Morbidity & Mortality
• Morbidity refers to the unhealthy state
of an individual,
while mortality refers to the state of
being mortal.
• Both concepts can be applied at the
individual level or across a population.
• For example, a morbidity rate looks at
the incidence of a disease across a
population and/or geographic location
during a single year.
• Mortality rate is the rate of death in a
population.
The two are often used together to
calculate the prevalence of a disease —
e.g., measles — and how likely that
disease is to be deadly, particularly for
certain demographics.
Comparison chart
Morbidity Mortality
Definition Morbidity refers to the state of Mortality is the term used for
being diseased or unhealthy within the number of people who died
a population. within a population.
Demographic Morbidity refers to an incidence Mortality refers to the
reference of ill health in a population. incidence of death or the
number of deaths in a
population.
Database / World Health Statistics (compiled The Human Mortality Database
Reports by WHO), MMWR (Morbidity and developed by the Department
Mortality Weekly Report, by Center of Demography at the
for Disease Control and University of California,
Prevention, USA), EMDB Berkeley and the Max Planck
(European hospital Morbidity Institute for Demographic
Database, Europe), NHMD Research in Rostock Germany.
(National hospital morbidity
Database, Australia).
Units of Morbidity scores or predicted Mortality rates are
measurement morbidity are assigned to ill generally expressed as
patients with the help of systems the number of deaths per
such as the APACHE II, SAPS II 1000 individuals per year.
and III, Glasgow Coma scale,
PIM2, and SOFA.
Types of data Data is collected according to The mortality rate can be
the disease type, gender age, distinguished into crude
area. death rate; perinatal
mortality rate; the
maternal mortality rate;
infant mortality rate; child
mortality rate;
standardized mortality
rate; and age-specific
mortality rate.
BASIC MEASUREMENT IN
EPIDEMIOLOGY
• Measurement of mortality
• Measurement of morbidity
• Measurement of disability
• Measurement of natality (birth rate)
• Measurement of the presence, absence or
distribution of the characteristics or attributes
of the disease
• Measurement of medical needs, health care
facilities, utilization of health services and
other health related events
• Measurement of the presence, absence or
distribution of the environmental and other
factors suspected of causing the disease.
• Measurement of demographic variables
TOOLS OF MEASUREMENT:
1. Rates
2. Ratios
3. Proportions
1. RATE
• A rate measures the occurrence of some
particular event in a population during a given
time period
• It indicates the change in some event that take
place in a population over a period of time
• Rate is expressed per 1000 or some other round
figures selected according to convenience
A rate comprises the
following
-Numerator
-denominator
-time specification &
multiplier.
The time
dimension is usually a
calendar year.
VARIOUS CATEGORIES OF RATES
CRUDE RATES:
(Unstandardized rates)
These are the actual observed rates
such as birth and death rates
CONT…………
Rates comprises 4 elements –
numerator, denominator, time
specification, multiplier
Number of deaths in 1 yr
Death rate= X 1000
Mid year population
• Specific rate: These are the actual observed
rate due to specific causes (e.g.. tuberculosis)
or occurring in specific groups (age-sex
groups) or during specific time periods (eg.
annual, monthly rates)
• Standardized rates: These are obtained by
direct or indirect method of standardization or
adjustment.
K (age and sex standardized rates).
RATIO: It expresses a relation in size
between two random quantities.
• The numerator is not a component of the
denominator.
• It’s the result of dividing one quantity by
other.
• Expressed as x/y
Eg: the ratio of WBC relative to red
cells is 1:600, meaning that for each
white cell, there are 600 red cells.
Example : -
No. of males
Male : Female =
No. of females
PROPORTION:
It is a ratio which
indicates the relation in
magnitude of a part of the whole
• Numerator is always included in
denominator.
Usually expressed as a
percentage
Example
No. of children with scabies
at a certain time
X 100
The total No of children in
the village at a same time
Concept of numerator &
denominator
• Numerator: Refers to the number of
times an event has occurred in a
population, during a specified time
period.
Eg: sickness, birth,death,episodes
of sickness
The numerator is a
component of the denominator in
calculating a rate, but not in a ratio
Denominator
• Numerator has little meaning
unless it is related to the
denominator.
• The epidemiologist has to
choose an appropriate
denominator while calculating
a rate.
It may be
A. Related to the population.
B. Related to the total events.
Related to the population
• Mid- year population: 1st of July every year
• Population at risk: Restricted solely to those
who are capable of having or acquiring the
disease or condition in question.
e.g.
- general fertility rate
- Food poisoning risk
• Person-time: [Link]-week, person-year
• Person-distance: eg. passenger-miles
Related to total events
In some instances ,the
denominator may be related to total
events instead of the total population,
as in case of infant mortality rate and
case fatality rate.
In case of accidents, the number of
accidents “per 1000 vehicles” or “ per
million vehicle-miles” be a more useful
denominator than the total population,
many of them may not be using
vehicles.
MEASUREMENT OF
MORTALITY
• INTERNATIONAL DEATH CERTIFICATE
• Basis of mortality data
The concept of “underlying cause” is the
essence of the international death certificate.
PART 1: It is defined as
• The disease or injury which initiated the train of
morbid events leading directly to death
• The circumstances of the accident or violence
which produced the fatal injury.
PART 2: any significant associated disease that
contributed to the death but did not directly lead
to.
