This document discusses various measures used to quantify disease frequency, association, and impact in epidemiology. It defines key terms like incidence, prevalence, risk, rate, and ratio. For measures of disease frequency, it distinguishes between incidence, which considers new cases over time, and prevalence, which includes all current cases. Measures of association like relative risk and odds ratio quantify the relationship between exposure and outcome by comparing disease occurrence between exposed and unexposed groups. Measures of impact, such as attributable risk, indicate the extent to which a disease can be attributed to a given exposure.
Measurement of Epidemiology
Radha Maharjan
MN (WHD)
Contents
5.1 Morbidity
Incidence
Prevalence
Attack Rate
Contents
5.2 Mortality
Crude Death Rate
Case Fatality Rate
Proportional Mortality Rate
Survival Rate
Standardized Death Rate
Contents
5.3 Disability
Disability Adjusted Life Years (DALY)
Quality Adjusted Life Years (QALY)
5.4 Tools of Measurements
Rate
Ratio
Proportion
5.4 Tools of Measurements
Numerator
Numerator refer to the number of times an event (e.g. number of birth) has occurred in a population, during a specified time period.
Denominator
Numerator has little meaning unless it is related to the denominator. The epidemiologist has to choose an appropriate denominator while calculating a rate.
It may be related to:
(I) population
(II) the total events.
Denominator related to the population
Mid year population
Population at risk
Person – time
Sub groups of the population
Denominator related to the Total Events
Mid year population
The population size changes daily due to births, deaths and migration, the mid year population is commonly chosen as a denominator.
The population as on 1st July is mid-year population.
Population at risk
It is important to note that the calculation of measures of disease frequency depends on correct estimates of the numbers of people under consideration.
Ideally, these figures should include only those people who are potentially susceptible to the disease studied.
Population at risk
For instance, men should not be included in denominator for the carcinoma of cervix.
Part of population, which is susceptible to a disease is called the population at risk,
e.g., Occupational injuries occur only among working people so the population at risk is the workforce.
Person – time
In some epidemiological studies (e.g. cohort studies), person may enter into the study at different times.
Consequently, they are under observation for varying time period.
In such case, the denominator is a combination of person and time.
Person – time
The most frequently used person time is person- years.
Some times this may be person- months, person -weeks or man- hours.
For example, if 10 persons were observed in the study for 10 years, person time would be 100 person years of observation.
Person – time
The same figure would be derived if 100 persons were under observation for one year.
These denominators have the advantage of summarizing the experience of persons with different duration of observation or exposure.
Sub groups of the population
The denominator may be subgroups of population
e.g. under-five, female, doctors, etc.
Denominator related to the Total Events
In some instances, the denominator may be related to total events instead of the total population, as in the case of infant mortality rate the denominator is total number of live births.
Definition concept and comparison of ratio, proportion and rate.
2. Measurements of Morbidity and Mortality.pptxFerhanKadir
The most ambitious definition of health is that proposed by WHO in 1948: “health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” but,
Practical definitions of health and disease are needed in epidemiology, which concentrates on aspects of health that are easily measurable and amenable to improvement.
Definitions of health states used by epidemiologists tend to be simple, for example, “disease present” or “disease absent”
Frequency measures of health is an important aspect in the planing of the type of services required in a specific population. This is due to the fact that they are able to indicate the type and level of health problems being faced In that population during a specified period of time.
Measurement of Epidemiology
Radha Maharjan
MN (WHD)
Contents
5.1 Morbidity
Incidence
Prevalence
Attack Rate
Contents
5.2 Mortality
Crude Death Rate
Case Fatality Rate
Proportional Mortality Rate
Survival Rate
Standardized Death Rate
Contents
5.3 Disability
Disability Adjusted Life Years (DALY)
Quality Adjusted Life Years (QALY)
5.4 Tools of Measurements
Rate
Ratio
Proportion
5.4 Tools of Measurements
Numerator
Numerator refer to the number of times an event (e.g. number of birth) has occurred in a population, during a specified time period.
