Measurement in

Epidemiology

By T. T

06/12/2025 BY T.T 1
Outline

 Epidemiological measurement
variables
 Measurement of disease occurrence
in population
 Mortality measures
 Measurement of association
 Evaluation of causation

06/12/2025 BY T.T 2
Measurement in Epidemiology
 Epidemiology is mainly a quantitative
discipline, so we should quantify health
and health related events.
 Epidemiological measurement variables
 Absolute number

 Ratio

 Proportion

 Rate

06/12/2025 BY T.T 3
  Measurement of disease occurrence in population
1. Incidence rate
 Cumulative Incidence
 incidence Density
2. Prevalence rate
 Point Prevalence
 Period Prevalence
 Measurement of mortality (death rate )
 Measurement of association
1. Risk ratio
2. Odd ratio,
3. Risk difference

06/12/2025 BY T.T 4
Measuring Disease Occurrence

Absolute number
 The number of cases(Absolute number
) in a given community can give more
epidemiologic sense if they are related to
the size of the population.
 Such tie of the number of cases with the
population size can be determined by
calculating ratios, proportions, and rates

06/12/2025 BY T.T 5
 Ratio x፡y
 Ratio: The value of x and y may be
completely independent. example (Male:
Female)
Proportion x/ x+y
 Proportion: is a ratio (expressed as a
percent) in which x is included in y.
 Example Female/Both sexes

(proportion of female in a community)

06/12/2025 BY T.T 6
 Rate
 Rate is a Proportion, it measures the
occurrence of an event in a population
over time.
 The time component is important in the
definition.

Measles cases in under five children

in 1995
Under five children in 1995
06/12/2025 BY T.T 7
 Notice three important aspects of this
formula.
1. The persons in the denominator must
reflect the population from which the
cases in the numerator arose.
2. The counts in the numerator and
denominator should cover the same time
period.
3. In theory, the persons in the
denominator must be “at risk” for the
event, that is, it should
06/12/2025 BY T.T
have been 8
Table1.1 Neonatal sepsis, Hospital A, Ethiopia, 2003

06/12/2025 BY T.T 9
 The line listing in the Table 1.1 presents some of the
information collected on infants born at Hospital
A with neonatal sepsis.

1. What is the ratio of males to females?

2. What proportion of infants lived?

3. What proportion of infants were delivered in a

delivery room?

4. What is the ratio of operating room deliveries to

delivery room deliveries?
06/12/2025 BY T.T 10
Incidence rate
 Incidence rates are the most common
way of measuring and comparing the
frequency of disease in populations.
 It measures the rate at which people
without the disease develop the disease
during a specified period of time.
 The incidence rate expresses the
probability or risk of illness in a
population over a period of time.

06/12/2025 BY T.T 11
  Since incidence is a measure of
risk, when one population has a
higher incidence of disease than
another, we say that the first
population is at a higher risk of
developing disease than the
second, all other factors being
equal.

06/12/2025 BY T.T 12
 Itis used to study disease aetiology
 Required data:
period of observation;( Time)

number of new cases; (n)

time of disease onset (diagnosis Time );

population at risk /denominator(N).

 The formula for calculating an incidence rate

follows:

06/12/2025 BY T.T 13
 The numerator of an incidence rate should
reflect new cases of disease which occurred
or were diagnosed during the specified
period.
 The denominator is the population at risk.

 This means that persons who are included in

the denominator should be able to develop
the disease that is being described during the
time period covered. BY T.T
06/12/2025 14
Risk (Cumulative Incidence)
 Measures the risk (the likelihood, probability)
that an individual will contract the disease
during a certain time period or before a given
age.
= New cases occurring during a given time
period
Population at risk during the same
period

 Cumulative incidence relates occurrences of

new cases to the population at the beginning of
the study period.
06/12/2025 BY T.T 15
Incidence Density

 Incidence density represents rate at which

new cases are occurring.
 Does not indicate the risk for any individual in a
population.

= New cases occurring in a specified period

Total person-time at risk in the same period

 An incidence measure is a speed, usually

expressed as number of cases per 1,000 or
100,000 units of follow-up time

06/12/2025 BY T.T 16
  The population at risk is dynamic
and each person in the population
contributes the amount of time
that they remained under
observation and free from
disease (person-time)
 The numerator is still the number of
new cases, but the denominator is
the sum of the time each person is
observed, totalled for all persons.
06/12/2025 BY T.T 17
  Person-time rates are often used in
cohort (follow-up) studies of
diseases with long incubation or
latency periods, such as
occupationally related diseases,
AIDS, and chronic diseases.
 Time unit=month, year, day

 person-time=person-year, person-
month,
06/12/2025 BY T.T 18
 Prevalence rate

 Prevalence, sometimes referred to as

prevalence rate, is the proportion of persons in
a population who have a particular disease or
attribute at a specified point in time or over a
specified period of time.
 Numerator is number of existing cases
 Denominator is your population of interest
(including all those in numerator)

 The formula for presence of disease is:

06/12/2025 BY T.T 19
06/12/2025 BY T.T 20
Point prevalence:-
Point prevalence is the amount of disease
present in a population at a single point in
time.

