Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
MORBIDITY & MORTALITY, 
HEALTH DATA 
Halyna Lugova, MD, PhD 
September 25, 2014 
1200 
1000 
800 
600 
400 
200 
0 
2 9 16...
Epidemiologic Language 
“The prevalence rates of HIV and DM amongst TB patients were 
7.7 and 30%, respectively. *…+ Diabe...
Role of Measurement 
“The death rate is a fact; anything 
beyond this is an inference.” 
― William Farr (1807 – 1883), Bri...
Ratio, Proportion and Rate 
• Ratio: one number divided by another number: 
4 
x/y 
often multiplied by k (100; 1,000; 10,...
Ratio, Proportion and Rate 
• Proportion: a specific ratio in which the numerator is 
a subset of the denominator: x/(x+y)...
Ratio, Proportion and Rate 
• Rate: basic measure in disease occurrences and 
vital statistics: 
x*/(x+y) 
usually multipl...
Ratio, Proportion or Rate? 
• The number of students who had dental caries divided by the 
number of students who did not ...
Measures of Morbidity 
Incidence: 
Rate of Disease Occurrence in Population 
• Measures change from non-disease to disease...
Measures of Morbidity 
Prevalence: 
Reflects Already Existing Disease 
• Proportion of population which has disease 
• Pre...
Relationship between Incidence and Prevalence 
10 
Source: Eric Notebook (1999) Issue 2: Incidence vs. Prevalence. Availab...
Difference between Incidence & Prevalence 
Characteristic 
What is 
measured 
Time of 
disease 
diagnosis 
Period of 
time...
Problems with Morbidity Data 
 Numerators: difficulties with diagnostics, problems with 
data on cases 
 Denominators: c...
Measures of Mortality 
Mortality data indicate severity of disease, risk of dying from a 
disease, and effectiveness of tr...
Case Fatality Rate 
Case fatality rate (percent) 
푁표.표푓 푖푛푑푖푣푖푑푢푙푎푠 푑푦푖푛푔 푑푢푟푖푛푔 푎 
푠푝푒푐푖푓푖푒푑 푝푒푟푖표푑 표푓 푡푖푚푒 푎푓푡푒푟 푑푖푠푒푎푠푒...
Proportionate Mortality 
Proportionate Mortality (percent) 
푁표.표푓 푑푒푎푡푕푠 푓푟표푚 푎 푝푎푟푡푖푐푢푙푎푟 푑푖푠푒푎푠푒 푖푛 푎 푦푒푎푟 
푇표푡푎푙 푑푒푎푡푕푠...
Proportionate Mortality 
16 
Community A Community B 
Mortality rate from 
all causes 
30/1,000 15/1,000 
Proportionate 
m...
Proportionate Mortality 
17 
Community A Community B 
Mortality rate from 
all causes 
20/1,000 10/1,000 
Proportionate 
m...
Problems with Mortality Data 
• Depends on death certification 
• Coding of death certificates including 
changes related ...
Commonly Used Health Indicators 
Annual crude live birth rate 
푁푢푚푏푒푟 표푓 푏푖푟푡푕푠 표푐푐푢푟푖푛푔 푖푛 푎 푑푒푓푖푛푒푑 푝표푝푢푙푎푡푖표푛 푑푢푟푖푛푔 푎 ...
Commonly Used Health Indicators (cont.) 
Annual infant mortality rate ( = IMR) 
푁푢푚푏푒푟 표푓 푑푒푎푡푕푠 푢푛푑푒푟 1 푦푒푎푟 표푓 푎푔푒 푖푛 푎 ...
Types of Health Data 
• Population data: the number of people in a population 
and their attributes 
• Vital statistics: l...
Population (age) pyramid 
 This population pyramid is wide at the base, which means 
there is a large proportion of young...
Population (age) pyramid 
• This shape is typical of a developed country. It is 
narrow at the base, wider in the middle, ...