Denominator
Numerator has little meaning unless it is related to the denominator. The epidemiologist has to choose an appropriate denominator while calculating a rate.
It may be related to:
(I) population
(II) the total events.
Denominator related to the population
Mid year population
Population at risk
Person – time
Sub groups of the population
Denominator related to the Total Events
Mid year population
The population size changes daily due to births, deaths and migration, the mid year population is commonly chosen as a denominator.
The population as on 1st July is mid-year population.
Population at risk
It is important to note that the calculation of measures of disease frequency depends on correct estimates of the numbers of people under consideration.
Ideally, these figures should include only those people who are potentially susceptible to the disease studied.
Population at risk
For instance, men should not be included in denominator for the carcinoma of cervix.
Part of population, which is susceptible to a disease is called the population at risk,
e.g., Occupational injuries occur only among working people so the population at risk is the workforce.
Person – time
In some epidemiological studies (e.g. cohort studies), person may enter into the study at different times.
Consequently, they are under observation for varying time period.
In such case, the denominator is a combination of person and time.
Person – time
The most frequently used person time is person- years.
Some times this may be person- months, person -weeks or man- hours.
For example, if 10 persons were observed in the study for 10 years, person time would be 100 person years of observation.
Person – time
The same figure would be derived if 100 persons were under observation for one year.
These denominators have the advantage of summarizing the experience of persons with different duration of observation or exposure.
Sub groups of the population
The denominator may be subgroups of population
e.g. under-five, female, doctors, etc.
Denominator related to the Total Events
In some instances, the denominator may be related to total events instead of the total population, as in the case of infant mortality rate the denominator is total number of live births.
Definition concept and comparison of ratio, proportion and rate.
2. Measurements of Morbidity and Mortality.pptxFerhanKadir
The most ambitious definition of health is that proposed by WHO in 1948: “health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” but,
Practical definitions of health and disease are needed in epidemiology, which concentrates on aspects of health that are easily measurable and amenable to improvement.
Definitions of health states used by epidemiologists tend to be simple, for example, “disease present” or “disease absent”
Frequency measures of health is an important aspect in the planing of the type of services required in a specific population. This is due to the fact that they are able to indicate the type and level of health problems being faced In that population during a specified period of time.
Chapter 3Measures of Morbidity and Mortality Used in .docxketurahhazelhurst
Chapter 3
Measures of Morbidity and
Mortality Used in
Epidemiology
Learning Objectives
• Define and distinguish among ratios,
proportions, and rates
• Explain the term population at risk
• Identify and calculate commonly used
rates for morbidity, mortality, and natality
• State the meanings and applications of
incidence rates and prevalence
Learning Objectives (cont’d)
• Discuss limitations of crude rates and
alternative measures for crude rates
• Apply direct and indirect methods to
adjust rates
• List situations where direct and indirect
adjustment should be used
Overview of Epidemiologic
Measures
Count
• The simplest and most frequently
performed quantitative measure in
epidemiology.
• Refers to the number of cases of a
disease or other health phenomenon
being studied.
Examples of Counts
• Cases of influenza reported in
Westchester County, New York,
during January of a particular year.
• Traffic fatalities in Manhattan in a 24-
hour time period
• College dorm students who had mono
• Foreign-born stomach cancer patients
Ratio
• The value obtained by dividing one
quantity by another.
• Consists of a numerator and a
denominator.
• The most general form has no specified
relationship between numerator and
denominator.
• Rates, proportions, and percentages are
also ratios.
Example of a
Simple Sex Ratio Calculation
• A ratio may be expressed at = X/Y
• Simple sex ratio (data from textbook)
• Of 1,000 motorcycle fatalities, 950 victims
are men and 50 are women.
Number of male cases 950
Number of female cases 50
19:1 male to female= =
Example of a
Demographic Sex Ratio Calculation
• This ratio refers to the number of
males per 100 females. In the U.S.,
the sex ratio in 2010 for the entire
population was 96.7, indicating more
females than males.
