This document discusses various health indicators used to measure morbidity and mortality in populations. It describes: 1. Sources of morbidity statistics including clinical records, surveys, and disease reporting. Morbidity is defined as any departure from well-being and can be measured by incidence, prevalence, and severity of illness. 2. The importance of morbidity data in understanding disease burden, informing research, and monitoring disease control programs. 3. Key terms related to morbidity rates including incidence rates, prevalence rates, and risk. Problems with calculating accurate numerators and denominators are also noted.

1. Health Indicators
Dr. Rahul Netragaonkar
Professor,
Dept. Of Community Medicine
ZMCH, Dahod

2. Measurements of
Morbidity

3. Sources of Morbidity Statistics
• Clinical and hospital
• Managed care
• Registries
• Vital statistics
• Surveys
• Disease reporting
• Insurance and pre-paid med. care plans
• Absenteeism records

4. Measurements of morbidity
•Morbidity is defined as “any departure,
subjective or objective, from a state of
physiological well-being”.
•Morbidity rates/ratios measured by
a) Frequency of disease: incidence and
prevalence
b)Duration of illness: days, months and years
c) Severity of illness: case fatality rates

5. Importance of morbidity data
•To know extent and nature of the disease load
in community and help in forming priorities.
•Provide more comprehensive and accurate and
clinically relevant information on patient
characteristics – essential for basic research.
•Starting point of etiologicalstudies and plays
crucial role in disease population.
•Needed for monitoring and evaluation of
disease control activities.

6. Terms Related to Morbidity
• Morbidity
✓The extent of illness, injury or disability in a defined
population
• Incidence of a disease (Incidence rate)
✓The number of new cases of a disease that occur during a
specified time period (numerator) in a population at risk
for developing the disease (denominator)
• Prevalence of a disease (Prevalence rate)
✓The number of total cases of disease present at a particular
time (numerator) in a specific population (denominator)
• Risk
✓The likelihood that an individual will contract a disease

7. Characteristics
RISK PREVALENCE
Probability of
disease
% of pop. with
the disease
No units No units
Existing
Newly
diagnosed
“Cumulative
incidence”
INCIDENCE
RATE
Rapidity of disease
occurrence
Cases per person-
time
Newly diagnosed
“Incidence
density”

8. 1.“Do you currently have asthma?”
Point prevalence
2. “Have you had asthma during the last 1
years?” Period prevalence
3. “Have you ever had asthma?”
Cumulative incidence

9. Other Measures of morbidity
1.Notification rate
2.Attendance rates at OPD, health
centers
3.Admission, readmission, and
discharge rates
4.Duration of stay in the hospital
5.Spells of sickness or absence from work
or school 68

10. Problems with Numerators
• Who has the disease?
• Who to include in
numerator?
• Interview errors

11. Problems with Denominator
• Selective undercounting
• Everyone in denominator
must have potential to enter
numerator group

12. Problems with Hospital Data
• Selective (many reasons)
• Data may be unavailable,
etc

13. Indicators Of Health
1. Mortality indicators
2 . Morbidity indicators
3 . Disability rates
4. Nutritional status indicators
5. Health care delivery
indicators
6. Utilization rates
7. Indicators of social and
mental health
8. Environmental indicators
9. Socio-economic indicators
10. Health policy indicators
11. Indicators of quality of life,
and
12. Other indicators.

15. Mortality Rates
• Each year, death information is analysed and
resulting tabulations made available by each
Government
• This mortality data provide the starting point for
many epidemiological studies

17. LIMITATIONS OF MORTALITY DATA
1.INCOMPLETE REPORTING OF DEATHS
2.LACK OF ACCURACY
3.LACK OF UNIFORMITY
4.CHOOSING SINGLE
CAUSE OF DEATH
5.CHANGING
6.DISEASE WITH LOW FATALITY RATE

18. USES OF MORTALITY DATA
1. FOR EXPLAINING TRENDS IN OVERALL
MORTALITY
LIKE ROAD TRAFFIC ACCIDENTS
2. FOR INDICATING PRIORITIES FOR HEALTH
ACTION
3. FOR ALLOCATION OF HEALTH RESOURCES
4. DESIGNIG INTERVENTION PROGRAMMES

19. MORTALITY RATES
1. CRUDE DEATH RATE
2. SPECIFIC DEATH RATE
3. CASE FATALITY RATE
4. PROPORTIONAL MORTALITY RATE
5. SURVIVAL RATE
6. ADJUSTED (OR) STANDARDIZED RATES

20. Crude death rate
• CDRis the number of deaths (from all causes) per 1000 estimated
mid year population in one year, in a given place.
• CDR = No. of deaths in one year ×1000
Mid year population
• Limitation of CDRis exposed when we compare age-specific death
rates b/w two populations.
• Major disadvantage of CDR is that they lack comparability for
communities populations that differ by age, sex, race, etc.

