of the health
conditions of the community.

*An increased IMR indicates poor maternal and child health care malnutrition.
*Poor environmental condition and inadequate delivery of health services.
*A decreased IMR means better health conditions

Mortality Measures
Population as Denominator

1. Crude Death Rate

CDR= no. of deaths in a year x 1000

estimated mid-year pop. for same year

2. Specific Death Rate by Cause

SDR= deaths from a given cause in a year x 1000

estimated mid-year population for same year

3. Age Specific Mortality Rate

ASM= no. of deaths in stated age group X 1000

estimated pop. of that age group

TOTAL DEATHS AS DENOMINATOR

1. Swaroop's Index (an increase results indicates a better health status or

standards of care)

Swaroop's Index = total deaths among 50 yrs & above x 100

total deaths of all causes

2. Proportionate Mortality Rate

(deaths due to specific causes as percent of total deaths)

PMR = no. of deaths from a specific cause x 1,000

no. of deaths from all causes

LIVE BIRTHS AS DENOMINATOR

1 . Infant Mortality Rate (deaths under 1 year of age per 1,000 live births)

IMR= deaths under 1 year of age in a year x 1,000

 registered live births during the same year

2.Neonatal Mortality Rate (deaths mainly due to prenatal or genetic factors)

NMR = No. of deaths among those under 28 days of age in a calendar year x 1,000
no. of registered live births in the same year

3.Post - Neonatal Mortality Rate (deaths influenced by infection,

nutritional, genetic or environmental factors)

PNMR= No. of deaths among those 28 days to less than 1 year of age in a calendar year x 1,000
no. of registered live births in the same year

4.Maternal Mortality Rate (deaths related to pregnancy per 1,000 live births)

MMR = no. of deaths from causes related to pregnancy, delivery, puerperium in a calendar yearx1,000
no. of registered live births in the same year

Case Fatality Rate - modified or influenced by reporting of death cases, the higher the result, the more
fatal the disease.

CFR = no. of deaths from specific disease x100

no. of cases of the same disease

Fertility Measures:

1. Crude Birth Rate

- measures the natural growth or increase in population through births.

CBR = No. of registered live birth x,1000

average mid-year population

CBR is affected by:

A. accuracy of registered live births

B. influence the fertility status of the female population

C. number of female in the child bearing stage

D. the cultüral or social practices (family planning)

2.General Fertility Rate - relates birth to the segment of population who

are actually at risk of giving birth.
GER= no. of registered live birth X 1,000
no. of women 15-44 years old

3.Age - Specific Fertility Rate

SFR = no. of live births to women of certain age x 1,000

estimated female population of that age

SUMMARY
To help assess the nature of a given community, nurses study and interpret data from sources such as
vital statistics. Health statistics are numerically stated facts pertaining or relating to diseases and
health in general. It is based on the results of the output of disease, their numbers (counts) and rates
(measurements) of persons ill (morbidity) and persons who die (mortality). These are essential tools'
in forecasting, implementing, monitoring and evaluating health programs. Health statistics includes
the population and its demographic characteristics such as age, sex and status. Other factors include
physical environment and conditions, such as water supply, waste disposal, which have direct bearing
on the health status. It is essential to maintain accurate, updated statistical record and reports of
health statistics since this will reflect the impact of health programs or services in the community that
can be considered for future directions as to health action. Knowledge of the significance of health
statistics, the basic processes involved in calculating statistics, and how to analyze and interpret data,
will enable the community health nurse become a more effective and efficient health care provider.