BASIC MEASUREMENTS IN

EPIDEMIOLOGY

Dr. Alok Acharya

Asst.Prof
Community Medicine
NOMCTH
Biratnagar
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 Measurements in Epidemiology
a. Measurement of mortality
b. Measurement of morbidity
c. Measurement of disability
d. Measurement of natality
e. Measurement of the presence, absence or distribution of the
characteristic or attributes of the disease
f. Measurement of medical needs, health care facilities, utilization of
health services and other health-related events
g. Measurement of the presence, absence or distribution of the
environmental and other factors suspected of causing the disease,
and
h. Measurement of demographic variables

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 Tools of measurement

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 Basic measurements in Epidemiology

• Tools of measurements
– Rates
– Ratios
– Proportions

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 Rate
• Rate measures the occurrence of some health
related event in a population during a given
time period.
• It can measure risk of developing a disease.
– E.g. Incidence rate of Lung cancer among
smokers is 8 per 1000. There is 8 per 1000
chance of developing Lung cancer among
smokers

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 Rate
• Rate has 4 elements
– Numerator,
– Denominator,
– Time specification
– Multiplier(1000 or 100,000… or 10n to
make round figure).

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 Rate
Numerator Time period
(Actual case)

Number of deaths in One Year

Death rate = X 1000

Mid- year population

Multiplier
Denominator
(Potential case)

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 Ratio
• Ratio expresses the relation in size between
two random quantities.
• The numerator is not a component of the
denominator
• The numerator and denominator represent
two different entities/ things

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 Ratio

Numerator

Number of Females in a population

Sex ratio =
Number of Males in a population

Denominator

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 Proportion
• Is a measure which indicates the relation of
part to the whole/full.
• The numerator is always part of denominator
• Usually expressed as a percentage

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 Proportion
• Proportion of children having scabies in a
village in year 2008 =
Numerator

Number of children with scabies (in 2008)

X 100

Total number of children in the village (in

2008)
Denominator

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 Mortality rates and ratios
• 1. Crude death rate
• The simplest measure of mortality is the
'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"

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 We can limit the rate to deaths from a
certain disease, that is, a disease specific
or a cause-specific rate

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We can also place restrictions on more than one
characteristic simultaneously, for example, age and
cause of death

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• 2. Specific death rates
– Cause or disease specific
– Group specific - age specific, sex specific

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 Adjusted or standardized rates
• If we want to compare the death rates of two
populations with different age-composition,
the crude death rate is not the right yardstick.
This is because, rates are only comparable if
the populations upon which they are based
are comparable.
• It is cumbersome to use a series of age
specific death rates.

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• Thus "age adjustment" or "age standardization“
is required,
• Age Standardization 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.
• The adjustment can be made not only for age
but also sex, ethnicity etc
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 Differences between Case fatality and
mortality

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 Case fatality
• In a mortality rate, the denominator represents
the entire population at risk of dying from the
disease, including both those who have the
disease and those who do not have the disease
(but who are at risk of developing the disease).
• In case fatality, the denominator is limited to
those who already have the disease.
• Case fatality is a measure of the severity of the
disease.
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 Case fatality
• Case fatality rate represents the killing power
of a disease - the ratio of deaths to cases.
• The time interval is not specified.
• Case fatality rate is typically used in acute
infectious diseases (e.g., food poisoning,
cholera, measles).
• Its usefulness for chronic diseases is limited.

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Proportional mortality rate (Ratio)
• Proportional mortality rate expresses the
"number of deaths due to a particular cause
(or in a specific age group) per 100 (or 1000)
total deaths".

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• E.g of proportional mortality rate.

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 INDIRECT AGE STANDARDIZATION
• Standard mortality ratio is a ratio (usually
expressed as a percentage) of the total
number of deaths that occur in the study
group to the number of deaths that would
have been expected to occur if that study
group had experienced the death rates of a
standard population (or other reference
population).

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• An SMR of 100 indicates that the observed
number of deaths is the same as the expected
number of deaths.
• An SMR greater than 100 indicates that the
observed number of deaths exceeds the
expected number,
• and an SMR less than 100 indicates that the
observed number of deaths is less than the
expected number.
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 Measurement of morbidity
• Incidence
• Prevalence

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 Incidence
• Incidence is defined as “the number of NEW
cases occurring in a defined population during
a specified period of time”.

Number of new cases of specific disease during a

Incidence= given period of time
X 1000

Population at risk during that period

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 Incidence
• There are 500 new cases of Hepatitis in a city with a
population of 30,000 in 2008
• Incidence of hepatitis =

500
= 16.7 per 1000 per
X 1000 year
30,000

• The Incidence rate MUST contain the time period

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 Incidence
• Incidence includes new cases recurring in the
same person
• If a person suffers from Common cold two
times in a year it has to be counted as two
new cases
• Special incidence rates are
– Attack rate
– Secondary attack rate

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• Risk
– The likelihood that an individual will
contract a disease

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 Problem with numerator
• Who has the disease?
• Who to include in numerator?
• Interview errors

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 Problem with denominator
• Everyone in denominator must have potential
to enter numerator group

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 Prevalence
• Prevalence is defined as all cases (old and
new) present at a given point of time or a
period of time in a given population.
• Prevalence is of two types:
– Point prevalence
– Period prevalence

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 Point Prevalence
• Point prevalence refers to the total number of
cases (old and new) present at given point of
time, usually a day.
• Prevalence of Cutaneous leishmaniasis in
Eastern Nepal on 5th May, 2009
• Normally when we say prevalence it is Point
Prevalence

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 Prevalence

Number of all current cases (old and new) of

specific disease during a given point of time
X 100
Estimated Population at at the same point in
time

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 Period Prevalence
• Is the total number of cases (old and new)
existing during a defined period of time in a
defined population.
• Prevalence of Pulmonary Tuberculosis in
Nepal in year 2008

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