BASIC EPIDEMIOLOGIC MEASURE

Bony Wiem Lestari

Departement of Epidemiology and Biostatistics
2012
 Learning objectives:
To understand:
Basic concept of measuring disease
occurence
Define and distinguish between
cumulative incidence, incidence rate,
and prevalence
Morbidity statistics
Mortality statistics
Demographic studies
What is Epidemiology?
The study of the
distribution and
determinants of disease in
populations.
(J. Last, Dictionary of Epidemiology, 1983)
 What Can Epidemiology Do?

Determine the impact of disease in

groups of people.
Detect changes in disease occurrence in
groups of people. (measuring disease
occurence)
Measure relationships between exposure
and disease. (measuring association)
Evaluate the efficacy of health
interventions and treatments.
 Demographic Studies - Purpose

The means by which the epidemiologist can

assess the health status of a population from
the perspective of morbidity and mortality,
Inexpensive, and the first test of an etiologic
hypothesis,
Can be conducted by using readily available
vital and health statistics
 Measuring Disease Occurence

I. Morbidity

II. Mortality
Measures of Disease Frequency

The most basic measure of

disease frequency is a simple
count of affected individuals.

However, counting is not enough!

 Measures of Disease Frequency

Why is a simple count not enough?

3 cases of cancer per year from a city of 1,000

people is very different than 3 cases per year
from a city of 100,000 people
Measures of Disease Frequency

So, in epidemiology we must know:

the size of the population from which

the affected individuals come, and
the time period the information was
collected.
Measures of Disease Frequency
Type of population
 Measures of Disease Frequency
1. Absolute value
2. Relative value : the value of each sub
category compared to the whole population.
- Ratio -----> a + b -------> a/b
- Proportion ---> a + b -------> a /(a+b)
- Rate -------> the same as proportion but the
numerator and denominator are of the
same certain time, e.g: incidence
Measures of Disease Frequency
 Measures of Disease Frequency
Rate
basic measure in epidemiology
the frequency with which an event
occurs in a group of people
used to compare the occurrence of
disease in different groups
tells us how fast the disease is
occuring in a population
 Measures of Disease Frequency

Rate = Number of events in a specified time period

Average population during the time period

***the measure of time is a critical part of a rate!

Such as, the number of newly diagnosed cases

of breast cancer per 100,000 women during
1999.
 Measures of Disease Frequency
Common Rates
mortality (death) rate is the number of
deaths in a defined group of people
during a specified time period.

birth rate is the number of live births in a

defined group of people over a specified
time period.
 Measures of Disease Frequency

Incidence Rate
a type of rate
the number of new cases that
develop in a group of individuals
during a specific time period
 Some medical statistic in Epidemiology :
Morbidity statistic
Mortality statistic
Measurement of Risk *)
Screening *)
Standardization *)

Statistical activity in Epidemiology :

to count the frequency
to compare : Rate, Ratio, Proportion, Relative
Risk, cause and effect association.
to predict by analyzing and conclusion
 STATISTICAL MEASURE IN EPIDEMIOLOGY

1. INCIDENCE RATE

2. INCIDENCE PROPORTION

3. ATTACK RATE

4. PREVALENCE PROPORTION

5. PROPORTIONAL DISTRIBUTION

6. MORTALITY RATE

7. RISK (Measure of association/ cause-effect)

 The Incidence rate, attack rate, prevalence
rate are used for measuring the occurrence of
the disease ( Morbidity Statistic ) or a certain
condition.
If the incidence rate of certain disease or
conditions in a group of people is higher than
the other group for the same disease or
condition, the first group is stated as higher
risk than the other group. In wide
population e.g. the age group, there are
group which are the High Risk Group .
Because they are most sensitive to get
disease or other condition than the other
group.
 INCIDENCE RATE
The number of new events (cases) divided
by the amount of person time in the base
population. It can be measured in closed
or open populations. It is often restricted
to include a maximum of one event per
person.

= number of new events during a period of time

number of persons at risk during this time period
 Incidence Rate
X
# Events
X Risk =
X
# of people initially at risk
X

Time
# Events
Incidence Rate =
individual time periods at risk
 Incidence Rate
The incidence rate is an instaneous measure.
Although it is measured over a period of time,
the measurement time has no connection
with the time units used to express rate, and
whatever its value, it refers to only an instant
in time.
E.g: vehicle speed
 Incidence Proportion
The average risk for a population
The proportion of a population that develops
a disease during a specified time.
It is measured only in closed populations
= cumulative incidence
 Incidence Proportion
and Incidence Rate
For small incidence proportion,
Incidence Proportion I T
For larger incidence proportion, if I is constant
over time,
Incidence Proportion = 1 e -I T
When I varies over time,
Incidence Proportion = 1 e -IiTi
 ATTACK RATE
Similar as Incidence rate
It is used in a short period of an event an
outbreak -, the population being affected is
limited closely, the duration of epidemic is
short period.
The formula is the same as the incidence
rate.
Prevalence proportion
The proportion of a population that has
disease at given instant.