Population (age) pyramid 
24 
Source: http://www.indexmundi.com
Vital and Health Statistics 
• Data collection should be fair and complete, therefore 
this data is usually collected by g...
Vital and Health Statistics in Malaysia 
• DSM gathers data through periodic statements/reports from 
government agencies ...
Vital and Health Statistics in Malaysia 
• MOH collects data through 
 Hospital admissions / discharge 
 Clinic attendan...
SUMMARY 
• Rates are an important concept, they allow 
measurement and comparison of health data 
• By exploring patterns ...
SUMMARY 
• Incidence rate is the number of new cases which occur 
during a specified time period in a defined at risk 
pop...
SUMMARY 
• Proper collection of vital and health statistics is very 
important; Dep of Statistics and MoH are key 
collect...
Upcoming SlideShare
Loading in …5
×

Morbidity & mortality

7,769 views

Published on

This lecture looks specifically at measures of disease frequency: morbidity and mortality. You will see how morbidity data can be used, how routinely collected mortality data can begin to throw light on very important issues that might determine health. You will review the sources of important, routinely collected population data in Malaysia: demographic data (e.g., population census) and health event data (e.g., mortality, hospital and general practice data).

Published in: Health & Medicine
  • DOWNLOAD FULL BOOKS, INTO AVAILABLE FORMAT ......................................................................................................................... ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • I recovered from bulimia. You can too! learn more... ♣♣♣ http://tinyurl.com/bulimia2recovery
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Morbidity & mortality

  1. 1. MORBIDITY & MORTALITY, HEALTH DATA Halyna Lugova, MD, PhD September 25, 2014 1200 1000 800 600 400 200 0 2 9 16 23 30 6 13 20 27 5 12 19 26 2 9 16 23 30 7 14 21 28 4 11 18 25 2 9 16 23 30 6 13 20 27 3 10 17 24 1 8 15 22 29 5 12 19 26 3 10 17 24 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
  2. 2. Epidemiologic Language “The prevalence rates of HIV and DM amongst TB patients were 7.7 and 30%, respectively. *…+ Diabetic TB patients had a higher mortality rate (7.5%) compared to the TB only and DM only groups (1 and 2%, resp.).” Suleiman, S. et al. (2012). Role of Diabetes in the Prognosis and Therapeutic Outcome of Tuberculosis. International Journal Of Endocrinology, 6 p. “The average annual incidence rate of DF per 100 000 populations was higher as compared to that of DHF. Conversely, the yearly mean mortality rate of DHF per 100 000 populations was greater than that of DF. *…+ The dengue situation in Malaysia has worsened with an increasing number of reported cases and deaths during the last decade.” Mia, M. et al. (2013). Trends of dengue infections in Malaysia, 2000-2010. Asian Pacific Journal of Tropical Medicine, 6(6), 462-466. 2
