B.

Ashok
2k4 batch
•Any departure ‘subjective or objective’
from a state of physical well being.

•Itis known by different names like illness,

disability, sickness.
 The extent & nature of the disease load in the
community.
 They provide more comprehensive, accurate

& clinically relevant information on patient

characteristics.
 Starting point for aetiological studies.
 Needed for monitoring and evaluation of

disease control activities.

 Incidence and prevalence.
 Notification rates.
 Attendance rates at op depts.
 Admission, readmission & discharge rates
 Duration of stay in hospital.
 Spells of sickness or absence from work or

school.
 Three aspects of morbidity are commonly
measured-
Frequency
Duration
Severity

 They are measured in terms of rates or ratios.

 Def: Number of NEW cases occurring in a defined population
during a specified period of time.

 An incidence rate includes three important elements:

1. a numerator -- the number of new cases
2. a denominator -- the population at risk
3. time -- the period during which the cases occurred.

no. of new cases of specific disease

during a given time period
INCIDENCE = X 1000
population at risk during that period
 NEW CASES : These include those
individuals who developed the disease
during the period of study. Those persons
who already have the disease when study
started are not included.

 POPULTION AT RISK: These include

individuals who are capable of having or
acquiring the disease or condition in
question.

 TIME PERIOD: incidence rate must include

the unit of time used in final expression.
 Cumulative Incidence

 Person-time Incidence (Incidence Density)

 Cumulative incidence is the proportion of a
fixed population that becomes diseased
during a stated period of time.

No of new cases identified over a

 Cumulative given time interval

Incidence =
rate Estimated population at beginning
of interval
 Problem occurs when a population or study group is
under observation for different length of time.

 This may occur for a variety of reasons, including

attrition or dropout, mortality, or development of the
disease under study.

 To allow for varying periods of observation of the

subjects ,one uses a modification of the formula for
the incidence rate in which the denominator becomes
person-time of observation and “incidence density” is
measured.
What is the incidence rate from
October 1, 1990 to Sep 30, 1991?

4 / 14
 No of new events occurring during a
Person-time specified period of time

Incidence rate =
Total person-time units at risk
 Person-time units:
Combined measure of number of persons and
time they were at risk
 Commonly: Person-Years
 Incidence rate of postmenopausal breast cancer
in the IWHS.
 Sample population in Jan 1986 = 41,837
women
 Population at risk =
women who were pre menopausal (n=569),
with breast cancer diagnosis (n=2,293) and
who had breast removed surgically (n=1,870).
41,837 – (569+2,293+1,870) = 37,105
 After 8 yrs of follow-up 1,085 cases were
identified through state health registry.
 Number of new cases during the 8 year period
= 1,085
 Cumulative incidence for
8 year for 1 lakh population

: 1085
----------- X 1,00,000 = 2924 (per 8
37,105 years per
1 lakh)

Cumulative incidence per 1 year :

: 2924 / 8 = 365.5 (per year per lakh )
 Total number of person time years
= 37,105 X 8 = 2,96,840

Total number of person time years observed in

the study = 2,76,453

Person time incidence rate :

1085
-------------- X 1,00,000 = 392.5 (per
2,76,453 year
per
1lakh)
Cumulative incidence :
= 365.5 (per year per lakh)

Person time incidence rate :

= 392.5 (per year per lakh )

 All current cases (NEW+ OLD) existing at a
given point or period of time in a given
population.

 Obtained from cross-sectional studies.

 Prevalence is two types:

point prevalence
period prevalence
 The point prevalence rate comprises all the cases
of a disease that exist at a point in time.

Number of persons with a specific

disease at a specific point in time
Point Prevalence= X100
Total defined population at
the same time
 Period prevalence is all cases whether old, new or
recurrent, arising over a defined period of time.

no. of persons with a specific disease

during a specific period of time.

 Period prevalence = X 100

total defined population during
specific period of time

 Generally the average or mid-interval population for

the specified time period
Point and Period Prevalence

1998 1999 2000 2001 2002 2003 2004 2005 2006

1 January
 I I
I Increased by: Decreased by:
I - longer duration
- prolongation of life
- shorter duration
- high case-fatality
I - increase in new cases - decrease in new cases
- out-migration of healthy - in-migration of health
Baseline
Prevalence
Pot
 It gives information about disease burden
in the community
 To estimate the magnitude of health

problems/ disease in the community.

 For administrative and planning

purposes.
e g; hospital beds, man power need,
rehabilitation facilities.
 Relationship between Incidence
and prevalence

 Assume that population is stable and

unchanged incidence and duration then

Prevalence = Incidence X Duration