Health Statistics and Epidemiology

A. Tools
1. Demography - Is the science which deals with the study of the human population's
size, composition and distribution in space.

a. Sources of Demographic data:

 Census
 Census is defined as an official and periodic enumeration of
population.
 During the census, demographic, economic and social data are collected
from a specified population group.
 These data are then collated, synthesized and are made known to the
public for purpose of determining and explaining trends in terms of
population changes and planning programs and services.

There are two ways of assigning people when the census is being taken:
 de jure method – is done when people are assigned to the place where they
usually live regardless of where they are at the time of the census.
 de facto – is used when the people are assigned to the place where they are
physically present at the time of the census regardless of their usual place of
residence.

b. Population size
 Refers to the number of people in a given place or area at a given time.
 Population size allows the nurse to make comparisons about population
changes over time.
 One Method of measuring the population size is by determining the increase in
the population resulting from excess of births compared to deaths. This can be
done in two ways:

1. Natural increase is simply the difference between the number of births and the number of
deaths occurring in a population in a specified period of time:

Natural increase = Number of births – Number of deaths

The second method of measuring population size is to determine the increase in
the population using data obtained during two census periods.

2. Absolute increase per year measures the number of people that are added to the population
per year. This is computed using the following data:
Absolute increase per year = Pt – Po
t

Where: Pt – population size at a later year(recent)

Po – population size at an earlier year
t - Number of years between time o and time t

3. Relative increase is the crucial difference between the two censuses counts expressed in
recent years relative to the population size made during an earlier year census.

Relative increase = Pt - Po
Po

Where: Pt – population size at a later time (recent)

Po- population size at an earlier time

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 c. Population composition refers to a certain variables such as sex, age, occupation
and educational level.

 Sex composition – compares the number of males to the number of females in

the population.

Sex Ratio = number of males

Number of females x 100
The sex ratio represents the number of males for every 100 females in the population.

 Age composition:

1. Median Age – divides the population into two equal parts. So, if the median age is
said to be19 years old, it means half of the population belongs to 19 years and above,
while the other half belongs to ages below 19 years old.
2. Dependency Ratio – compares the number of economically dependent with
economically productive group in the population.
0 – 14 years old and 65 years old and above are considered economically
dependent.
15– 64 years old – are considered productive age group

d. Population Distribution – it can be described in terms of urban-rural distribution,

population density and crowding index.
 Urban-Rural Distribution – simply illustrates the proportion of people living in
urban compared to the rural areas.
 Crowding index – describe the ease by which a communicable disease can be
transmitted from one host to another susceptible host. This described by
dividing the number of persons in a household with the number of rooms used
by the family for sleeping.
 Population density – determine how congested a place is. It can be computed
by dividing the number of people living in a given land area.

2. Vital and Health Statistics/Indicators

 General fertility Rate (GFR) – This rate is a more refined measure than crude
birth rate because the denominator makes use of the number of women of a
child-bearing age. However, it is still limited in the sense that not all women of
child-bearing age are expected to give birth for various reasons. This rate is
obtained by the following formula:

GFR= Total live births in the calendar year x 1000

Mid-year population of women of
Child-bearing age (15-44 or 48 years) for that year

 Infant Mortality Rate (IMR). This rate is considered one of the most sensitive
indices of the health conditions obtained in a population. Infant deaths are
associated with acute communicable diseases and such factors as poor
environmental sanitation and poor hygiene. This rate is obtained by the
following formula:

IMR= total deaths, less than 1 yr of age in a calendar year x 1000

Total live births in the same year

 Maternal Mortality Rate (MMR). This rate measures the risk of dying from
causes with childbirth. Maternal death is defined as the death of a mother
directly due to pregnancy, labor and puerperium within 90 days of delivery. The
MMR is obtained from the following formula:

MMR = total maternal deaths in a calendar year x 1000

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 Total live births in the same year