  3. 3. Role of Measurement “The death rate is a fact; anything beyond this is an inference.” ― William Farr (1807 – 1883), British epidemiologist, one of the founders of medical statistics “What gets measured gets done.” ― Mason Haire (Author of Modern Organization Theory) 3 Source: http://www.epimonitor.net/Quotable_Quotes.htm Images from public domain
  4. 4. Ratio, Proportion and Rate • Ratio: one number divided by another number: 4 x/y often multiplied by k (100; 1,000; 10,000; 100,000) Examples: 3 hospitals/60,000 people = 0.00005 hospitals per person *k (100,000) = 0.00005 * 100,000 = 5 hospitals per 100,000 people 40 observed cases of DM /20 expected cases of DM = 2 (no units) OR = odds ratio SMR = standardized mortality ratio
  5. 5. Ratio, Proportion and Rate • Proportion: a specific ratio in which the numerator is a subset of the denominator: x/(x+y) usually multiplied by k (100; 1,000; 10,000) x – the number of individuals in the population with characteristic C x+y – the number of individuals in the same population with and without characteristic C Example: proportional mortality no. of TB deaths / total no. of deaths in 2008 in Malaysia = 0.03 *k (100) = 3% or3 per 100; *k = 1,000 = 30 per 1,000 5
  6. 6. Ratio, Proportion and Rate • Rate: basic measure in disease occurrences and vital statistics: x*/(x+y) usually multiplied by k (100; 1,000; 10,000) x* = the frequency of events during a certain time period x+y = the number at risk of the event during that time period, i.e. the sum of follow-up time contributed by the people at risk of the event Example: incidence rate 6
  7. 7. Ratio, Proportion or Rate? • The number of students who had dental caries divided by the number of students who did not have dental caries Ratio • The number of students who had dental caries divided by the number of students who had oral health diseases Proportion (numerator is a subset of denominator) • The number of dentists divided by the number of population Ratio • The number of students newly diagnosed with dental caries from Jan 2013 till Dec 2013 divided by the number of students who had not been diagnosed with the disease before Jan 2013 Rate (indicates frequency of event over population at risk during specific time) 7
  8. 8. Measures of Morbidity Incidence: Rate of Disease Occurrence in Population • Measures change from non-disease to disease • Incidence rate is defined as a number of new cases in the population at risk which occurred over a given period of time Incidence = Number of new cases X k Population at risk • Population-at-risk: all persons in the population who have not been diagnosed with the disease of interest at the beginning of the observation period, but who are capable of developing the disease 8
  9. 9. Measures of Morbidity Prevalence: Reflects Already Existing Disease • Proportion of population which has disease • Prevalence is defined as a number of existing cases in a population at a specified time: • Population: Number of persons present in the population of interest 9 Prevalence = Number of cases with the disease/condition at a specified time X k Population at a specified time