Period Prevalence
The total number of persons known to have
had the disease or attribute at any time during
specified period .
Annual Prevalence
 PROPORTIONAL DISTRIBUTION
The percentage of a disease or event in a
defined population to all diseases or events
happened in those population.
Example :
Percentage of death of heart disease
compared to all death happened in the
population.
Percentage of sickness cause by certain
disease compare to all disease happened in
the population.
 THE INCIDENCE CHARACTERISTICS
1. Indicated for the new events or cases
occurred in the population
2. A fundamental tool in etiological study of
disease
3. Act as direct indicator of the risk of getting
sick ( the probability of getting sick )
 THE INCIDENCE CHARACTERISTICS

4. The change in incidence rate means the

change of etiological balance
5. The Incidence Rate obtained accurately by
cohort study
THE CHARACTERISTIC OF PREVALENCE
1. The subjects are all cases / events in
population
2. Depend on the incidence and duration of the
disease
3. The low Prevalence Rate because of low
incidence, short duration of disease or fast
cured of the disease
4. Therapy to prevent the death but can not
omit the disease might increasing the
prevalence of the disease
THE CHARACTERISTIC OF PREVALENCE
5. In chronic disease the prevalence = I x D
6. It is useful to describe the chronic disease
7. It is an important and useful measure of the
burden of disease in a community
8. Determined by a single survey (cross
sectional study)
9. It is valuable for planning health services.
 Prevalence, Incidence Rate and
Mean duration of illness

In a steady state,
Prevalence proportion = I x D/ (1 + I x D)
Prevalence odds = I x D

For prevalence proportion near zero,

Prevalence proportion I x D
 RISK
The probability that an individual will develop
disease in a specified time
 Distinguishing Characteristics of Incidence and
Prevalence
Measure Type of Units Range Type of cases Major uses
number
Cumulative Proportion None 0 to 1 New Research on
Incidence causes,
incidence,
prevention,
and treatment
of disease
Incidence True rate 1/time 0 to infinity New Research on
rate causes,
prevention,
and treatment
of disease
Prevalence Proportion None 0 to 1 Existing Resource
planning
 Morbidity Statistics
Disease control programs
Tax-financed public assistance programs
School & employment records
Insurance data
Special research programs
Morbidity surveys on population samples for
illness in general and for specific diseases
Some sources of Morbidity Statistics
1. Disease reporting : communicables disease,
cancer registries
2. Data accumulated as a by-product of
insurance and prepaid medical care plans
a. Group health and accident insurance
b. Prepaid medical care plans
c. State disability insurance plans
d. Life insurance companies
e. Hospital insurance plans
f. Railroad Retirement Board
Some sources of Morbidity Statistics
3. Tax-financed public assistance and medical
care plans
a. Public assistance, aid to the blind, aid to the
disabled
b. State or federal medical care plans
c. Armed forces
d. Veterans Administration
4. Hospitals and clinics
5. Absenteeism records: industry and schools
Some sources of Morbidity Statistics
6. Pre-employment and periodic physical
examinations in industry and schools
7. Case-finding programs
8. Records of military personnel
9. Morbidity surveys on population samples
(e.g., Susenas, Riskesdas)
 Morbidity Statistics:
Surveillance systems
Focused on identification of infected
individuals, with the goal of isolation to
minimize disease transmission
Ongoing collection of data by a data center,
analysis, dissemination and implementation
of a response based upon analyses
Sentinel Surveillance
 Morbidity Statistics:
Time - Incubation period; Time & Space
clusters
Place -
Person - age, gender, ethnicity and social
status can influence morbidity.
Mortality Statistics:

VITAL EVENTS:
Births
Marriages
Divorces
Deaths
 Mortality Studies
Distribution of mortality in populations
Time: Trend in mortality rates - secular trends
- trends over time
Place: Migrant studies - helps to establish an
environmental contribution to disease
Person: Age, gender, race & ethnicity, social
class, birth cohort
 Mortality Data Sources
Autopsy records
Financial records (insurance, pension)
Hospital records
Occupational records
Death Certificates
 Mortality statistics - Autopsies
Autopsy data and hospital records may be more
accurate about details, but may not represent
the general population
Useful for investigating diseases with a high-case
fatality
Problem of selection bias - impossible to
correlate an autopsy series with any well-
defined population at risk, or to estimate the
frequency of disease
MORTALITY RATE :
The rapidity with which persons within a given
population die from a particular disease
MORTALITY STATISTIC
The are 3 elements :
1. Group of population who are at risk of death
(denominator)
2. Designed period of time
3. Number of death in group of population in
designed period of time (numerator)
 CRUDE DEATH RATE (CDR)
Number of population dying every year or
number of death in the community per 1000
population divided by population taken at
midyear.
 Age Specific Death Rate
Number of death of specific group every year
per 1000 of specific group divided by number
of specific group.
E.g. : Neonatal Mortality Rate, Perinatal
Mortality Rate, Infant Mortality Rate,
Maternal mortality Rate, etc.
 CAUSE SPECIFIC DEATH RATE
Death rate for any specific disease, such as
heart disease, may be stated for the entire
population or for any age, race, or sex
subgroup.
 CASE FATALITY RATE ( in % )
The number of death due to the disease in a
specified period of time divided by the
number of cases of the disease in the same
period of time.
The k = 100
 Other Demographic Measures:
Survival Analysis
Used to make demographic predictions and to
analyze data in clinical trials
Years of Potential Life Lost (YPPL)
o Recognizes that death occurring in the same
person at a younger age clearly involves a greater
loss of future productive years than were it to
occur at an older age.
o Measures the impact of premature mortality on a
population
YPLL before age 65 years among
children younger than 20.