Basic measurements in

epidemiology/ Measurements of
Mortality

Prepared by
Krupa Mathew. M,
Associate professor
Define epidemiology
The study of the distribution and determinants of health-related states or events
in specified population and the application of the study to control of health problems
(J.M. Last 1988)

Uses of epidemiology
 Investigation of causation of disease.
 Study of the natural history and prognosis of diseases.
 Description of the health status of the populations.
 It includes proportion with ill Health, change over time, change with age etc
 Evaluation of the interventions.
 Planning health services, Public policy and programs.

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 Measurements used in epidemiology
• Measurement of mortality
• Measurement of morbidity
• Measurement of disability
• Measurement of natality
• Measurement of disease attributes
• Measurement of health care services
• Measurement of the risk factors
• Measurement of demographic variables
 Tools of measurement
The epidemiologist usually expresses disease magnitude as a rate, ratio, proportion.
The basic tools of measurement in epidemiology are

• Proportion
• Rate
• Ratio

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 Proportion
A part/share or number considered in comparative relation to a whole. Usually expressed as a percentage %.
This is also relation /magnitude between two quantities, and numerator is always part of denominator and
expressed as percentage
• Usually expressed as a percentage %
– Numerator (which is part of denominator)
– Denominator
– Multiplier
– No time factor

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 Proportion – example
-Proportion of female students.
-Proportion of anaemic mothers (60% mothers are anaemic)
What proportion of the population is suffering from diabetes?

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 Rate
It Measures the occurrence of an event or disease in a given population during a given period (one Year).
(Birth rate, growth rate, accident rate). Usually expressed per 100 or per 1000 population. It has a time
dimension, whereas a PROPORTION does not.

Contains
• Numerator (which is part of denominator)
• Denominator
• Multiplier
• Time period
• Usually expressed per 100 / per 1000 population

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 Rate – example
𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑖 𝑛 𝑜 𝑛 𝑒 𝑦 𝑒 𝑎 𝑟
Death rate = X 1000
𝑇𝑜𝑡𝑎𝑙 𝑝 op𝑢 𝑙 𝑎 𝑡 𝑖 𝑜 𝑛 𝑖 𝑛 𝑡ℎ𝑎 𝑡 𝑦 𝑒 𝑎 𝑟

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 Ratio
The value obtained by dividing one quantity by another - X / Y.
A ratio often compares two rates. Ratio also expresses relation of size between the two quantities. 
Numerator is not part of Denominator.
Expressed as X / Y.
Examples:
 Male to female ratio.
  Doctor : Population ratio.
 Male : Female ratio.
 WBC : RBC ratio

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MEASUREMENT
OF
MORTALITY

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 Measurement of mortality

Disease or injury that initiated the train of morbid

events leading directly to death.
• Crude death rate
• Specific death rate
• Proportional mortality rate
• Case fatality rate
• Survival rate
• Adjusted/standardized rates

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 Crude Death Rate

It is defined as “the number of deaths from all causes per 1000 estimated
mid-year population in one year, in a given place”.

The simplest measure of mortality is the crude death rate

𝐶𝐷𝑅 =
𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑 𝑢 𝑟 𝑖 𝑛 𝑔 𝑜 𝑛 𝑒 𝑦 𝑒 𝑎 𝑟 X 1000

𝑀𝑖𝑑 𝑦 𝑒 𝑎 𝑟 𝑝 𝑜 𝑝 𝑢 𝑙 𝑎 𝑡 𝑖 𝑜 𝑛

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 Specific death rate
When analysis planned to throw light on aetiology, it is essential to use specific death rates.
The specific death rates may be
(i) cause or disease specific eg. TB, cancer
(ii) related to specific groups eg. Age-specific, sex specific etc.,
i. Cause specific
e.g. Deaths due to cholera

