MEASUREMENTS OF

EPIDEMIOLOGY

- SHUNMATHY S M
MPH PART I

1
DEFINITION OF EPIDEMIOLOGY:
“The study of distribution and determinants of health related states or
events in specified populations, and the application of this study to the
control of health problems”.

- JOHN M. LAST (in 1988)

THE 3 COMPONENTS:
- Disease frequency
- Distribution of disease
- Determinants of disease
2
MEASUREMENTS:

“ If you can measure that of which you speak, and can express
it by a number, you know something of your subject,
but if you cannot measure it, your knowledge is meager and
unsatisfactory”.

- WILLIAM THOMSON.

3
 MORTALITY
DATA
MORBIDITY
DISABILITY DATA
DATA
SCOPE OF
MEASUREMENT OF MEASUREMENT DISTRIBUTION OF
MEDICINAL NEEDS, CHARACTERISTICS
FACILITIES,ETC. OF DISEASE

NATALITY ENVIRONMENTAL
DATA FACTORS

4
EPIDEMIOLOGICAL APPROACH:
• Asking questions:
a) Related to health events.
b) Related to health action.

• Making comparisons:
a) Random allocation.
b) Matching.
c) Standardization.

5
BASIC REQUIREMENTS OF MEASUREMENT:

1. Validity 2. Reliability 3. Accuracy 4. Sensitivity 5. Specificity

VARIATE: Any piece of information referring to the patient or his disease is

called a variate.
VARIATE

DISCRETE CONTINUOUS
CIRCUMSTANCE: Any factor in the environment that might be suspected of
causing a disease.
Eg: air/water pollution.
6
TOOLS OF MEASUREMENT:
1. RATE.
2. RATIO.
3. PROPORTION.

Others:
- Relative risk.
- Odds ratio.

7
 RATE
• A rate measures
- the occurrence of some particular event (development of disease or
occurrence of death)
- in a specified population
- during a given time period.

• It comprises- numerator, denominator, time specification and

multiplier.
• Expressed per 1000 or 10,000 or 100,000..
• Numerator is always a part of the denominator.

8
Various categories of RATE:
• Crude rates or Unstandardized rates:
Eg: birth and death rates.

• Specific rates:
- due to specific causes or in specific groups or during specific time
periods.

• Standardized rates:
- Either by diret or indirect method of standardization/adjustment.
9
 RATIO
• Another measure of disease frequency.
• It expresses a relation in size between two random quantities.
• The numerator is not a component of the denominator.

PROPORTION
• A proportion is a ratio which indicates the relation in magnitude of a
part of the whole.
• Numerator is always included in the denominator.
• Usually expressed in percentage(%).

10
• NUMERATOR:
- No. of times an event has occurred in a population, during a specific time
period.

• DENOMINATOR:
a) Related to the population:
- Mid year population.
- Population at risk.
- Person-time/ Person-years/ Person-distance.
- Sub groups of the population.

b) Related to total events:

Eg: “per 100 vehicles”
11
MEAUREMENT OF MORBIDITY
• MORBIDITY- “any departure, subjective or objective, from a state of
physiological well being”

• Measured in terms of 3 units – persons who were ill, the illness and
the duration of the illness.

• Morbidity rates/ratios are measured by

- Frequency of disease: incidence and prevalence.
- Duration of disease.
- Severity of illness.
12
 INCIDENCE
• “The number of NEW cases occurring in a defined population during a
specified period of time”.

• INCIDENCE
= No. of new cases of specific disease during a given time period 1000
Population at risk during that period

• Usually restricted to acute diseases.

13
SPECIAL INCIDENCE RATES
• ATTACK RATE:
No. of new cases of a specified disease during a specified time 100
Total population at risk during the same time interval

• SECONDARY ATTACK RATE:

No. of exposed persons developing the disease during incubation 100
Total no. of exposed persons
• CUMULATIVE INCIDENCE
• INCIDENCE DENSITY
14
 PREVALENCE
• “All the current cases (old and new) existing at a given point in time, or
over a period of time in a given population”.
• 2 types:
- Point prevalence
- Period prevalence
RELATIONSHIP BETWEEN INCIDENCE AND PREVALENCE:
P=I D

15
FACTORS AFFECTING PREVALENCE:

16
INCIDENCE, POINT OR PERIOD
PREVALENCE?

17
MEASUREMENT OF MORTALITY:
USES LIMITATIONS
1. Explaining trends and differentials in 1. Incomplete reporting of deaths.
overall mortality.
2. Indicates priorities for health action. 2. Lack of accuracy.
3. For allocation of resources. 3. Lack of uniformity.
4. In designing intervention 4. Choosing a single cause of death.
programmes.
5. Assessment and monitoring of 5. Changing.
public health problems.
6. Gives important clues for 6. Diseases with low fatality.
epidemiological research.

18
MORTALITY RATES AND RATIOS:
• CRUDE DEATH RATE:
No. of deaths in one year 1000
Mid-year population

• SPECIFIC DEATH RATE:

Death due to specific cause 1000
Mid-year population

19
• CASE FATALITY RATE:
Total no. of deaths due to particular disease 100
Total no. of cases due to the same disease

• PROPORTIONAL MORTALITY RATE (RATIO):

No. of deaths due to particular disease 100
No. of cases due to that particular disease

• SURVIVAL RATE:
Total no. of patients alive after 5 years 100
Total no. of patients diagnosed/treated
20
OTHER IMPORTANT
MEASUREMENTS:
• LIFE EXPECTANCY is a “Positive mortality indicator”.

• Fertility: General fertility rate, Age-specific fertility rate, Total fertility

rate, Gross reproduction rate, Net reproduction rate.

• SEX RATIO.
• DEPENDENCY RATIO.
• MATERNAL MORTALITY RATIO.
• INFANT MORTALITY RATE.
• LITERACY RATE.
21
MEASURES OF IMPACT OF DISEASE:
HDI PQLI

COMPONENTS 1. Longevity 1. Life expectancy at age 1.

2. Income. 2. Infant mortality rate.
3. Knowledge. 3. Literacy rate.

RANGE 0 to 1 0 to 100

VALUE OF INDIA 0.624 65

22
• SULLIVAN’S INDEX: Disability Free Life Expectancy (DFLE)
- Life expectancy duration of disability

• Disability Adjusted Life Years (DALY)

- Years of Life Lost Years Lost to Disability

• Quality Adjusted Life Years (QALY):

- Years of life lived in perfect health.

• Years of Potential Life Lost (YPLL):

- Years of life lost due to premature death.
- Type of mortality indicator.

• Health Adjusted Life Expectancy (HALE):

23
REFERENCES:
1. Grimes DA, Schulz KF, An overview of clinical research, Lancet,
2002;359: 57-61.
2. Gordis, Leon, Epidemiology, Sixth edition, Philadelphia, PA: Elsevier
Saunders, 2014.
3. Park K, Park’s textbook of preventive and social medicine, 23rd
edition, India, Bhanot publishers, 2015.

24
25