  10. 10. Relationship between Incidence and Prevalence 10 Source: Eric Notebook (1999) Issue 2: Incidence vs. Prevalence. Available at: http://cphp.sph.unc.edu/trainingpackages/ERIC/eric_notebook_2.pdf Incidence is a measure of the flow of water into the tub Prevalence measures the proportion of the tub (the total population) filled with water (the prevalent cases) . Prevalence = Incidence x Duration (approx.)
  11. 11. Difference between Incidence & Prevalence Characteristic What is measured Time of disease diagnosis Period of time Denominator Incidence Rapidity of disease occurrence Newly diagnosed Period of study that allows monitoring disease occurrence Population at-risk Prevalence Proportion of population with disease Surviving cases diagnosed at any time Specific time Whole population 11
  12. 12. Problems with Morbidity Data  Numerators: difficulties with diagnostics, problems with data on cases  Denominators: certain groups in the population may be underrepresented, problems with defining population-at-risk  Hospital Data: selective admissions, missing or incomplete records, problems of comparability between different hospitals, absence of defined catchment area (problems with denominator)
  13. 13. Measures of Mortality Mortality data indicate severity of disease, risk of dying from a disease, and effectiveness of treatment and prevention programs. It is useful in comparison between different populations and in time. Annual mortality rates are calculated by all causes or by specific diseases; by age, sex, ethnicity. Most of the countries’ legislation imposes a requirement of compulsory registration of all deaths. Therefore, mortality statistics is usually more available than information on morbidity If the disease does not ordinarily cause death then mortality rates are useless 13
  14. 14. Case Fatality Rate Case fatality rate (percent) 푁표.표푓 푖푛푑푖푣푖푑푢푙푎푠 푑푦푖푛푔 푑푢푟푖푛푔 푎 푠푝푒푐푖푓푖푒푑 푝푒푟푖표푑 표푓 푡푖푚푒 푎푓푡푒푟 푑푖푠푒푎푠푒 표푛푠푒푡 표푟 푑푖푎푔푛표푠푖푠 푁표. 표푓 푖푛푑푖푣푖푑푢푎푙푠 푤푖푡푕 푡푕푒 푠푝푒푐푖푓푖푒푑 푑푖푠푒푎푠푒 x 100 • Measure of the severity of a disease • Measure of the benefits of a disease intervention program, new treatment In 2008, population of children under 14 years of age in Malaysia was 8 millions of whom 210,000 were sick with TB 2,000 of 210,000 died from TB. The mortality rate as a result of TB in 2008 = ퟐ,ퟎퟎퟎ ퟖ,ퟎퟎퟎ,ퟎퟎퟎ = 0.00025, or 0.025% or 0.25 per 1,000 children The case-fatality rate as a result of TB in 2008 = ퟐ,ퟎퟎퟎ ퟐퟏퟎ,ퟎퟎퟎ = 0.0095, or 0.95% or 9.5 per 1,000 children 14
  15. 15. Proportionate Mortality Proportionate Mortality (percent) 푁표.표푓 푑푒푎푡푕푠 푓푟표푚 푎 푝푎푟푡푖푐푢푙푎푟 푑푖푠푒푎푠푒 푖푛 푎 푦푒푎푟 푇표푡푎푙 푑푒푎푡푕푠 푖푛 푎 푦푒푎푟 x 100 • Proportion of deaths in a population caused by a particular disease • Shows trends but not risk or cause • Useful to compare impact of diseases in a population 15
  16. 16. Proportionate Mortality 16 Community A Community B Mortality rate from all causes 30/1,000 15/1,000 Proportionate mortality from disease X Mortality rate from disease X 9/1,000 9/1,000
  17. 17. Proportionate Mortality 17 Community A Community B Mortality rate from all causes 20/1,000 10/1,000 Proportionate mortality from disease X Mortality rate from disease X 14/1,000 17/1,000