Point prevalence =
all the cases of factor of interest at a given
time x10n
total population

06/12/2025 BY T.T 21
Period prevalence.
The numerator in period prevalence is
the number of persons who had a
particular disease or attribute at any
time during a particular interval (week,
month, year, decade, or any other
specified time period).
Period prevalence =
all cases (old and new) of the factor of interest during the time
period x 10n
average population during the given period of
time
06/12/2025 BY T.T 22
Calculation : in f/up {cohort study )
Incidence rate;-
 Subtract old case from
denominator(risk )
 Subtract dead, cure case from the
numerator=new case=point type)
Point Prevalence rate :-
 Subtract dead, cure case from the
numerator = (old &new
case )=point prevalence
06/12/2025 BY T.T 23
Characteristics of Prevalence
Cause and effect measured
simultaneously
-Impossible to infer causation
Useful for planning (e.g. beds, clinics,
workforce needs)
High prevalence  high risk
 could reflect increased survival(improved
care, behavior change - long duration)/old case
Low prevalence  low risk
 could reflect rapid fatal or cure process
- short duration)
Easy to obtain need
06/12/2025 BY T.T
only one 24
Figure 3.2 Relationship between prevalence and incidence

Care,
Migration
behavioral
change ,
-Dx

06/12/2025 BY T.T 25
Relationship between prevalence and incidence

 Prevalence is based on both

incidence (risk) and duration of
disease.
P ≈ I*D
 High prevalence of a disease within a
population may reflect high risk, or it
may reflect prolonged survival
without cure.
 Conversely, low prevalence may
indicate low incidence, a rapidly fatal
process, or rapid recovery.
06/12/2025 BY T.T 26
Comparison of prevalence and incidence

 The prevalence and incidence of disease are

frequently confused.
 They are similar, but differ in what cases are
included in the numerator.
 Numerator of Incidence = new cases
occurring during a given time period
 Numerator of Prevalence = all cases
present during a given time period
 As you can see, the numerator of an
incidence rate consists only of persons whose
illness began during a specified interval.

06/12/2025 BY T.T 27
 Prevalence rate increased
by
•Longer duration of the disease
•Prolongation of life of patients
without cure.
•Increase in new cases
•Immigration of cases
•Out migration of health people
•In-migration of susceptible
people
•Improved diagnostic facility
06/12/2025 BY T.T 28
 Prevalence rate decreased
by
•Shorter duration of disease.
•High case-fatality rate from
disease.
•Decreases in new cases
(decrease in incidence)
•In-migration of healthy
people.
•Out migration of cases.
•Improved cure rate of case

06/12/2025 BY T.T 29
 Attack Rate

 An attack rate is a variant of an incidence

rate, applied to a narrowly defined population
observed for a limited time, such as during an
epidemic.
 The attack rate is usually expressed as a per
cent, so 10n equals 100.
 For a defined population (the population at
risk), during a limited time period.

06/12/2025 BY T.T 30
 Example
 Of 75 persons who attended a church
picnic, 46 subsequently developed
gastroenteritis.
 To calculate the attack rate of
gastroenteritis we first define the
numerator and denominator:
X = Cases of gastroenteritis occurring within
the incubation period for gastroenteritis
among persons who attended the picnic =46
Y = Number of persons at the picnic = 75
Then, the attack rate for gastroenteritis is :

06/12/2025 BY T.T 31
 Secondary Attack Rate

A secondary attack rate is a measure

of the frequency of new cases of a
disease among the contacts of known
cases/primary case.
 The formula is as follows:-

06/12/2025 BY T.T 32
 EXAMPLE
 To calculate the total number of
household contacts, we usually subtract
the number of primary cases from the
total number of people residing in those
households.
 Seven(7) cases of hepatitis A occurred
among 70 children attending a child care
centre.
 Each infected child came from a different
family. The total number of persons in
the 7 affected families was 32.

06/12/2025 BY T.T 33
 o One incubation period later, 5 family
members of the 7 infected children
also developed hepatitis A.
o Calculate the attack rate in the child
care centre and the secondary attack
rate among family contacts of those
cases?.
o Attack rate in child care centre:
x = cases of hepatitis A among children
in child care center = 7
y = number of children enrolled in the
child care centre = 70

06/12/2025 BY T.T 34
Figure 3.4

06/12/2025 BY T.T 35
06/12/2025 BY T.T 36
Mortality Measures

Mortality Rates:-
 A mortality rate is a measure of the
frequency of occurrence of death in a
defined population during a specified
interval. For a defined population, over a
specified period of time.

 The following are frequently used

mortality measures,
06/12/2025 BY T.T 37
Case-fatality rate

The case-fatality rate is the proportion of

persons with a particular condition (cases)
who die from that condition.

06/12/2025 BY T.T 38
 Proportionate mortality
Ratio

Proportionate mortality describes the

proportion of deaths in a specified population
over a period of time attributable to different
causes. Each cause is expressed as a
percentage of all deaths, and the sum of the
causes must add to 100%.

06/12/2025 BY T.T 39
 Crude Death Rate
(CDR):

CDR = No. of deaths in a year x 1000

Total mid-year population

= Hard to use to compare different

populations, due to distortions by
differences in age-sex composition

06/12/2025 BY T.T 40
 Thank you !!

06/12/2025 BY T.T 41