Number of male cases 151,781,326
Number of female cases 156,964,212
96.7X 100 = =X 100
Example of a
Sex Ratio at Birth Calculation
• The sex ratio at birth is defined as:
(the number of male births divided by
the number of female births)
multiplied by 1,000.
Number of male births
Number of female births
X 1,000
Definition of Proportion
• A measure that states a count relative
to the size of the group.
• A ratio in which the numerator is part
of the denominator.
• May be expressed as a percentage.
Uses of Proportions
• Can demonstrate the magnitude of a
problem.
• Example: 10 dormitory students
develop hepatitis. How important is
this problem?
– If only 20 students live in the dorm, 50%
are ill.
– If 500 students live in the dorm, 2% are
ill.
Example of a Proportion
• Calculate the proportion of African-
American male deaths among African-
American and white boys aged 5 to 14
years.
Rate
• Definition: a ratio that consists of a
numerator and a denominator and in
which time forms part of the denominat ...
This PPT discusses
Basics measurements in epidemiology
Basics requirements of measurements
Tools of measurements
Measures of morbidity
Measures of disability
Measures of mortality
Mesurement of morbidity (prevalence) presentationDrsadhana Meena
measurement of morbidity (prevalence ) presentation by dr. sadhana, sms medical college , jaipur
included all aspects related to prevalence - objectives,types,significance ,comparison between prevalence and incidence , practical example of prevalence.
Basics of Epidemiology and Descriptive epidemiology by Dr. Sonam AggarwalDr. Sonam Aggarwal
Epidemiology is the basic science of Preventive and Social Medicine.
Epidemiology is scientific discipline of public health to study diseases in the community to acquire knowledge for health care of the society. (prevention, control and treatment).
Chapter 3Measures of Morbidity and Mortality Used in .docxketurahhazelhurst
Chapter 3
Measures of Morbidity and
Mortality Used in
Epidemiology
Learning Objectives
• Define and distinguish among ratios,
proportions, and rates
• Explain the term population at risk
• Identify and calculate commonly used
rates for morbidity, mortality, and natality
• State the meanings and applications of
incidence rates and prevalence
Learning Objectives (cont’d)
• Discuss limitations of crude rates and
alternative measures for crude rates
• Apply direct and indirect methods to
adjust rates
• List situations where direct and indirect
adjustment should be used
Overview of Epidemiologic
Measures
Count
• The simplest and most frequently
performed quantitative measure in
epidemiology.
• Refers to the number of cases of a
disease or other health phenomenon
being studied.
Examples of Counts
• Cases of influenza reported in
Westchester County, New York,
during January of a particular year.
• Traffic fatalities in Manhattan in a 24-
hour time period
• College dorm students who had mono
• Foreign-born stomach cancer patients
Ratio
• The value obtained by dividing one
quantity by another.
• Consists of a numerator and a
denominator.
• The most general form has no specified
relationship between numerator and
denominator.
• Rates, proportions, and percentages are
also ratios.
Example of a
Simple Sex Ratio Calculation
• A ratio may be expressed at = X/Y
• Simple sex ratio (data from textbook)
• Of 1,000 motorcycle fatalities, 950 victims
are men and 50 are women.
Number of male cases 950
Number of female cases 50
19:1 male to female= =
Example of a
Demographic Sex Ratio Calculation
• This ratio refers to the number of
males per 100 females. In the U.S.,
the sex ratio in 2010 for the entire
population was 96.7, indicating more
females than males.
Number of male cases 151,781,326
Number of female cases 156,964,212
96.7X 100 = =X 100
Example of a
Sex Ratio at Birth Calculation
• The sex ratio at birth is defined as:
(the number of male births divided by
the number of female births)
multiplied by 1,000.
Number of male births
Number of female births
X 1,000
Definition of Proportion
• A measure that states a count relative
to the size of the group.