  18. 18. Problems with Mortality Data • Depends on death certification • Coding of death certificates including changes related to changes of ICD. • Errors in diagnosis, counting population or percentages of population at risk, identification of age and other demographic groups 18
  19. 19. Commonly Used Health Indicators Annual crude live birth rate 푁푢푚푏푒푟 표푓 푏푖푟푡푕푠 표푐푐푢푟푖푛푔 푖푛 푎 푑푒푓푖푛푒푑 푝표푝푢푙푎푡푖표푛 푑푢푟푖푛푔 푎 푦푒푎푟 푁푢푚푏푒푟 푖푛 푡푕푎푡 푝표푝푢푙푎푡푖표푛 푎푡 푚푖푑푦푒푎푟 표푓 푡푕푒 푠푎푚푒 푦푒푎푟 x 1.000 Annual crude death rate 푁푢푚푏푒푟 표푓 푑푒푎푡푕푠 표푐푐푢푟푖푛푔 푖푛 푎 푑푒푓푖푛푒푑 푝표푝푢푙푎푡푖표푛 푑푢푟푖푛푔 푎 푦푒푎푟 푁푢푚푏푒푟 푖푛 푡푕푎푡 푝표푝푢푙푎푡푖표푛 푎푡 푚푖푑푦푒푎푟 표푓 푡푕푒 푠푎푚푒 푦푒푎푟 x 1.000 Annual specific death rate (by age, sex, cause or a combination) 푁푢푚푏푒푟 표푓 푠푝푒푐푖푓푖푒푑 푑푒푎푡푕푠 표푐푐푢푟푖푛푔 푖푛 푎 푑푒푓푖푛푒푑 푝표푝푢푙푎푡푖표푛 푑푢푟푖푛푔 푎 푦푒푎푟 푁푢푚푏푒푟 표푓 푠푝푒푐푖푓푖푒푑 푝표푝푢푙푎푡푖표푛 푎푡 푚푖푑푦푒푎푟 표푓 푡푕푒 푠푎푚푒 푦푒푎푟 x 1.000 Annual maternal mortality rate 푁푢푚푏푒푟 표푓 푑푒푎푡푕푠 푓푟표푚 푚푎푡푒푟푛푎푙 푐푎푢푠푒푠 푖푛 푎 푑푒푓푖푛푒푑 푝표푝푢푙푎푡푖표푛 푑푢푟푖푛푔 푎 푦푒푎푟 푎푡 푎 푔푖푣푒푛 푡푖푚푒 푁푢푚푏푒푟 표푓 푤표푚푒푛 표푓 푐푕푖푙푑푏푖푟푡푕 푎푔푒 푖푛 푡푕푎푡 푝표푝푢푙푎푡푖표푛 푑푢푟푖푛푔 푡푕푒 푠푎푚푒 푦푒푎푟 x 1.000 Annual maternal mortality ratio 푁푢푚푏푒푟 표푓 푑푒푎푡푕푠 푓푟표푚 푚푎푡푒푟푛푎푙 푐푎푢푠푒푠 푖푛 푎 푑푒푓푖푛푒푑 푝표푝푢푙푎푡푖표푛 푑푢푟푖푛푔 푎 푦푒푎푟 푎푡 푎 푔푖푣푒푛 푡푖푚푒 푁푢푚푏푒푟 표푓 푙푖푣푒 푏푖푟푡푕푠 푖푛 푡푕푎푡 푝표푝푢푎푙푡푖표푛 푑푢푟푖푛푔 푡푕푒 푠푎푚푒 푦푒푎푟 x 1.000 19
  20. 20. Commonly Used Health Indicators (cont.) Annual infant mortality rate ( = IMR) 푁푢푚푏푒푟 표푓 푑푒푎푡푕푠 푢푛푑푒푟 1 푦푒푎푟 표푓 푎푔푒 푖푛 푎 푑푒푓푖푛푒푑 푝표푝푢푙푎푡푖표푛 푑푢푟푖푛푔 푎 푦푒푎푟 푁푢푚푏푒푟 표푓 푙푖푣푒 푏푖푟푡푕푠 표푐푐푢푟푖푛푔 푖푛 푡푕푎푡 푝표푝푢푎푙푡푖표푛 푑푢푟푖푛푔 푡푕푒 푠푎푚푒 푦푒푎푟 x 1.000 Annual neonatal mortality rate 푁푢푚푏푒푟 표푓 푑푒푎푡푕푠 푢푛푑푒푟 28 푑푎푦푠 표푓 푎푔푒 푖푛 푎 푑푒푓푖푛푒푑 푝표푝푢푙푎푡푖표푛 푑푢푟푖푛푔 푎 푦푒푎푟 푁푢푚푏푒푟 표푓 푙푖푣푒 푏푖푟푡푕푠 표푐푐푢푟푖푛푔 푖푛 푡푕푎푡 푝표푝푢푎푙푡푖표푛 푑푢푟푖푛푔 푡푕푒 푠푎푚푒 푦푒푎푟 x 1.000 Annual post-neonatal mortality rate 푁푢푚푏푒푟 표푓 푑푒푎푡푕푠 푏푒푡푤푒푒푛 28 푑푎푦푠 푎푛푑 1 푦푒푎푟 표푓 푎푔푒 푖푛 푎 푑푒푓푖푛푒푑 푝표푝푢푙푎푡푖표푛 푑푢푟푖푛푔 푎 푦푒푎푟 푁푢푚푏푒푟 표푓 푙푖푣푒 푏푖푟푡푕푠 표푐푐푢푟푖푛푔 푖푛 푡푕푎푡 푝표푝푢푎푙푡푖표푛 푑푢푟푖푛푔 푡푕푒 푠푎푚푒 푦푒푎푟 x 1.000 Annual stillbirth rate (fetal death rate) 푁푢푚푏푒푟 표푓 푑푒푎푡푕푠 푎푡 20 표푟 푚표푟푒 푤푒푒푘푠 푔푒푠푡푎푡푖표푛푎푙 푎푔푒 푖푛 푎 푑푒푓푖푛푒푑 푝표푝푢푙푎푡푖표푛 푑푢푟푖푛푔 푎 푦푒푎푟 푁푢푚푏푒푟 표푓 푙푖푣푒 푏푖푟푡푕푠 표푐푐푢푟푖푛푔 푖푛 푡푕푎푡 푝표푝푢푎푙푡푖표푛 푑푢푟푖푛푔 푡푕푒 푠푎푚푒 푦푒푎푟 x 1.000 20
  21. 21. Types of Health Data • Population data: the number of people in a population and their attributes • Vital statistics: live births, deaths, and marriages • Health statistics: morbidity by type, data on notifiable diseases, impairment, cancer registries • Health services statistics: number and types of facilities, nature of services; costs, payment mechanisms • Data on social inequalities in health: rates of poverty, level of education, and occupational conditions 21
  22. 22. Population (age) pyramid  This population pyramid is wide at the base, which means there is a large proportion of young people in the country. It tapers very quickly as you go up into the older age groups, and is narrow at the top. 22  This pyramid is expanding; it shows that a very small proportion of people are elderly. This shape of pyramid is typical of a developing country Source: http://www.indexmundi.com
