Health Indicators | Epidemiology

EPIDEMIOLOGY & COMMUNITY MEDICINE
WRITTEN AND COMPILED BY DR. EMAN ABD ALHALIM MD, PHD
The Health indicators
Third year
Level 6
Lecture 3

• Explain the health indicators .
• List health indicators
• Explain morbidity indicators
disability
mortality indicators

• Health indicators are quantifiable characteristics
of a population use for describing the health of a
population.
• Often used by governments to guide health care
policy.

• A health indicator is a variable that can be measured directly to
reflect the state of health of people within a community.
• Health indicators can also be used as components in the
calculation of a broader social development index.
• The best example is the Human Development Index, which
ranks countries each year according to a combination of the
level of economic development, literacy, education, and life
expectancy

I- Morbidity indicators:
–Prevalence
–Incidence
II- Mortality indicators: (Examples)
–Crude death rate
–Infant mortality rate
–Maternal mortality rate

III- Health status (conditions):
–Some examples: Low birth weight , obesity, arthritis, diabetes,
asthma, hypertension, cancer.
–Usually for common diseases.
IV- Other indicators (Disability , nutritional)

• Ratio:
– Numerator (x) and denominator (y) may be completely independent,
or x may be included in y
• Female / Male ratio vs. Female /All (M+F) ratio (both are ratio)
• Proportion:
– A ratio in which numerator is included in denominator
• Female / All (M+F)
• Rate:
– Measures the occurrence of an event in a population over time
• Mortality rate for CVD was 314 per 100,000 per year

• The incidence of disease represents the rate of occurrence of new
cases arising in a given period in a specified population,
Uses
• Expresses the risk of becoming ill
• The main measure of acute diseases , but also used for chronic
diseases
• More useful for studies of causation
• Incidence is calculated as follows:
10n : means 100, 1000, 100,000 , 1,000,000: (0.00314 vs. 314 per 100,000)

• The prevalence is the frequency of existing cases (new & old) in a
defined population at a given point in time.
Uses:
• Proportion of a population that has the disease of interest
– Prevalence of hypertension in adults was 15.1% (means that 15.1% of adult
population have hypertension)
• Useful in the study of the burden of chronic diseases and implication
for health services.
• Prevalence (P) of a disease is calculated as follows:

A, Level of prevalence in the population.
B, Increased prevalence resulting from incidence.
C, Decreased prevalence resulting from deaths and/or cures.
D, Overall impact on prevalence of incidence, deaths, and/or cures.
Relationship between incidence and prevalence

• Prevalence = incidence x duration of disease
• An increase in prevalence rate may be due:
–Increase in incidence rate
–Decrease in death (Diabetes prevalence increased
dramatically after insulin)
–Decrease in recovery rates
• Example:
–In almost all nations: diabetes prevalence is much more
higher than cancer prevalence, while cancer mortality rates
are higher than diabetes mortality rates.

• Epidemiologists are concerned not only with the
occurrence of disease, but also with the consequences of
disease: impairments, disabilities and handicaps.
• These have been defined by the WHO International
Classification of Functioning, Disability and Health (ICF).
• ICF is a useful tool for understanding and measuring
health outcomes.

• The key parameters of ICF are as follows:
• Impairment: any loss or abnormality of psychological, physiological or
anatomical structure or function;
• Disability: any restriction or lack (resulting from an impairment) of
ability to perform an activity in the manner or within the range
considered normal for a human being;
• Handicap: a disadvantage for a given individual, resulting from an
impairment or a disability, that limits or prevents the fulfilment of a
role that is normal (depending on age, sex, and social and cultural
factors) for that individual.

The death rate (or crude mortality rate) for all deaths or a specific cause of
death is calculated as follows:
Infant mortality
• Used as an indicator of the level of health in a community (Angola: 47
per 1000 live birth vs. Singapore 2.31)
• Measures the rate of death in children during the first year of life, the
denominator being the number of live births in the same year.
• The infant mortality rate is calculated as follows:

• The maternal mortality rate refers to the risk of mothers dying
from causes associated with delivering babies, complications of
pregnancy or childbirth.
• 3 death cases per 100,000 live birth in developed countries ,
vs. 1500 per 100,000 in very low developed countries
• The maternal mortality rate is given by:

• Crude rate:
– Apply to the total population in a given area
• Specific rate
– Apply to specific subgroups in the population (age, sex etc) or specific
diseases
– Some examples:
1. Age specific mortality rate
– Mortality rate limited to a particular age group.
2. Sex specific mortality rates
– Mortality rate limited to male of female
3. Cause-specific mortality rate
– Mortality rate from a specified cause , e.g. CVD mortality rate is 304
per 100,000 per year. (Death caused only by cardiovascular diseases).

Basic epidemiology
R Bonita, R Beaglehole
and T Kjellström
2nd edition 2006
World Health Organization
ISBN 92 4 154707 3
ISBN 978 92 4 154707 9
e-mail: permissions@who.int

Health Indicators | Epidemiology

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