• A ratio in which the numerator is part
of the denominator.
• May be expressed as a percentage.
Uses of Proportions
• Can demonstrate the magnitude of a
problem.
• Example: 10 dormitory students
develop hepatitis. How important is
this problem?
– If only 20 students live in the dorm, 50%
are ill.
– If 500 students live in the dorm, 2% are
ill.
Example of a Proportion
• Calculate the proportion of African-
American male deaths among African-
American and white boys aged 5 to 14
years.
Rate
• Definition: a ratio that consists of a
numerator and a denominator and in
which time forms part of the denominat ...
This PPT discusses
Basics measurements in epidemiology
Basics requirements of measurements
Tools of measurements
Measures of morbidity
Measures of disability
Measures of mortality
Mesurement of morbidity (prevalence) presentationDrsadhana Meena
measurement of morbidity (prevalence ) presentation by dr. sadhana, sms medical college , jaipur
included all aspects related to prevalence - objectives,types,significance ,comparison between prevalence and incidence , practical example of prevalence.
Basics of Epidemiology and Descriptive epidemiology by Dr. Sonam AggarwalDr. Sonam Aggarwal
Epidemiology is the basic science of Preventive and Social Medicine.
Epidemiology is scientific discipline of public health to study diseases in the community to acquire knowledge for health care of the society. (prevention, control and treatment).
Similar to MEASURES OF DISEASE FREQUENCY. ASSOSCIATION AND IMPACT (20)
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Contents
1. Rationale for measurement of health and disease
2. Tools of measurement
3. Measures of disease frequency
4. Measures of association
5. Measures of impact
6. Summary
7. References
2
3. Rationale
Measurement of health and disease is important due to the following reasons:
a. Need for data to guide efforts towards reducing the consequences of disease
b. To understand and assess health status of a population and its changes with time
c. Need for evidence-based decisions in healthcare
3
4. How do we measure disease?
4
Count Divide Compare
5. These are: Count, Rate, Ratio, Proportion
Count:
• Simplest and most basic form of measurement.
• It represents the number of individuals who meet the case definition.
• Limitation:
(i) Count do not consider the size of population at risk
(ii)Count do not specify the time of observation
Tools of measurement- Count
5
6. Count
6
Example:
Count:
Number of new
cases
Year Population
City A 58 1990 25,000
City B 35 1989-90 7,000
Divide:
City A (58/25,000)/1 year=0.00232
City B (35/7,000)/2 years= 0.0025
Compare:
City A 232/100,000 per year
City B 250/100,000 per year
7. Common tools of measurement used in research are – rate, ratio, proportion.
Basic formula:
• Numerator - count of an event in a population during a specific time period.
• Denominator - population pool
Tools of measurement
ꭓ 10𝑛
𝑁𝑢𝑚𝑒𝑟𝑎𝑡𝑜𝑟
𝐷𝑒𝑛𝑜𝑚𝑖𝑛𝑎𝑡𝑜𝑟
7
What is in the
denominator?
8. • Measures the occurrence of an event in a defined population during a given
period of time.
• It is a statement of the risk of developing a condition and is used for
comparison between different locations, time periods or groups.
• E.g., death rate and is given by the formula:
Death rate =
8
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑖𝑛 𝑜𝑛𝑒 𝑦𝑒𝑎𝑟
𝑀𝑖𝑑 − 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
∗ 1000
Rate
Rate- expressed per 1000 or round figure (10,000;100,000) selected according to convenience to avoid fractions.
numerator
denominator
time
multiplier
9. • Concept of numerator in rate: Numerator is a component of denominator in calculating a rate.
• Concept of denominator in rate: Appropriate denominator should be chosen to calculate a rate.
9
Denominator
Related to
Population
Mid year
population
Population at
risk
Person-time
Subgroups of
the
population
Related to
Total events
10. 10
Mid -year population
• The population size changes
daily due to births, deaths or
migration.
