HEALTH FREQUENCY MEASURES

Dr. dr. Siswanto, MSc.

dr. Holipah
SESSION OBJECTIVES

Demonstrate to
measure morbidity
and mortality

Explain the role of

morbidity and
mortality
 SUB TOPIC
DEFINITION

MORTALITY
MORTALITY FREQUENCE

MEASURES
TOPIC
PREVALENCE
RATE
MORBIDITY
INCIDENCE
RATE
RATE VS RATIO
INCIDENCE RATE
the most common way of measuring
and comparing the frequency of
disease in populations

Incidence rate expresses the

probability or risk of illness in a
population over period of time

Since incidence is a measure of risk, when one

population has a higher incidence of disease
than other , we say that the first population
has a higher risk of developing of disease than
the second
 The formula for calculating an IR
new cases occuring during a given time period
IR  100
population at risk during the same time period
• The numerator of an incidence rate should reflect new cases of
disease which occurred or were diagnosed during the specified
period. ( not include cases which occurred or were diagnosed
1 earlier )

• The denominator is the population at risk.This mean

that person who are included in the denominator
2 should be able to develop the disease

• The denominator should represent the population

3 from which the cases in the numerator arose
 EXAMPLE
In 2012, 733 new cases of Tuberculosis were
reported among the Malang civilian
population. The 2012 mid-year population
was estimated to be 246,552.
• Calculate the 2012 tuberculosis IR
• What does it mean ?
• Who are person have probability to get the
disease ( Tuberculosis) ?
• Is the denominator representative for the
population ?
 PREVALENCE

persons having a particular disease during gv time p

prevalence  k
population during the same time period

Example : In a survey of patient at a sexually

transmitted disease clinic in Malang. 180 of 300
patients is interviewed use of a condom at least
during 2 months before the interview.

The period prevalence of condom use

( 2 months) = 180 / 300 X 100 = 60 %
Comparison of prevalence and
incidence
INCIDENCE
• Numerator : new cases occurring a given
time period
• The numerator of incidence consists only of
persons whose illness began during a
specified interval

PREVALENCE
• Numerator : all cases present during a
given time period
• Prevalence includes all persons ill from a
specified interval regardless of when the
illness began. It include not only new cases
but also old cases
 • The factor that link incidence and
Inc vs Prev prevalence

• Diseases that are short-lived, because they are

Inc vs Prev rapidly cured or are fatal at an early stage, will have
a relatively low prevalence compared with their
incidence

• Diseases with a low mortality and low cure rate, leaving

Inc vs Prev people with the disabling effect of the disease will have
a high prevalence compared with their incidence
 EXAMPLE

Two survey were done of the same community 12

months apart. Of 5000 people surveyed the first time,
25 had antibodies to histoplasmosis. 12 months later, 35
had antibodies, including the original 25.
Prev at the second survey = 35/5000 X1000 = 7/1000

Incidence during the 12-month period

= ???
CALCULATE
 ATTACK RATE ( AR)

Number of new cases among the pop during the perd

AR  100
population at risk during the same time period

AR is a variant of an incidence r, applied to a

narrowly define pop observed for a limited
time, such as during an epidemic.
 Example
Of 75 persons who attended a picnic, 46
subsequently developed gastroenteritis.

AR =.........
 SECONDARY ATTACK RATE ( SAR)

Number of new cases among contact of primary cases

SAR  100
Total number of contacts

SAR is a measure of the frequency of new cases

of a disease among the contacts of known
cases.
 Example
7 cases of hepatitis A occurred among 70 children
attending a child care center. Each infected child came
from a different family. The total number of persons in the
7 families was 32. One incubation period later , 5 family
members of the 7 infected children also developed
hepatitis A.

