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Measures of Disease Occurrence

ABDUL ZAHID ILYAS
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To describe the disease

AIMS occurrence quantitatively in
the population
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 Population biologically capable of

developing disease of interest
Population at  Examples:
Risk  Uterine infections (females only)
 Mastitis (productive females only)
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Ratios, Proportions and Rates:

Ratio
A value obtained by dividing one quantity by another
𝒂
Ratios =
𝒃

a and b are two mutually exclusive frequencies

Examples
 Male to female ratio
 Clinical to subclinical ratio of disease cases
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Proportion
 Special case of a ratio in which the numerator consist of some of the individuals in
the denominator
𝒂
𝐏𝐫𝐨𝐩𝐨𝐫𝐭𝐢𝐨𝐧 =
𝒂+𝒃

 It is usually expressed as percentage

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Male  Proportion of male = 36/180 = 0.2 = 20%
(20%)
 Proportion of female = 144/180 = 0.8 = 80%
 Some ratios can be readily converted to proportion:
144 Female ❖ If male to female ratio in a population 1:4 (36:144), then
(80%)
the proportion of male is 1/(1+4) = 20%.
Rate
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 A ratio that expresses a change in one quantity (the numerator) with respect to
another quantity (the denominator)

𝒂
𝐑𝐚𝐭𝐞 =
𝒙

“a” is included in x
“x” represent population time

 Represents the average speed of events over time

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Morbidity Rate

Prevalence
Number of individuals having a disesase at a particular point in time
Number of individuals in the population at risk at that point in time
 Like a photograph of all disease present at a given point in time (old + new cases)
 Static measure of disease, not a rate
 Proportion (0 to 1) or percentage (0 to 100%)

Example:
 If 10 cows in a herd of 100 cows were lame on a particular day ( September 1st, 2021), then
the prevalence of lameness in the herd on that day would be 10/100, that is, 0.1 or 10 %.
Survey: September 1st, 2021 8

n = 100 → 10 cows were lame:

- 4 new cases on September 1st, 2021
- 6 old cases occurred before September 1st, 2021
Prevalence = 10/100 = 10%
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Incidence
 The number of new cases that occur in a known population over a specified period
of time.
 The two essential components of an incidence value are :
 the number of new cases
 the period of time over which the new cases occur
 Two main types:
 Cumulative incidence (CI)
 Incidence rate (IR)
 Proportion (0 to 1) or percentage (0 to 100%) per time interval (Cumulative
Incidence), or case/animal-time at risk (Incidence Rate).
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Cumulative Incidence (CI)

𝐍𝐮𝐦𝐛𝐞𝐫 𝐨𝐟 𝐢𝐧𝐝𝐢𝐯𝐢𝐝𝐮𝐚𝐥𝐬 𝐭𝐡𝐚𝐭 𝐛𝐞𝐜𝐨𝐦𝐞 𝐝𝐢𝐬𝐞𝐚𝐬𝐞𝐝 𝐝𝐮𝐫𝐢𝐧𝐠 𝐚 𝐩𝐚𝐫𝐭𝐢𝐜𝐮𝐥𝐚𝐫 𝐩𝐞𝐫𝐢𝐨𝐝

𝑪𝑰 =
𝐍𝐮𝐦𝐛𝐞𝐫 𝐨𝐟 𝐡𝐞𝐚𝐥𝐭𝐡𝐲 𝐢𝐧𝐝𝐢𝐯𝐢𝐝𝐮𝐚𝐥𝐬 𝐢𝐧 𝐭𝐡𝐞 𝐩𝐨𝐩𝐮𝐥𝐚𝐭𝐢𝐨𝐧 𝐚𝐭 𝐭𝐡𝐞 𝐛𝐞𝐠𝐢𝐧𝐧𝐢𝐧𝐠 𝐨𝐟 𝐭𝐡𝐞 𝐩𝐞𝐫𝐢𝐨𝐝

 Measure of the average risk, that is, the probability that an individual would
develop disease in a specified time period
 Additional animals at risk cannot be added to the initial number at risk during the
period of observation.
 Have an interpretation of the population and individuals
 Range from 0 to 1 and must be accompanied by a specified time period
Example:
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 20 animals in a cattery develop feline viral rhinotracheitis during a week, and there
are 100 healthy cats in the cattery at the beginning of the week, then, for the
week:
CI = 20/100 = 20%

If non-diseased animals are removed from the population during this period :