•Mid-point refers to the
population estimated as on
first of July of a year.
Population at risk
•Focus is on the groups at risk
of disease rather than on
individuals.
• The concept of ‘population
at risk’ is restricted solely to
those who are capable of
having or acquiring the
disease or condition in
question.
Person -time
• When persons enter the
study at different times, they
are under observation for
varying time period.
•In such cases the
denominator is a
combination of persons and
time (as in person -years,
person -months, person -
weeks or man- hours).
•Person – distance is a variant
of person – time as in
passenger -miles.
Sub-groups of the population
•Denominator may be
subgroup of a population
•e.g., age, gender, occupation
etc.
These denominators have the advantage of summarizing the experience of persons with different durations of
observation or exposure.
a) Related to the population:
11. Example:
Mortality rate of tetanus in Monduli in 1995
Tetanus deaths: 17
Population in 1995: 58 million
Mortality rate =0.029/ 100,000 per year
The number of death due to tetanus is 2900 per 100,000 total death.
12. • In some instances, the denominator may be related to total events instead of total population.
• E.g. in the case of motor vehicle accidents, the number of accidents “per 1000 vehicles” will be a more
useful denominator than the total population (as many of them may not be using a vehicle).
12
b) Related to total events
13. • This tool of measurement express a relation
in size between two random quantities.
• Numerator is not a component of the
denominator.
• The numerator and denominator may
involve an interval of time or may be
instantaneous in time.
Ratio is expressed as:
X: Y or 𝑿/𝒀 13
Ratio
Example:
• # beds per doctor
850 beds/10doctors
Ratio= 85 beds for 1 doctor
• Sex-ratio
• Dentist – population ratio
14. • A proportion indicates the relation in
magnitude of a part of the whole
(comparison of a part to the whole).
• Numerator is always included in the
denominator.
• Proportion is usually expressed as a
percentage.
14
Number of persons or events with a particular
characteristic (x)
Total number of persons or events, of which the
numerator is a subset(x+y)
∗ 100
𝑃𝑟𝑜𝑝𝑜𝑟𝑡𝑖𝑜𝑛 =
Proportion
Example:
Population- 3500 women, 6500 men
• Proportion of men=
6500/(3500+6500)
= 0.65 or 65 %
• M:F ratio = 6500/3500= 1.86
• F:M ratio =3500/6500=0.54
15. 15
Measures of Disease Frequency
Population at risk
• Part of a population which is susceptible to a disease is called the population at risk.
• Risk factor is a characteristic which is more frequent in a group of subjects who develop a
certain disease than in subjects who do not develop the disease .
Risk is the probability of becoming ill, or the proportion of people who become ill (new cases)
during a specified time interval.
• The risk is therefore a proportion, its minimum value is 0 and maximum value is 1
• Population at risk can be defined on the basis of demographic or environmental
factors.
Risk = Number of new cases during a period of time
Population at risk at the beginning of period
16. • It is the number of new cases occurring in a
defined population during a specified period of
time.
Uses of incidence data
• Describe trends in diseases
• Evaluate impact of primary prevention
programmes
• Research into etiology, pathogenesis and
distribution of diseases
• helps in taking action to control disease.
16
Incidence Risk of disease
17. 17
Incidence
Risk or cumulative incidence- is related to the population at risk at the beginning of the study period
Incidence risk=
Number of new cases of disease in a specified period of
time
Number of disease- free persons at the beginning of the
time period
Incidence rate=
Number of new cases of disease in a given time period
Total person-time at risk * during the study period
For e.g, some participants may : develop the outome under investigation, refuse to continue to participate
in the study, migrate, die, enter the study some time after it starts
Incidence rate/ incidence density-Is related to a more precise measure of the population at risk during the
study period and is measured in person-time units.
Difference between
incidence risk and
incidence rate and why
incidence rate is better
18. 18
Refers to all current (old and new) cases existing at a given point in time or over a period of time in a given
population.