Uses of mortality data
Explaining trends & differentials in
overall mortality
Indicating priority for action
Allocation of resources
Designing intervention programmes
Assessment & monitoring of public
health problems & programmes
Gives important clues for
epidemiological research
LIMITATIONS OF MORTALITY DATA:
• Incomplete reporting of deaths
• Lack of accuracy
• Lack of uniformity
• Choosing a single cause of death
• Changing coding system and changing fashions in
diagnosis
• Diseases with low fatality
Commonly used rates & their
formulae
Crude death rate
Total number of deaths in an
area during the year
1000
Estimated mid year population
2. Specific death rates:
when analysis is planned to
throw light on etiology, Specific death
rate is used. It may be
• Cause or disease specific
• Related to specific groups
Age specific death rates
No. of death of a specified age
group in an area during the yr
1000
Estimated mid year population
Date of
Year Death rate
Information
2003 8.49 2003 est.
2004 8.28 2004 est.
2005 8.28 2005 est.
2006 8.18 2006 est.
2007 6.58 2007 est.
2008 6.4 2008 est.
July 2009
2009 6.23
est.
Sex specific death rate
No. of deaths of males or females
in an area during the year
1000
Estimated male or female population
3. Case fatality rate (ratio)
= total number of deaths due to a particular
disease *100
total number of cases due to the same
disease
• Represents the killing power of a disease
• Time interval is not specified
• Acute infectious disease
• Related to virulence
4. Proportional mortality rate (Ratio)
“It is number of deaths due to a
particular cause (or in a specific age group)
per 100 (or 1000) total deaths”.
Useful to know what proportion of total
deaths due to particular cause or what proportion
of deaths are occurring in a particular age group.
Proportionate mortality rate
Total no. of death from specific cause
at a given time in a specified area
X 100
Total no. of deaths from all causes
in the same area at that time
c) Proportional mortality rate for
aged 50 years and above
= number of deaths of persons aged 50 years
and above * 100
total deaths of all age groups in that year
Under-5 proportionate mortality rate
= number of deaths under 5 years of age in a given
year *100
total deaths during same period
Survival rate
It is the proportion of survivors in a group
studied and followed over a period
= total number of patients alive after 5
years * 100
total number of patients diagnosed or
treated
It is a method of describing prognosis in
certain disease condition
Perinatal mortality rate
FoetalPerinatal
deaths + mortality
Deaths under
rate1 wk
of birth in an area during the year
X 1000
Total live births & still births in
the same area during the same year
Neonatal Mortality Rate
No of deaths under 28 days of
Neonatal
age in an area mortality rate
during the year
X 1000
No of live births in the same area
During the same year
Infant mortality rate
No. of deaths under one year of
Infant mortality rate
ge in defined population in a yr
X 1000
No. of live births in the same
Population in the same year
Maternal mortality rate
No. of deaths from puerperal causes in
defined populations during the year
Maternal mortality rate
X 1000
No. of live births during that year
Attack rate
No of new cases of specific disease
occurring from time to time in a
Attack rate
place during the specified period
X 100
Specific population at risk in the
same place during the same period
Adjusted or standardized rates
If we want to compare the
death rates of 2 populations with
different age-composition, the crude
death rate is not the right yard stick.
Rates are only comparable,
if the populations upon which they
are based are comparable.
It is difficult to use a series
of age specific death rates.
• The answer is “ 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.
MEASUREMENT OF MORBIDITY
Morbidity has been defined as “any departure,
subjective or objective, from a state of
physiological well-being”.
It can be measured in terms of 3 units
a) Persons who were ill
b) The illnesses (periods or spells of illness) that
these persons experienced
c) The duration (days, weeks etc) of these
illnesses
Y morbidity data????
• Extent and nature of the disease load and assist
in the establishment of priorities
• More comprehensive and more accurate and
clinically relevant information on patient
characteristics
• Starting point for etiological studies
• Monitoring and evaluation of disease control
activities
INCIDENCE
• 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 given time period*1000
Population at risk during that period
It refers to:
»Only new cases
»During a given period
»In a specified population or
“population at risk”
»Refers to new spells or episodes of
disease arising in a given period of
time, per 1000 population
If there had been 500 new cases
of an illness in a population of
30,000 in a year, Find out the
incidence rate …….?
500
= ---------- 1000
30,000
= 16.7 per 1000 per year
USES
• To control disease
• For research into etiology and
pathogenesis, distribution of
disease, and efficacy of
preventive and therapeutic
measures
PREVALENCE
• It refers to all current cases ( old + new ) existing at a
given point in time or over a period of time in a given
population.
• It is defined as “the total number of all individuals who
have an attribute or disease at a particular time (or
during a particular period) divided by the population
at risk of having the attribute or disease at this point in
time or midway through the period”.
• Referred as rate, prevalence rate is really a ratio
TYPES
POINT PREVALENCE
Defined as the number of all
current cases (old and new) of a disease at
one point of time in relation to a defined
population
= Number of all current cases of a specified
disease existing at a given point in time *
100
Estimated population at the same point of
time
PERIOD PREVALENCE
• Less commonly used method
• It measures the frequency of all current cases
existing during a defined period of time
expressed in relation to a defined population
= number of existing cases of a specified
disease during a given period of time interval
* 100
estimated- mid interval population at
RELATIONSHIP BETWEEN
PREVALENCE AND INCIDENCE
P=I*D
I = Incidence
D = Mean duration
Eg. Incidence= 10 cases per 1000
population per year
Mean duration of disease= 5 years
prevalence= 10*5=50 per 1000 population
It is possible to derive incidence
& duration as follows:
• Incidence= P/D
• Duration= P/I
USES
a. Helps to estimate the magnitude of health/
disease problems in the community and
identify potential high risk population
b. Useful for administrative and planning
purposes
[Link] beds, manpower needs etc