Number of individuals that become disease during a particular period

𝑪𝑰 =
Number of healthy individuals in the population at the beginning of that period
−𝟏/𝟐(the value of the number removed)

 From the illustration above, if 10 animals were sold during of time period of
observation, then:
𝟐𝟎
𝑪𝑰 = = 𝟎. 𝟐𝟏 = 𝟐𝟏%
𝟏
𝟏𝟎𝟎 − ൗ𝟐 (𝟏𝟎)
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Incidence Rate

Number of new cases that occur in population during a particular period of time
𝑰=
the sum, over all individuals, of the length of time at risk of developing disease

 Have interpretation for population, not individual

 Calculated per animal-month, per animal-year, and so on
 This unit of time is termed the internal time component.
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Example:
 5 animals are observed for 1 year and 3 develop disease.
one at day 72 (0.20 year)
one at day 180 (0.50 year)
one at day 290 (0.80 year)

using the exact denominator:

I = 3/(2 + 0.20 + 0.50 + 0.80)
= 3/3.50 = 0.86 cases/ animal-years at risk;

using the approximate denominator:

I = 3/ {(5 + 2)/2}
= 3/(7/2) = 0.86 cases/ animal-years at risk.

 The exact and approximate values are equal because the exact average
period of risk for diseased animals is half of the period of observation = (0.20 +
0.50 + 0.80)/3 = 0.50 years (six months).
 If the excact average period of risk of diseased animal is less than half of 14
period of observation → the approximate denominator underestimates
the exact rate, and vice versa.
Example:
- If five animals are observed, and three develop disease:
- Two at day 120 (0.33 year)
- One at day 240 (0.67 year)
Using the exact denominator:
I = 3/(2+0.33+0.33+0.67) = 0.90 → using the approximate denominator, again
I = 0.86 (underestimate)
- If five animals are observed, and three develop disease:
- One at day 120 (0.33 year)
- Two at day 240 (0.67 year)
Using the exact denominator:
I = 3/(2+0.33+0.67+0.67) = 0.82 → using the approximate denominator, again
I = 0.86 (overestimate)
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Attack Rate

 Alternative to cumulative incidence, used when the nature of the problem is of

short duration (e.g. food-borne illness)

Number of new cases of disease during a period

𝑨𝑹 =
Population at risk at beginning of period
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Mortality Rate (M)

1. Crude Mortality Rate:

number of deaths that occur in a population during a particular period 𝐨𝐟 𝒕𝒊𝒎𝒆

=
the sum, over all individuals, of 𝐭𝐡𝐞 𝐥𝐞𝐧𝐠𝐡𝐭 𝐨𝐟 𝐭𝐢𝐦𝐞 𝐚𝐭 𝐫𝐢𝐬𝐤 𝐨𝐟 𝒅𝒚𝒊𝒏𝒈

2. Cause-specific Mortality Rate:

number of deaths due to the disease that occur in a population during a particular period 𝐨𝐟 𝒕𝒊𝒎𝒆
=
the sum, over all individuals, of 𝐭𝐡𝐞 𝐥𝐞𝐧𝐠𝐡𝐭 𝐨𝐟 𝐭𝐢𝐦𝐞 𝐚𝐭 𝐫𝐢𝐬𝐤 𝐨𝐟 𝒅𝒚𝒊𝒏𝒈
3. Case Fatality Rate (CFR)
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 The tendency for a condition to cause the death of affected animals in a specified
time
 The proportion of affected individuals that die from the disease. A measure of
disease severity or virulence of infectious agent
 Take values between 0 and 1 (or 0 -100%).

number of deaths
CFR = number of diseased animals
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Proportional Rates

1. Proportional Morbidity Rate:

number of animals with a specified diseas𝒆
total number of diseased animal

2. Proportional Mortality Rate:

number of deaths from a specified cause
𝐭𝐨𝐭𝐚𝐥 𝐧𝐮𝐦𝐛𝐞𝐫 𝐨𝐟 𝐝𝐞𝐚𝐭𝐡
Incidences of Mortality 19

A=general population

B=cases of
disease X

C=death
from  Crude mortality = D/A
disease X
 Cause specific mortality for disease X = C/A
D=death from all  Case fatality for disease X = C/B
causes  Proportional mortality for disease X = C/D
Examples of Crude Mortality, Cause Specific Mortality, and Case Fatality Rate : 20
 At a dairy farm, it is known that 40 cows died in one year. The total number of dairy
cows at the beginning of the year was 400, mid-year 420 and the end of years 390.
So the crude mortality rate is:
= 40/{(400+390)/2}=40/395 = 0.101 (10.1%)
Or = 40/{(400+420+390)/3}=40/403 = 0.099 (9.9%)