Point prevalence: Point prevalence of a disease is defined as the number of all current cases (old and new) of a
disease at one point of time, in relation to a defined population.
The “point” in the point prevalence, may for all practical purposes consist of a day, several days or even a few weeks
depending on the time it takes to examine the population sample.
Point prevalence =
Number of all current cases of a specific disease at a
given point of time
Estimated population at the same point in time
𝑥100
Prevalence Burden of disease
19. 19
Point prevalence =
Number of all current cases of a specific disease at a
given point of time
Estimated population at the same point in time
𝑥100
Prevalence
Example:
Scenario:
• 150 children in a school
• Screening for refractory errors at time ‘t’
• 15 children require glasses
Prevalence of refractory errors = 15/150=10%
20. 20
Period prevalence: Measures the frequency of all current (old and new) cases over a period of time (e.g. annual
prevalence) in a defined population.
Period prevalence =
Number of all current cases of a specific disease during a
given period of time interval
Estimated mid −interval population at risk
𝑥100
Example:
Scenario:
• Population of 150 persons
• Follow up for one year
• 25 had a disease of interest at the beginning
• Another 15 new cases developed during the year
Period prevalence=(25+15)/150=0.27 (27%)
21. Uses of prevalence data:
• Assessing health care needs
• Planning health services
• Measure occurrence of conditions with gradual onset
• Study chronic diseases
Causes of increase and decrease of prevalence:
Increase Decrease
• Long duration
• Low cure rate
• Low case fatality
• Increase in new cases
• Immigration of patients
• Improved detection
• Emigration of healthy people
• Shorter duration
• High cure rate
• High case fatality
• Decrease in new cases
• Emigration of patients
• Improved cure rate
• Immigration of healthy people
Changes in prevalence may have many causes and are difficult to interpret
22. Factors influencing prevalence:
• Number of new cases
• Duration of the illness
• If the disease is short, the prevalence is reduced
• The prevalence of sudden infant death = 0
• If the disease is long, the prevalence is increased
• Rare lifelong disease can accumulate to build up a large prevalence
23. 23
Relationship between Prevalence (P) and Incidence (I)
P = I x D, where D is duration of illness
Change in prevalence from one time period to another may be the result of changes in
incidence rates, changes in the duration of disease, or both.
Patterns of incidence and prevalence
• High prevalence and low incidence
e.g., Diabetes Mellitus
• Low prevalence and high incidence
e.g., Common cold
24. 24
Other commonly used measures of disease frequency in epidemiology
Mortality rates and ratios:
Crude death rate
= Number of deaths during the year
Mid-year population
𝑥1000
Specific death rate due to tuberculosis
=
Number of deaths from TB during a calendar year
Mid-year population
𝑥1000
=
Total number of deaths due to a particular disease
Total number of cases due to the same disease
𝑥100
Case fatality rate (ratio)
25. 25
Proportional mortality rate (ratio) from a specific disease
= Number of deaths from the specific disease in a year
Total deaths from all causes in that year
𝑥100
Survival rate
=
Total number of patients alive after 5 years
Total number of patient diagnosed or treated
𝑥100
Morbidity:
Attack rate
Number of new cases of a specified disease
during a specified time interval
Total population at risk during the same
interval
𝑥100
=
Other commonly used measures of disease frequency in epidemiology
Primary attack rate-
primary source
Secondary attack rate-
secondary source
Eg: coronavirus
26. • quantifies the relationship between exposure and outcome.
• compare measures of disease occurrence among the exposed and unexposed groups.
Measures of association are –
• Relative Risk (RR)
• Odds Ratio (OR)
26
Measures of Association
28. • Also known as Risk Ratio
• Defined as the ratio between the incidence of disease among exposed persons and incidence among non-
exposed.
• Relative Risk can be exactly determined only from a cohort study.
