Instructor Resource

Chapter 3

Copyright © Scott B. Patten, 2015.

Permission granted for classroom use with Epidemiology

for Canadian Students: Principles, Methods & Critical
Appraisal (Edmonton: Brush Education Inc.
www.brusheducation.ca).
 Chapter 3. Basic
measures based on
frequencies and rates
Objectives
• Distinguish the parameter families of prevalence
and incidence.
• Define key parameters within each family.
• Explain the relationship between proportions and
odds.
• Describe the relationship between prevalence and
incidence.
• Define cumulative incidence and how to calculate
it.
“Basic” parameter families
• These are “basic” in the sense that they do not
embody a comparison (e.g., they do not compare
an exposed and nonexposed group).
“Basic” parameter families
Prevalence:
• point prevalence
• period prevalence
• lifetime prevalence
Incidence:
• incidence proportion
• incidence rate
Prevalence
• This can be a count: the number of people with a
disease.
• It can be a proportion: the proportion of people
with a disease.
• It can be odds: the odds of having a disease.

Prevalence is most often expressed as a proportion—

you can assume we are talking about it as a
proportion unless otherwise specified.
The prevalence family
• Point prevalence is the proportion of a population
with a disease at a point in time.
• Period prevalence is the proportion of a population
with a disease at any time during a specified time
period.
• Lifetime prevalence is the proportion of the
population with a disease at any time in their life
(up to the time/age when assessed).
Lifetime prevalence
• Lifetime prevalence is not as important as the other
2 forms of prevalence (point and period).
• It mixes up (confounds) “ever” having a condition
with “ever having a condition and surviving.”
• It is usually used for lifelong conditions that can go
into remission but never go away (e.g., some
mental disorders).
Expressing prevalence
• Imagine a classroom during the peak of the
influenza season. There are 25 students in the class,
5 of whom have influenza:

• prevalence count: 5
• prevalence proportion: 5/25
• prevalence odds: 5/20
Expressing prevalence
• Note that the prevalence proportion and the
prevalence odds are both ratios.
• A ratio is 1 number (numerator) divided by another
(denominator).
• In a proportion, the contents of the numerator are
included in the denominator, whereas this is not
true for odds.
Ratios and probabilities
• In epidemiology, we are interested mostly in
probabilities.
• Prevalence can be conceptualized as the probability
that a member of the population has a disease.
• The probability is estimated by calculating a
proportion, using data.
• The relationship between proportions and
probabilities is central to epidemiological reasoning
—we will see it again and again.
The incidence family
• Whereas prevalence quantifies how many people
have a disease, incidence quantifies the
development of new cases of a disease (risk).
• Incidence can be calculated as a proportion or a
rate.
• An incidence proportion must have a defined time
interval (a 5% risk in 1 day is different than a 5% risk
over 1 year!).
• An incidence rate has a person-time denominator
(e.g., person-days, person-years).
What is “person-time”?
• One person at risk of a disease observed for 1 year
= 1 person-year.
• One person at risk of a disease observed for 1
month = 1 person-month.
• Person-time has units, e.g. year-1 or month-1.
Rates and proportions
• Rates and proportions are not the same thing.
• This distinction is important to know, but be ware
that the terminology is used inconsistently.
• For example, an “attack rate” is an incidence
proportion calculated after an exposure that has
caused an outbreak of disease.
• “Prevalence rate” doesn’t make much sense either,
but people use it anyway.
The incidence proportion
• Incidence proportions have new cases in the
numerator.
• They have population at risk in the denominator.
• As a proportion, the denominator includes
everyone in the numerator.
• Remember: They need a specified time interval (5%
risk over 1 day is different than 5% risk over 1 year).
Odds from proportions

proportion
odds=
1 − proportion
Proportions from odds

odds
proportion=
1+ odds
Proportions and odds in rare
diseases
• Consider the 1 x 2 table representing sample data:
Has disease No disease Row totals

a b n

• When a is very small (the disease is very rare):

≈ odds =
Example calculations (n = 10)
Prevalence and incidence

incidence

Point prevalence is the balance

between inflow to the prevalence
pool (incidence) and outflow (e.g.
recovery and/or mortality).

recovery death
Prevalence and incidence (continued)

incidence

Prevalence Odds = Incidence Rate x Mean Duration

recovery death
Units for person-time & duration
• Time has units (e.g. years).
• Person-time has units (e.g. years-1).
• What happens to the units in this formula?

Prevalence Odds = Incidence Rate x Mean Duration

Crude mortality rates
• These are a special type of incidence rate (death is
always a “new event”).
• They are typically calculated as the number of
deaths in a year (numerator) divided by the
midyear population (denominator).
• The midyear population is an approximation of
person-years at risk of death during that year – so it
is reasonable to call these a rate.
End