 Crude Birth Rate – The Crude birth rate is only a rough measure of fertility in
the population since it makes use of the mid-year population (which ignores the
number of men and women incapable of child bearing) as its denominator. This
rate is obtained using the following formula:

CBR= Total live births in a calendar year x 1000

Mid-year population for that year

 The SWAROOP’S INDEX is another proportional mortality indicator. It gives the

percentage of all deaths, which occur in persons 50 years and above as shown in
the following formula:

= total deaths in persons 50 years and above x 100

Total number of deaths for all ages

The Swaroop’s index is directly proportional to the health status of a

population.
 For example a Swaroop’s index of 80% means that only 20% of the
population is dying before the age of 50 years, which is a good indication of
the health of a population.
 A low index, on the other hand, implies the life expectancy is short and
people die more of acute and communicable diseases.

 Morbidity rates - refer to the number of people within a certain unit of the
general population who have a certain disease or condition.
 The unit of population is generally 100,000, although this may vary
depending on location and the condition in question.
 Morbidity rates are used to help determine the overall prevalence of a
specific illness.
 Morbidity rate =(number of new cases of a disease during a specific period
of time)/ (number of individuals in the population)

 LEADING CAUSES OF DEATH, 2017

LEADING CAUSES OF DEATH

TIME SERIES WITH NUMBER

Cause of Death 2013 2014 2015 2016 2017

Ischaemic heart diseases 65,378 65,551 68,572 74,134 84,120

Neoplasms 53,601 55,588 58,715 60,470 64,125

Cerebrovascular diseases 54,578 52,894 58,310 56,938 59,774

Pneumonia 53,101 53,689 49,595 57,809 57,210

Diabetes Mellitus 27,064 31,539 34,050 33,295 30,932

Hypertensive diseases 29,067 34,902 34,506 33,452 26,471

Chronic lower respiratory

23,867 24,686 23,760 24,365 24,818
infections

Respiratory Tuberculosis 22,013 23,157 24,644 24,462 22,523

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Other heart diseases 33,027 34,141 31,729 28,641 22,134

Remainder of the diseases of the

16,785 17,220 18,061 19,759 15,717
genitourinary system
  The leading cause of death in 2017 in the Philippines was ischaemic heart
disease, followed by neoplasms and cerebrovascular diseases (see table below).
Although the ischaemic heart diseases were the leading cause of death in 2016,
the numerical change is statistically significant.

 Leading Causes of Morbidity

MORBIDITY: 10 Leading Causes, Number and Rate

2010*
Diseases
Number Rate
A. Philippine Health Situation
1. Acute Respiratory Infection ** 1,289,168 1371.3

2. Acute Lower Respiratory Tract Infection

586,186 623.5
and Pneumonia

3. Bronchitis/Bronchiolitis 351,126 373.5

4. Hypertension 345,412 367.4
5. Acute Watery Diarrhea 326,551 347.3
6. Influenza 272,001 289.3
7. Urinary Tract Infection** 83,569 88.9
8. TB Respiratory 72,516 77.1
9. Injuries 51,201 54.5

10. Disease of the Heart 37,589 40.0

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B. Epidemiology and the Nurse
EPIDEMIOLOGY
 Science concerned with the circumstances under which diseases occur, where
diseases tend to flourish and where they do not.
 is the field of science, which is concerned with the various factors, and
conditions that determine the occurrence and distribution of health, disease,
defects, disability and death among groups of individuals.
 Is the study of the distribution and dynamics of disease occurrence in human
populations as a basis for determining preventive and control measures.