Relative Risk (RR)
RR =
𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑎𝑚𝑜𝑛𝑔 𝑒𝑥𝑝𝑜𝑠𝑒𝑑
𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑎𝑚𝑜𝑛𝑔 𝑛𝑜𝑛 𝑒𝑥𝑝𝑜𝑠𝑒𝑑
Null value is 1 (divide)
29. Relative Risk (RR)
Interpretation of RR:
• RR =1; identical risk among 2 groups (no association between exposure & outcome)
• RR > 1; increased risk for the exposed group (positive association) (risk factor)
• RR < 1; decreased risk for the exposed group (negative association; exposure protects against disease occurrence)
Lung cancer
Lung cancer
absent
Smokers
(exposed)
15 (a) 45 (b)
Non-smokers
(unexposed)
6(c ) 24 (d)
Example:
RR = 𝑎/𝑎+𝑏÷𝑐/𝑐+𝑑
= (15/60)/(6/30)
= 1.25
RR =
𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑎𝑚𝑜𝑛𝑔 𝑒𝑥𝑝𝑜𝑠𝑒𝑑
𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑎𝑚𝑜𝑛𝑔 𝑛𝑜𝑛 𝑒𝑥𝑝𝑜𝑠𝑒𝑑
Interpretation: The risk of smokers developing lung cancer
is 1.25 times higher than non smokers.
30. 30
• Also known as Cross Product Ratio
• Measure of the strength of association between risk factor and outcome.
• Odds ratio is the key parameter in the analysis of case control studies.
• It is based on three assumptions:
a) the disease being investigated must be relatively rare
b) the cases must be representative of those with the disease
c)the controls must be representative of those without the disease
Odds Ratio (OR)
31. 31
Odds Ratio (OR)
Interpretation of OR:
• OR =1; No association between exposure and outcome
• OR > 1; positive association(risk factor)
• OR < 1; negative association (protective factor)
Lung cancer
Lung cancer
absent
Smokers
(exposed)
17 (a) 83 (b)
Non-smokers
(unexposed)
1(c ) 99 (d)
•Odds in exposed group (a/b) = (smokers with
lung cancer) / (smokers without lung cancer) =
17/83 = 0.205
•Odds in not exposed group (c/d) = (non-
smokers with lung cancer) / (non-smokers
without lung cancer) = 1/99 = 0.01
•Odds ratio (ad/bc)= (odds in exposed group) /
(odds in not exposed group) = 0.205 / 0.01 =
20.5
Example:
Interpretation: Smokers showed a
risk of having lung cancer 20.5
times that of non -smokers
32. • Also known as risk difference or absolute risk reduction
This measure indicates the
• extent to which the disease under study can be attributed to the exposure.
• It is the difference in incidence rates of disease between an exposed group and non-exposed
group.
32
Measures of Impact-
Attributable risk (AR)
AR = 𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑟𝑎𝑡𝑒 𝑎𝑚𝑜𝑛𝑔 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 −𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑟𝑎𝑡𝑒 𝑎𝑚𝑜𝑛𝑔 𝑛𝑜𝑛 𝑒𝑥𝑝𝑜𝑠𝑒𝑑
Null value is 0 (differnce)
33. Cigarette
smoking
Lung cancer
Lung cancer
absent
Smokers
(exposed)
800 200
Non-smokers
(unexposed)
40 1960
Example:
AR%= 800-40/ 800 x 100
= 95%
AR% =
𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑟𝑎𝑡𝑒 𝑎𝑚𝑜𝑛𝑔 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 −𝐼𝑛𝑐𝑖𝑑𝑒𝑛
𝑐𝑒 𝑟𝑎𝑡𝑒 𝑎𝑚𝑜𝑛𝑔 𝑛𝑜𝑛 𝑒𝑥𝑝𝑜𝑠𝑒𝑑
𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑟𝑎𝑡𝑒 𝑎𝑚𝑜𝑛𝑔 𝑒𝑥𝑝𝑜𝑠𝑒𝑑
𝑥100
AR % =
𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑟𝑎𝑡𝑒 𝑎𝑚𝑜𝑛𝑔 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 −𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑟𝑎𝑡𝑒 𝑎𝑚𝑜
𝑛𝑔 𝑛𝑜𝑛 𝑒𝑥𝑝𝑜𝑠𝑒𝑑
𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑟𝑎𝑡𝑒 𝑎𝑚𝑜𝑛𝑔 𝑒𝑥𝑝𝑜𝑠𝑒𝑑
𝑥100
Attributable Risk percent :
Interpretation: 95% of lung cancer among
smokers is due to smoking
34. Population Attributable Risk:
Incidence in the general population- incidence in the unexposed population
Amount of risk that would be eliminated from the general population if the exposure were eliminated
Population Attributable Risk percent (PAR%):
Incidence in the general population- incidence in the unexposed population
Incidence in the general population
General population =
62
100,000
Non-smokers =
7
100,000
PAR =62-7= 55 deaths per 100,000
PAR% = 62-7/62=0.89X100=89%
Example:
35. • Excess risk is the difference between the incidence rate among exposed and non-exposed
groups.