𝑁𝑜 .𝑜𝑓 𝑑 𝑒 𝑎 𝑡 ℎ𝑠 due to cholera 𝑑 𝑢 𝑟 𝑖 𝑛 𝑔 𝑜 𝑛 𝑒 𝑦 𝑒 𝑎 𝑟 X 1000

𝑀𝑖𝑑 𝑦 𝑒 𝑎 𝑟 𝑝 𝑜 𝑝 𝑢 𝑙 𝑎 𝑡 𝑖 𝑜 𝑛
ii. Age specific
e.g. Infant deaths

𝑁𝑜 .𝑜𝑓 infants 𝑑 𝑒 𝑎 𝑡 ℎ𝑠 𝑑 𝑢 𝑟 𝑖 𝑛 𝑔 𝑜 𝑛 𝑒 𝑦 𝑒 𝑎 𝑟 X 1000

𝑀𝑖𝑑 𝑦 𝑒 𝑎 𝑟 𝑝 𝑜 𝑝 𝑢 𝑙 𝑎 𝑡 𝑖 𝑜 𝑛

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• Sex specific
e.g. Maternal deaths
𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 among males 𝑑 𝑢 𝑟 𝑖 𝑛 𝑔 𝑜 𝑛 𝑒 𝑦 𝑒 𝑎 𝑟
X 1000
• Time specific 𝑀𝑖𝑑 𝑦 𝑒 𝑎 𝑟 𝑝 𝑜 𝑝 𝑢 𝑙 𝑎 𝑡 𝑖 𝑜 𝑛
– Weekly deaths

𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 in week X 52

X 1000

𝑀𝑖𝑑 𝑦 𝑒 𝑎 𝑟 𝑝 𝑜 𝑝 𝑢 𝑙 𝑎 𝑡 𝑖 𝑜 𝑛
 PROPORTIONAL MORTALITY
RATE/RATIO
• It helps to know what proportion of total deaths are due to a
particular cause(eg. cancer) or what proportion of deaths are
occurring in a particular age group (eg. above the age of 50yrs)
• It expresses the number of deaths due to a particular cause (or in
a specific age group) per 100(or 1000) total deaths.
Proportional mortality rate
a. Proportional mortality rate from a specific disease
𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑒 𝑡𝑜 𝑎 𝑝𝑎𝑟𝑡𝑖𝑐𝑢𝑙𝑎𝑟 𝑐𝑜𝑛𝑑𝑖𝑡𝑖𝑜𝑛 in a year

X 100
𝑇𝑜𝑡𝑎𝑙 𝑛𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 from all causes in that year
b. Under five proportionate mortality rate

𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 due to cholera 𝑑𝑢𝑟𝑖𝑛𝑔 𝑜𝑛𝑒 𝑦𝑒𝑎𝑟 X 1000

Total no. of deaths during the same period

 Case fatality rate
𝑁𝑜.𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑 𝑢 𝑒 𝑡𝑜 a particular disease
CFR = X 100

𝑇𝑜𝑡𝑎𝑙 𝑛𝑜.𝑜𝑓 𝑐𝑎𝑠𝑒𝑠 due to same disease

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 Survival rate
It is the proportion of survivors in a group, studied and followed over a period.
It is a method of describing prognosis in certain disease conditions.
• Used in research studies
• Like cancer therapy or survival

𝑃𝑎𝑡𝑖𝑒 𝑛𝑡𝑠
= 𝑎𝑙𝑖𝑣𝑒 𝑎 𝑡 𝑡 ℎ𝑒 𝑒 𝑛 𝑑 𝑜 𝑓 5 𝑦 𝑒 𝑎 𝑟 X 100
𝑇𝑜 𝑡𝑎𝑙 𝑛 𝑜 .𝑜 𝑓 𝑝 𝑎 𝑡 𝑖 𝑒 𝑛 𝑡 𝑠

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 ADJUSTED OR STANDARDIZED RATES

• To compare the death rates of two populations with different age –

composition, the crude death rate is not the right yardstick.
• Hence we are using the adjusted or standardized rates
• The rate is either “age adjustment” or “age standardization” which
removes the confounding effect of different age structures and yields a
single standardized or adjusted rate, by which the mortality experience
can be compared directly.
• Standardization is carried out by one of the two methods – direct or
indirect standardization. Both the methods begin by choosing a
standard population not the age-structures of the populations
 Standardized mortality ratio
Observed deaths
SMR = X 100
Expected deaths

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Direct standardization

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Indirect standardization

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 CDR
Total population

Total deaths – all causes Specific DR

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Cholera deaths PMR