Uses of Epidemiology:
 Determine whether epidemiologic data are consistent with etiological
hypothesis
 Provide basis for preventive and public health services.
 Provide knowledge of disease frequency and distribution during epidemic and
non-epidemic times

Terms used in epidemiology:

 Endemic – the constant presence of a disease or infectious agent within a given
geographic area.
 Epidemic – the occurrence in a community or region of cases of a disease
condition clearly in excess of normal expectancy and derived from a common or
propagated source.
 Pandemic – denoting a disease affecting or attacking all or a large portion of the
population
 Sporadic – A term describing the occurrence of a few cases of a disease every
now and then in a geographic area. There are more immunes than susceptible.
 Infection – the entry and development of an infectious agent in the body of man
or animal.

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  Infectious agent – an organism, chiefly a microorganism but including helminths
that is capable of producing infection or infectious disease.
 Infectious disease – an apparent or manifest condition of man or animals
resulting from an infection.
 Incubation period – the time interval between exposure to an infectious agent
and the appearance of the first signs and symptoms
 Source of infection – the person, animal, object or substance from which an
infectious agent passes immediately to a host.
 Primary case – the first case that occurs to a family or community as a unit.
 Secondary case – a case resulting from a primary case.
 Reservoir – any human being, animal, anthropoid, plant, soil, or inanimate
object in which infectious agent normally lives and multiplies.
 Susceptible- a person or animal presumably not possessing sufficient resistance
against a particular agent to prevent contracting a disease if or when exposed to
the agent.
 Carrier – A person (or animal) who harbors a specific disease causing agent, in
the absence of clinical manifestations and who served as a source of infection
for others.
 Contact – A person (or animal) who has been in association with the infected
person or animal or a contaminated environment.
 Incidence – frequency or occurrence of new cases of a disease in a population
over a stated period of time expressed as a rate.
 Isolation – limitation of movement of a person having a communicable disease
or of a carrier who harbors an infectious agent.
 Quarantine – restriction of movement of those who have been in contact with a
communicable disease for a period of time during which they maybe potentially
infectious to others.
 Host – an animal or plant in or upon which a parasite live. Any organism that
harbors and provides nourishment for another organism.
 Herd immunity – is the probability of a group or community developing an
epidemic upon introduction of an infectious agent.

The Epidemiologic Triad

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  The interaction of host, agent and the environment determines the modes of
transmission, natural history, occurrence, and control of disease, illness or other
condition.
 An agent of a disease is an any, substance or force, either animate or inanimate,
the presence or absence of which may serve as stimulus to initiate or
perpetuate a disease process.
 This happens only when the agent comes in contact with a susceptible host and
under proper environmental conditions.

1. Agent Example
Biological Virus, bacteria, fungus, parasite, protozoa
Chemical Lead, mercury, insecticide, gases, dust, vapors and liquids
Physical Humidity, atmospheric pressure, radiation, noise
Mechanical trauma
Nutritive Iron or iodine deficiency, cholesterol

2. Host
 Demographic characteristics - age, sex, ethnic group, etc.
 General Health Status - anatomic structure, physiological state, nutrition, genetic
determinants, reaction to stress.
 Body defenses - skin and mucous membranes, lymphatic system
 State of immunity and immunological response – natural immunity, artificial
immunity (passive, active).

3. Environment
 Physical – weather, climate, season, soil, terrain, geology, geography
 Biological – animal reservoirs, arthropod, vectors, food supply
 Social – family and community structure, population density and mobility, political
and economic realities, occupations, roles and status, schools, housing,
transportation and provision of health services.

Phases of epidemiological Approach

1. Descriptive Epidemiology
 concerned with disease distribution and frequency

The various aspects involved in descriptive epidemiology are the following:

 Observation and recording of existing patterns of occurrence of the health
condition under study
 Description of the disease/condition as to person, place and time
characteristics
 Analysis of the general pattern of occurrence of the disease or condition.

2. Analytical Epidemiology
 attempts to analyze the causes or determinants of disease through
hypothesis testing
3. Intervention or experimental Epidemiology
 answers questions about the effectiveness of new methods for controlling
diseases for improving underlying condition
4. Evaluation Epidemiology
 attempts to measure the effectiveness of different health services and
programs