  23. 23. Population (age) pyramid • This shape is typical of a developed country. It is narrow at the base, wider in the middle, and stays quite wide until the very top, as there is a sizable percentage of older people. 23  This pyramid is contracting, showing lower numbers or percentages of younger people. Source: http://www.indexmundi.com
  24. 24. Population (age) pyramid 24 Source: http://www.indexmundi.com
  25. 25. Vital and Health Statistics • Data collection should be fair and complete, therefore this data is usually collected by governmental agencies • In Malaysia, there are various agencies that collect data: the key health data collectors are the Department of Statistics of Malaysia (DSM) and the Ministry of Health (MOH) 25
  26. 26. Vital and Health Statistics in Malaysia • DSM gathers data through periodic statements/reports from government agencies and from the census conducted (Banci Negara) • DSM also receives data on births and deaths from the National Registration Department (JPN) • Vital Statistics Malaysia, 2012 report presents statistics on births and deaths for 2011 (final) and 2012 (preliminary) at state and administrative district levels*. • The population estimates used in the calculation of these indicators are based on the Population and Housing Census 2010, which is done every 10 years *Source: Department of Statistics Malaysia, Official Portal http://statistics.gov.my/portal/images/stories/files/LatestReleases/vital/Vital_Statistics_Malaysia_ 2012.pdf 26
  27. 27. Vital and Health Statistics in Malaysia • MOH collects data through  Hospital admissions / discharge  Clinic attendance and diagnosis  Periodic district health reports  Monthly reports from Vector Borne Disease Control Program Notifiable Disease Reports Health Facts (published annually, 2014 ed. available with data from 2013) Health Indicators (annually, currently latest is 2013 data) Source: Official Portal Ministry of Health Malaysia http://www.moh.gov.my/english.php/pages/view/56 27
  28. 28. SUMMARY • Rates are an important concept, they allow measurement and comparison of health data • By exploring patterns and variations in the health outcomes we can begin to hypothesize about possible determinants of population health, and this is the essence of descriptive epidemiology. Descriptive epidemiology relates to the study of variations in population health by time and person and place 28
  29. 29. SUMMARY • Incidence rate is the number of new cases which occur during a specified time period in a defined at risk population • Prevalence is a number of cases in a defined population at a particular point in time, or during a specified period • The relationship between incidence and prevalence is determined by the duration of disease 29
  30. 30. SUMMARY • Proper collection of vital and health statistics is very important; Dep of Statistics and MoH are key collectors in Malaysia • Mortality data is usually more available than morbidity data, but it depends on death certification aspects, diagnostics criteria and other factors 30

×