Calculate
AR
SAR
• AR = 7/70 X 100 = 10 %
• SAR = 5/25 X 100 = 20 %
 MORTALITY RATES

Number of death in a specified period

CMR  100
Average total population during that p

NOTICE : Death are usually accurately measured

compared with morbidity data.
 Disadvantage of a CMR is that it takes no account of
the fact that the chance of dying varies according to
age, sex, race, socioeconomic class and other factors. It
is usually not appropriate to use CMR for comparing
different time periods different geographic areas.
 EXAMPLE
• The death rate of people living in a new
housing estate with many young families will
be very much lower than that in a old housing
estate where many retired people chose to
live.
 INFANT MORTALITY RATE

Number of deaths of infants less than 1 y

IMR  1000
Number of live births in year

NOTICE : IMR is often used as a measure of

overall health status when comparing different
countries. ( Why ?? )
( Indicator health status of a community)
East Java ( 2003) IMR = 42 /1000 LB
Indonesia ( 2001) IMR = 50/ 1000 LB
• Is the IMR rate a proportion ? No , it is a ratio
but not a proportion.
• Relate to the socioeconomic status of an area
or country ( Poverty )
 Case Fatality Rate
Number of cause - specific deaths
among the incident cases
CFR  100
Number of incident cases

NOTICE : CFR is a measure of the severity of a

disease, in term deaths.
CRUDE MORTALITY RATE
The crude mortality rate is the mortality rate
from all causes of death for a population.
CAUSE – SPESIFIC MORTALITY RATE
mortality rate from a specified
cause for a population

The numerator is the number of

deaths attributed to a specific
cause

The denominator remains the size

of the population at the midpoint
of the time period
AGE-SPECIFIC MORTALITY RATE
mortality rate limited to a particular age group

The numerator is the number of deaths in that age

group

the denominator is the number of persons in that

age group in the population

Some specific types of age-specific mortality rate

are neonatal, post neonatal, and infant mortality
rates
INFANT MORTALITY RATE

one of the most commonly used measures

for comparing health services among nations

The numerator is the number of deaths

among children under 1 year of age reported
during a given time period, usually calendar
year

The denominator is the number of live births

reported during the same time period. The
infant mortality rate is usually expressed per
1,000 live births
NEONATAL MORTALITY RATE

The neonatal period is defined as the period

from birth up to but not including 28 days

The numerator of the neonatal mortality rate

therefore is the number deaths among
children under 28 days of age during a given
time period

The denominator of the neonatal mortality

rate, like that of the infant mortality rate, is
the number of live births reported during the
same time period
POSTNEONATAL MORTALITY RATE
The post neonatal period is defined period from
28 days of age up to but not including 1 year of
age

The numerator of the post neonatal mortality

rate therefore is the number of deaths among
children from 28 days up to but not including 1
year of age during a given time period

The denominator is the number of live births

reported during the same time period.
MATERNAL MORTALITY RATE
The maternal mortality rate is really
a ratio used to measure mortality
associated with pregnancy

The numerator is the number of

death assigned to cause related to
pregnancy during a given time period

The denominator is the number of

live births reported during same time
period
SEX-SPECIFIC MORTALITY RATE

• A sex-specific mortality

1 rate is a mortality rate

among either males or
females

• Both numerator and

2 denominator are limited

to the one sex
RACE-SPECIFIC MORTALITY RATE

• mortality rate limited to

1 a specified racial group

• Both numerator and

2 denominator are limited
to the specific race
 COMBINATIONS OF SPECIFIC
MORTALITY RATE
• Mortality rates can be further refined to
combinations that are cause-specific, age-
specific, sex-specific, and/or race-specific
COMBINATION

• the mortality rate attributed to HIV among 25 –

to 44- year-olds in the united states in 1987
was 9,820 deaths among 77.6 million 25- to 44-
EXAMPLE year-olds, or 12.7 per 100,000. This is a cause-
and age-specific mortality rate, because it is
limited to one cause (HIV infection) and one
age group (25 to 44 years
The factors that influence mortality

Sex
Education Marriage
level status

morta
Socioeco lity Health
nomic services
status status

Urban
or rural
Age
THANK YOU