• Base line risk is the incidence of disease among non-exposed group.
• Number Needed to Harm (NNH) or Number Needed to Treat(NNT):
• Measure of the number of people who need to be exposed to a risk factor (or a
treatment) for one person to have a particular adverse effect (or to prevent an additional
bad outcome).
• NNH (or NNT) is the reciprocal of attributable risk- NNT= 1/AR
• Lower the NNH- more the risk of harm
35
38. Absolute Risk
The absolute risk of an event is a likelihood of occurrence of that event in the population at risk.
i.e the absolute risk is the probability of an event in a sample or population of interest.
It is expressed a s percentage , also in terms of person-years of exposure to the risk factor.
Absolute risk of an event=
Number of persons who experience the event
Total number of persons exposed to the risk of that
event
𝑥1000
39. Summary
• Risk: the probability of an outcome
• Relative risk is a measure of the strength of association and possibility of a causal relationship
• Attributable risk indicates the potential for prevention if the exposure could be eliminated.
• The comparisons like observed amount of disease in a population with the expected amount of
disease, can be quantified by using such measures of association as risk ratios, rate ratios, and
odds ratios. These measures provide evidence regarding causal relationships between exposures
and disease.
• RR is the risk of an event in an experimental group relative to that of control group
• OR is the odds of an event in an experimental group relative to that of control group
40. Reference
1. Park, Park’s Textbook of Preventive &Social Medicine, 25th Edition, Jabalpur: Banarsidas
Bhanot,2019.
2. Dicker RC, Coronado F, Koo D, Parrish RG. Principles of epidemiology in public health practice;
an introduction to applied epidemiology and biostatistics.
3. Noordzij M, Dekker FW, Zoccali C, Jager KJ. Measures of disease frequency: prevalence and
incidence. Nephron Clinical Practice. 2010;115(1):c17-20.
4. Hennekens CH, Buring JE. Epidemiology in Medicine, Lippincott Williams & Wilkins, 1987.
5. Rothman KJ. Epidemiology: an introduction. Oxford university press; 2012 May 4.
6. Mehendale S, Murhekar MV, Ramakrishnan R. NOC: Health Research Fundamentals.
Editor's Notes
Components of rate
For every 1 dr 85 beds are there
Incidence and prevalence are two measures of frequency that are used to characterize the occurrence of health event in a population.
To account for these variations during follow up, a more precise measure can be calculated, the incidence rate .
Prevalence is of two types – Point prevalence, Period prevalence.
Prevalence is of two types – Point prevalence, Period prevalence.
Used to summarize frequencies of disease and exposure and used for calculation of association
Sometimes called as contingency tables
Used tor ecord and analyze relationships
Lists outcomes in the column
List exposures in the rows
Cell data Are counts
1 or greater indicates- greater indicates an increased risk
A relative risk less than 1 indicates a decreased risk
the risk of smokers developing lung cancer is 1.25 times higher than non smokers