Morbidity and Mortality

Measurements in a
Population
WHY IMPORTANT FOR MEDICAL DOCTOR?
AS A CLINICIAN:

1. Patient Diagnosis
2. Determine Therapy

1. Estimate Prognosis
2. Trend of mortality
PREVALENCE
INCIDENCE
Morbidity
Mortality
SURVIVAL
RATE
CASE
FATALITY
RATE
Greenberg, Epidemiologic Measures, pages 15-23
As a public health doctor

1. Diagnose community health problems
2. Intervention/program evaluation
3. Program Management
4. Compare community health status
ABSOLUTE, RATIO, PROPORTION, RATE
TYPES OF MEASUREMENT
ABSOLUTE/FREQUENCY, RELATIVE
(RATIO, PROPORTION, RATE)
CRUDE, SPECIFIC, ADJUSTED
ABSOLUTE
(Frequency of numerator)
Logistic planning

Diagnose community health
problem
Evaluate program
Etiology Study
Ok
X
RATIO
Def: Comparison between two independent
numbers
Example:
SEX RATIO number of men : number of women

AIRT and Diarrhea number of AIRT patients :
diarrhea patients
Interpretation ??
X
Y
PROPORTION
Def: comparison between two number in which
the numerator is part of the denominator
Example:
AIRT Proportion from total clinic visits
TBC proportion from total TBC and HIV in USA

Interpretation: .
X
X + Y
* INCIDENCE
* PREVALENCE

- What? (Definition)
- How to measure ?
- What for? (usage)
X
X + Y
RATE
RATE
A proportion when the denominator is
population at risk.
Rate always proportion but not all
proportion is rate.
Example:
Crude death rate
Cause specific death rate
Infant mortality rate
Fetal death rate
X
X+Y
RATE CONDITION
Numerator/ Denominator, Constant, Time
1 2 5 4 3

1. Numerator and denominator have similar
characteristics
2. Denominator is population at risk
3. Presented in a unit of period
4. Stated in a constant of round number
(kelipatan 10)
6. Denominator is population at certain
geographic area
DEFINITION
Incidence rate: proportion of people
who are previously not suffer for
disease and become ill in a period
of time toward observed at risk
population

Prevalence: proportion of ill people
at a point of time toward observed at
risk population
Figure-1

1/1/06
31/12/06
500
people
1. Direct observation toward a group of
people (primary data).

2. Estimation using secondary data.
3. Estimation using prevalence data and
average of illness duration.
Formula: P = I x d
Methods to gain incidence rate
INCIDENCE RATE
Method 1. Direct Observation
x
x
x
1/1/92 30/3/92 31/6/92 30/9/92
31/12/92

Numerator of Incidence rate:
Number of people
Number of incident (J umlah kejadian)
Sampel
500 pop
at risk
Gonorrhea

1/1/06
31/12/06
Case 1
Case 2
Case 3
Case 4
1500 population
at risk
Method 2. Secondary Data
Numerator (those who became ill)
Posyandu, Puskesmas pembantu, Puskesmas,
RS, RSUP, Laboratory (Public/private),
public/private doctor and paramedic
Denominator (at risk)
Population in a certain area at a point of time.
1. Population Census
2. Estimation of number of population based on
population growth rate and census
3. Population Registration or vital statistic.
Method 3: By formula
Prevalence depend on:
1.Previous incidence.
2.Duration of illness.
P I x d

Only for Chronic Disease
DENOMINATOR of Incidence rate
Population at risk.
Those who are NOT at risk:
Have had ill and become immune
Have immunization
Have been ill at the point of incidence
measurement
Died
Lost to follow up
Which population to be denominator?
Average of population
Initial + End population divided by 2.
Mid-year population or mid-time of
measurement period
Person years the most accurate
- Point Prevalence
- Period Prevalence
1/1/06 31/12/06
500
people
1/6/06
Incidence Prevalence
Risk to suffer for disease
(period of time)
Proportion of suffering
disease (point of time)
For acute/chronic For chronic
Application:
- Etiology
- Management
Application:
- Management
COMPARISON BETWEEN INCIDENCE
AND PREVALENCE