 From the illustration above, it is known that 20 of cows died due to babesiosis, so
the mortality rate due to babesiosis is:
= 20/395=0.051=5.1%
Or = 20/403=0.05=5%

 From the illustration above, for example there were 50 cows suffering from
babesiosis during the observation period, the case fatality rate is:
20/50 = 0.4 = 40%
Example of Proportional Morbidity Rate (PMR):
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 During 6 months of observation there were 80 cases at cattle farm. The disease
data is presented in the following table:

Disease Number of Cases PMR (%)

Septicemia epizootica 4 5
Helminthiasis 40 50
Bloat 20 25
Pink Eye 16 20
Total Number of Cases 80 100
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Crude and Specific Measure

 Crude measure are an expression of amount disease or deaths in a population as a

whole, they take no account of the characteristic of the population affected.
 Specific measure describe diseases occurrence and deaths in specific categories
of the population related to host attributes such as age, sex, breed, method of
husbandry, and others.

Example: Crude and specific measure

 In a backyard poultry flock, 10 of 100 birds were found dead. Of the 100 birds, 50 were
young and 50 were old. Nine the dead birds were young.
- Crude Mortality Rate = 10/100 = 10%
- young-bird specific mortality rate = 9/50 = 18%
- old-bird specific mortality rate = 1/50 = 2%
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Adjustment/Standardization of Rate

 Crude value can only be used to make comparisons between two different
populations if the populations are similar with respect to all characteristics that might
affect disease occurrence.
 If the populations are dissimilar → The confounding effect must be removed by
adjustment (standardization) by direct and indirect method.
 Direct adjustment method:

direct adjusted value = Sr1 x (S1/N) + Sr2 x (S2/N) + Srn x (Sn/N)

Note :
Sr : specific value in study population;
S : frequency of characteristic in the standard population;
N : total number in the standard population (N=S1+S2+…..Sn)
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Example:
 A survey has been carried out to detect subclinical mastitis in two dairy farms, i.e.
Farm A and Farm B. 40 out of 1000 dairy cows on Farm A had subclinical mastitis
cases, while 46 out of 600 dairy cows on Farm B had cases of the same disease.
From this data, the prevalence for each farm can be calculated:
• Farm A = 40/1000 = 4%
What is our conclusions ?
• Farm B = 46/600 = 8%
 Further information obtained more detailed data regarding the
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composition/characteristic of the population based on the category of the
lactation period and the number of disease cases in each category in the
two farms. The data are presented in the following table

Number of Number of
Dairy Farm Lactation Period Prevalence
Cows Cases
- 1st lactation period 600 12 0.02
A - 2nd lactation period 200 8 0.04
- 3rd lactation period 200 20 0.10
- 1st lactation period 100 2 0.02
B - 2nd lactation period 100 4 0.04
- 3rd lactation period 400 40 0.10

What is our conclusion ?

 To draw conclusion as a whole, calculate adjusted value(prevalence) for
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both farms. The first select a standard population in which the frequency of
the characteristics (lactation period) is known. In this example, the total of
the three group are used, that is, 700 1st lactation period, 300 2nd lactation
period, and 600 3rd lactation period.
𝑆1 𝑆2 𝑆3
Direct adjusted value= 𝑆𝑟1 × + 𝑆𝑟2 × + 𝑆𝑟3 ×
𝑁 𝑁 𝑁

700 300 600

• Farm A = 0.02 × + 0.04 × + 0.10 ×
1600 1600 1600

= 0.00875 + 0.0075 + 0.0375

= 0.05375 = 5.375 per-100 = 5.4 %
700 300 600
• Farm B = 0.02 × + 0.04 × + 0.10 ×
1600 1600 1600

= 0.00875 + 0.0075 + 0.0375

= 0.05375 = 5.375 per-100 = 5.4 % What is our conclusion ?
 The other ways to calculate adjusted value is as follows: 27

Farm A
Number of cases based on standard population:
- 1st lactation period = 0.02 x 700 = 14
- 2nd lactation period = 0.04 x 300 = 12
- 3rd lactation period = 0.10 x 600 = 60
Number of cases = 86
Total number in the = 1600
standard population
86
Adjusted value = = 0.05375 = 5.375 per-100= 5.4%
1600
Farm B = the same
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