21. Specific death rate (SDR)
• SDR = Death due to specific cause ×1000
Mid year population
• Useful when planning to find out etiology :
• Cause or disease specific e.g. TB, Cancer, etc.
• Related to specific groups- age specific, sex specific, etc.

22. Specific death rate
• Advantages: It helps us to identify particular groups or groups at risk
for preventive action. They permit comparisons b/w different causes
with in same population
• Disadvantages: mainly used in developed countries where they have
civil registration system.

24. Case fatality rate (CFR)
•CFR = Total no. of deaths due to particular disease ×100
Total no. of cases due to the same disease
• It represents the Ratio of death to cases
• Virulence of organism & killing power of a disease
• Useful in acute infectious diseases e.g. cholera, measles
• Time interval is not specified

25. Case Fatality Rate - CFR
• It is the proportion of people diagnosed with a certain disease, who end up dying of it
• CFR =
Number of Deaths from a disease X 100
Number of Confirmed cases of that disease

26. CFR
•Total cases of TB in Gujarat in 2021 – 2000, People
died from TB – 16, Calculate CFR.
•Total cases of Malaria in India in 2020 - 10,000,
People died from Malaria – 600, Calculate CFR.

27. Proportional mortality rate (ratio)
• No of deaths due to a particular cause or in a specific age group per
100 or 1000 deaths”.
a) Proportional mortality of a specific disease
=
No. of deaths from the specific disease in a year
×100
Total deaths from all causes in that year
b) Under 5 proportionate mortality rate
= No. of deaths under 5 yrs of age in a given year ×100
Total no. of deaths during the same period

28. Proportional mortality rate (ratio)
•Proportional mortality rates are usually used
for broad disease group and for specific
disease of major public health importance
e.g., cancer, CHD
•It is used when population data is not
available
•Depends upon only two variables, which
differ. So, it cannot be used for comparison
b/w population groups or different time
periods.

29. Proportionate Mortality Rate - PMR
•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%.
•PMR =
Deaths from any specific cause x 100
Total deaths in a given time period

30. PMR
• Total cases of Covid-19 in Dahod in 2021 – 4000, Total Deaths in 2021 – 15,000, Deaths from
Covid – 19 – 300,
Calculate PMR, CFR.
• Total Cases of Dengue in Gujarat in 2020 – 10,000, Total deaths in 2020 in Gujarat – 5,00,000,
Deaths from Dengue – 200, Calculate PMR and CFR from Dengue.

31. IMR – Infant Mortality Rate
• Most important Health indicator
• Denotes overall health status of community
• India – 34, Highest in MP – 47, Lowest in Goa - 8
• IMR =
Total deaths of infants <1year x 1000
Total number of live births in the year

32. IMR
• Calculate IMR for Gujarat
• Children <1yr died – 200, total live births – 40,000 in year 2020.

33. MMR – Maternal Mortality Ratio
• Maternal mortality in India is the maternal death of a woman in India during pregnancy or after
pregnancy, including post-abortion or post-birth periods till 42 days (6weeks post delivery) per 1
lakh live births.
• Post partum Hemorrhage is the most important cause

34. MMR
• In MP in year 2010, there were 4,50,000 live births and total 800 cases of maternal deaths within
42 days of delivery and 100 cases of deaths post illegal abortions, calculate MMR.

35. Survival rate (SR)
•SR = Total no. of patients alive over a period ×100
Total no. of patients diagnosed or treated
•It is the population of survivors in a group studied
and followed over a period. e.g. for 5 years period
•Helps in describing prognosis in certain disease
•Can be used as a yard stick
for the assessment of standardsof therapy.

36. Population growth
•Population growth is the increase in the number of people in a
population. Global human population growth amounts to
around 83 million annually, or 1.1% per year.
•The global population has grown from 1 billion in 1800 to 7.9
billion in 2020.
•The UN projected population to keep growing, and estimates
have put the total population at 8.6 billion by mid-2030, 9.8
billion by mid-2050 and 11.2 billion by 2100.

37. Thanks