Manana Maridashvili.

MD, PhD, Associated Professor

CIU

Epidemiology

Lecture 2

Basic Measurement
Basic Measurement in Epidemiology

o Morbidity

o Mortality

o Disability

Tools of Measurement

o Rates

o Ratios

o Proportions

o Relative Risk

o Odds Ratio

Basic Measurement

o Tools to quantify how common an illness is in a population in a time.

o Case (event/outcome of interest)

o Size of a population (the population at risk)

o Time

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 o Measurement of disease frequency is a prerequisite for any epidemiologic
investigation

Tools of Measurement Ratio

 Ratio

 Proportion

 Rate

1) Prevalence Rate

2) Incidence rate

3) Case fatality rate

4) Mortality rates(age specific/cause specific)

5) Attack rate

. 1. RATIO: A fraction in which the numerator is not part of the denominator.

Ex: Fetal death ratio: Total no. of fetal deaths/total no. of live births

Fetal deaths are not part of live births

2. PROPORTION: A fraction in which the numerator is part of the denominator.

Ex: Proportional mortality.

Most fractions in epidemiology are proportions.

3.RATE: A proportion in which change over time is considered

- But in practice, the term “ rate” is often used interchangeably with ratio without
reference to time

Ex: fetal death rate & fetal death ratio, maternal mortality rate & maternal mortality
ratio.

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 Prevalence vs. Incidence

o Prevalence: frequency of existing cases

o Incidence: frequency of new cases

o New cases are called incident cases.

Existing cases are called prevalent cases.

PREVALENCE RATE:

No. of people with disease at specified time

No. of people in Population at risk at specified time

x 10n

expressed as cases per 1000/ 10,000

o Point prevalence: Proportion of a population affected by a disease at a given

o Period Prevalence: Proportion of individuals in a specified population at risk who

Ex: annual prevalence rate.

(When the type of prevalence rate is not specified it is usually point prevalence, or its
closest practical approximation)

Prevalence Increased by :

o longer duration of the disease

o prolongation of life without cure

o increase of new cases( i. e. incidence)

o in-migration of cases

o out-migration of healthy people

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 o in-migration of susceptible people

o improved diagnostic facilities

o Prevalence Decreased by:

o Shorter disease duration

o High case fatality from disease

o decrease in new cases

o In-migration of healthy people

o Out-migration of cases

o Improved cure rate of cases

Since prevalence rates are influenced by so many factors unrelated to disease causation,
do not usually provide strong evidence of causality

Prevalence rates are used to measure the occurrence of chronic conditions. Ex:
Diabetes, Rheumatoid arthritis and assessing the health care needs & health planning.

Ex: The percentage of people with malaria parasite in their blood in a village in
Chandragadhi in a survey in December 2007 and the Percentage of under five children
with acute malnutrition in Humla in March 2008

INCIDENCE RATE

Incidence Rate is defined as the no. of NEW cases occurring in a defined population
during a specified time period.

No. of new cases of specific disease during a given time period Population at risk during
that period

X 1000

Prevalence = Incidence x Duration of disease

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 INCIDENCE RATE

o Larger studies: mid-period population

o Also called incidence density or force of morbidity (mortality)

o Expressed as number of new cases per person-time at risk

o Person-time can be person-days, person-months, person years, but more

For example , if there had been 500 new cases of an illness in a population of 30,000
in a year, the incidence rate would be :

500/30000 x 1000 = 16.7 / 1000 per year

o Incidence rate must include the unit of time used in final expression

o Incidence rate refers to only new cases.

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Cumulative Incidence

The probability that an event will occur

if during outbreak called Attack rate

Number of new cases with disease in a specified time period

CI = ----------------------------------------------------------

Number of disease-free people at the start of the time period

Disease-free persons are Population at risk.

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Attack Rate (AR)

o Cumulative incidence during an outbreak

o Usually expressed for the entire epidemic period, from the first to the last case
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 o Not really a rate but a proportion

Ex: Outbreak of cholera in country X in March 1999 Number of cases = 490, Population at
risk = 18,600

Then the Attack rate = 2.6%

Case Fatality Rate

• Measure of the severity of a disease which defined as the proportion of cases of a

= no. of death from a disease in a specified period

no. of diagnosed cases of disease in same period

Cause specific mortality rate

o No. of deaths from a specific disease

in a population in a given period x 1000 Mid year population

o Cause specific mortality rate can be used for certain age groups for example in
under 5 mortality , the common causes are ARI or Diarrhea.

Proportional Mortality Rate

It expresses the no. of death due to a particular cause (or in a specific age group) per
100 (or 1000) total deaths

Proportional mortality for a specific cause:

No. of deaths from the specific disease in a year x 100

Total deaths from all causes in that year

Other Measures

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 o Maternal mortality ratio (MMR): The number of women who die as a result of
pregnancy and childbirth complications per 100,000 live births in a given year.

o Crude death rate: Annual number of deaths per 1,000 population.

o Crude birth rate: Annual number of births per 1,000 population.

o Under-five mortality rate: Probability of dying between birth and exactly five
years of age expressed per 1,000 live births.

o Infant mortality rate: Probability of dying between birth and exactly one year of
age expressed per 1,000 live births.

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