Lecture 3:
Measuring the Occurrence of
Disease
DR. ELIJAH KAKANDE
MBCHB, MPH
DEPARTMENT OF PUBLIC HEALTH
Measures
How do we express the extent of morbidity and mortality
resulting from disease?
Counts
number of individuals who meet the case definition
Ratio
a fraction with no relationship between numerator and denominator
Proportions
what fraction of the population is affected
Rates
how fast things are occurring
Measures
Measures of morbidity
Prevalence: a proportion
Cumulative incidence: a rate
Incidence density: a rate
Measures of mortality
Mortality rate: a rate
Standardized mortality (SMR)
Defining case
Natural course of disease
Exposure onset symptoms dx outcome
Incubation Clinical Recovery
period Stage Death
Chronic disease
Subclinical
Stage
Counts
Prerequisite for epidemiologic investigation
Simplest measure of disease frequency
Frequency of affected individuals
Useful for planning adequacy of health care allocation at
a particular level
For example:
Number of West Nile virus cases
Ratio
A fraction with no specified relationship between
numerator and denominator
Range: 0 to
A/B
Examples
sex ratio (M:F)
Number of people with Syphilis in 1991;
Males; 2412 Females; 2314
Ratio of males:females 2412/2314=1.04
Proportion
Type of ratio
Numerator included in denominator
May be expressed as percentage
Percentage = proportion x 100 %
Range: 0 to 1
A/(A+B)
Example
Prevalence
Prevalence
Allindividuals with a disease at a given point in time
Defined by;
number of cases (A) today
P=
total population (A+B) today
Prevalence
Proportion of individuals in a population who have the
disease or condition of interest at a specific time period
Utility
Describe health burden of a population
Status of disease in a population
Estimate the frequency of exposure
Project health care needs of affected individuals
Types of prevalence
Point prevalence – proportion of all cases at a specific
point in time
Period prevalence – proportion of all cases during a
period of time
Point and period prevalence
Point prevalence
Do you currently have asthma?
Period prevalence
Have you had asthma during the last five years?
Every person in the numerator had the disease at some time
during the period specified.
Period prevalence consists of the point prevalence at the beginning
of a specified period of time plus all new cases that occur during
that period.
Rate
A special type of proportion
Unit of time in denominator
A/(A+B) per time interval
Always two components:
New cases and time
Incidence
Incidence is an important rate…
It is the proportion of people (at risk) who develop diseased during a
specific time period.
Three key elements:
Only new cases included in numerator
Total population at risk in the denominator
Time element – period over which new cases developed
Two main types of Incidence:
Cumulative Incidence
Incidence Rate (a.k.a. incidence density)
Cumulative Incidence
One of the most widely used measures of disease risk.
Estimate of probability (risk) that an individual will develop
disease during a specified period of time
Cumulative Incidence =
No. of new cases in a given period of time
No. of people at risk during that time
Incidence rate (incidence density)
Cumulative Incidence gives each individual equal weight, but
different people stay in the study for different length- having
different contribution.
Measure of the true rate of disease development
Incidence rate =
No. of new cases in a given period of time
total person-time of observation
Person-time
ID 1995 1996 1997 1998 1999 2000 Total
A x 3
B
3
C 5
x
D x
1
E x
4
Total years at risk 16
• = enter the study, X = having disease,
loss to follow-up
5-year (1995-2000) Incidence rate
= 3/16 = 18.75/100 person-years of observation
Prevalence vs. incidence
ID 1995 1996 1997 1998 1999 2000
x
A
B
C x
D x
E x
• = enter the study, X = having disease,
loss to follow-up, disease developing
1997-2000 cumulative incidence cases: A, E
1997-2000 period prevalence cases: A, D, E
1998 point prevalence: A, D
Relationship between prevalence and
incidence
Incidence is a proxy for “risk”, whereas prevalence is best for
assessing disease burden or case load in a geographic area.
There is a well known relationship between them, namely –
Prevalence = Incidence x Duration of disease
P = I x D
Examples of P = I x D
Ifthe incidence of diabetes mellitus is 1% per year and its
approximate duration is 5 years, then what is its expected point
prevalence?
Assuming equal incidence of disease, which is more prevalent:
pancreatic cancer or brain cancer?
Average duration of pancreatic cancer = 3 months
Average duration of brain cancer = 1.5 years
Measures of mortality
Annual mortality rate from all causes =
Total no. of death from all causes in 1 year
No. of people in the population at midyear
Case-fatality rate =
No. of individuals dying during a specified period of time
after disease onset
No. of individuals with the specified disease
Three common forms of rates
Crude rates
e.g. crude birth rate, crude death rate
Specific rates
e.g. sex-specific, age-specific, race-specific
Adjusted rates
e.g. age-adjusted
Crude rate: example
Suppose County B recorded 4000 births and 1500 deaths in 1999.
Using U.S. Census data, we find that the population size is 200,000.
Crude death rate =
No. of deaths in time interval T
Total population
= 1,500/200,000 = 7.5 deaths per 1,000
Qn; Calculate the crude birth rate.
Routine epidemiological data
Advantages Disadvantges
1. readily available 1. Not always up-to-date (dependent on
2. low cost when collected)
3. useful for identifying hypotheses 2. Lack of completeness (except census)
4. useful for initial assessment 3. Some variables of interest may not be
5. provides baseline data on expected collected
levels of health/disease 4. Occasionally subject to political
influences and manipulation
Sources of routine data giving population health information
are:
[Link] (Stock status report, Uganda Pharmaceutical sector report)
[Link] (Census, UDHS,MIS)
[Link] Health Information System
THANK YOU
