Basic Epidemiology

WHAT IS EPIDEMIOLOGY?
 Epidemiology
is the branch of medical science that
investigates all the factors that determine the
presence or absence of diseases and
disorders.
 Vital Statistics
Concerned mainly with the study of births,
illnesses, and deaths occurring in a defined
population for a specified time period
An indispensable tool in the planning,
implementation, and evaluation of health/
nursing program
 Importance of Vital Statistics:
Serve as an indices of health conditions of a
community or population group
Provide valuable clues as to the nature of
health services or actions needed
Serve as a bases of determining the success or
failure of such services or action
 Health Personnel Task:
Share with the community they serve the
responsibility of planning and taking the
necessary actions to solve the latters health
problem
They are expected to be able to maintain
accurate and updated statistical records and
reports.
DEFINITION OF TERMS
 Statistics.
the science which deals with the collection,
classification and use of numerical facts or
data bearing on a subject or matter; the
numerical facts or data themselves
 Vital Statistics (Biostatistics)
statistical data which relate the total number of
various kinds of biologic or vital events (like
births, marriages, illnesses and deaths) to the
size and characteristics of the affected
population
 Population..
An aggregate or group of people under study
Ex: all persons living in the city of Manila or all
females in the reproductive age group
 Mid-year population..
the population of the area under study as of July
1( mid-year) of a calendar year.Assuming that
births, deaths, and migration ( additions to
and substractions from the population) are
equally distributed throughout the year, the
midyear population can be considered as
representative of the population for the whole
year
 What is Health Indicators?
An important health and health-related
information which determine the health of
the people in a particular community and
which will help the health care provider
describe the health status of the same
community
 The ff are health indicators:
1. Birth
2. Death
3. Marriages
4. Migration
 Health Vital Statistics
Generally expressed as Vital Rates which may
be grouped under three categories:
1. Fertility or Birth Rates
2. Mortality or Death Rates
3. Morbidity or Sickness Rates
These rates serves as indices of the health of a
population based on the birth illness and
death patterns obtaining in the community
A. FERTILITY OR BIRTH RATES

1. Crude Birth Rate

2. General Fertility Rate
3. Age- Specific Fertility Rate
 I. Crude Birth Rate (CBR)
A rough measure of fertility in the population
since it makes use of the mid-year in the
population ( which includes the number of
men and women incapable of child- bearing)
Formula:

Total live births in a calendar year

CBR= Mid-year population for that year
x 1000
Example:
- Davao del Norte in Region II registered a
total of 22,609 live births in 1975
- Since its population for that year was
571,800 the crude birth rate would be 22,609
571,800 x 1000 = 39.5 per 1000 population
 II. General Fertility Rate (GFR)
More specific measure than crude birth rate
because the denominator makes use of the
number of women of child- bearing age.
Formula:
Total live births in a calendar year
GFR = Mid-year population of women of child x 1000
bearing age (15-44) or 48 years for that
year
Example:
- in 1975 the Philippines female
population of the 15-44 age group numbered
9,227,500 while the total live births registered
1,223,837
- this represents a fertility rate of
1,223,837 9,227,500 x 1000 = 132.6 per
1000 population
Note: child- bearing age may vary from
country to country.. Some use 15- 44 years
while others use 15-49 years.
 III. Age- Specific Fertility Rate
One of the most accurate refinements made
in the study of fertility
This permits a more in-depth study of the
differences in fertility at specific ages
throughout the reproductive period and the
impact of birth control measures on fertility
Formula:
Total births to women age X years
x 1000
= Mid-year population of women age X years
Example:
- if there were 705 births registered to
425,000 women of 18 yrs., the age specific
fertility rate for that age (18) is 705 425,000
x 1000 = 1 per 1000 population
B. MORTALITY OR DEATH RATES

1. Crude Death Rate (CDR)

2. Age-Specific Death Rate
3. Age and Sex-specific Death Rate
4. Cause- Specific Death Rate
5. Proportional Mortality Rate
6. Case Fatality Rate
7. Infant Mortality Rate
8. Fetal Death Rate
9. Maternal Mortality Rate
10. Perinatal Mortality Rate
 I. Crude Death Rate (CDR)
Only a rough measure of the force of mortality or probability
of drying in a population because of death rates are
influenced to a large extent by the age and sex composition of
the population
Formula:
Total deaths in a calendar
CDR = x 1000
Mid-year population for that year

EX:
A total of 271,136 deaths were registered for the Philippines
which had a population of 42,517,300 in 1975
This represents a crude death rate of 271,136 42,517,300 x
1000 = 6.4 per 1000 population
 II. Age-Specific Death Rate
Gives a better picture of the force of mortality
in a given population than the crude death
rate since the age factor is held constant.
Formula:
Total deaths, specific age group,
calendar year
= Mid-year population, same age
xF

group, same year

Note:
- that the factor (F) is not specified
- this means that any factor may be used
as long as it gives a whole # when multipled
by the quotient
Example:
- the total # of deaths reported for 1-4 age
group in the Philippines in 1975 was 36,350,
while the population for that age group was
5,629,300
- the age specific death rate for the age
group would be 36,350 5,629,300 x 1000 =
6.5 per 1000 population
 III. Age and Sex- specific Death Rate
Similar to the age specific death rate but
specifies the sex as well.
Formula:
=
Total deaths age group and sex calendar year
xF
Mid-year, population, same age group, sex & year

Example:
- in 1975, the Philippines male population for the 1-4 age
group is 2,872,700 and the total # of deaths in the same sex
and the total # of deaths in the same sex & age group is
19,347. the age & sex-specific death rate would be 19,347
2,872,700 x 100,00 = 673 per 100,000 population
 IV. Cause- Specific Death Rate
This rate specifies the cause rather than the
age and sex
Formula: Total deaths from a particular cause
in a calendar
CSDR= Mid-year population for that year x F
Example:
- in 1975 there were 43,349 reported
deaths from pneumonia
- this would give a cause-specific death
rate of 43,349 42,517,300 x 100,000 = 102
per 100,000
This rate may also be refined as to age and sex
in which case it becomes the age, sex and
cause-specific death rate
 V. Proportional Mortality Rate
This rate denotes the percentage of all deaths
attributed to a certain diseases.
Used in ranking the cause of death by
magnitude of frequency
Formula:
Total deaths from a particular
cause in a calendar year
= Total deaths from all causes in
x 100

the same year

Note: that it is always expressed in percentage
since the factor used is 100
Example: if the reported deaths from
pneumonia were 43,349 & the total # of
deaths was 271,136, the proportional
mortality rate for pneumonia would be 43,349
271,136 x 100 = 16%
 Swaroops Index
Another proportional mortality indicator
It gives the percentage of all deaths which occur in persons 50 years
and above
Formula:
SI= total deaths in persons 50 years and above/ total number of deaths for
all ages X 100
EX:
Is a directly proportional to the health status of a population
EX:
index of 80% means that only 20% of the population are dying
before the age of 50 years ( which is a good indication of the health
of a population
Low index implies that life expectancy is short and more people are
dying at an early age
 VI. Case Fatality Rate
Measures the killing power of a disease or injury as expressed in
terms of percentage.
Ex: rabies and meningitis are known to have a high CFR while;
measles and mumps are known to have a low CFR
To determine the CFR of a disease, it is necessary to follow- up the
cases for a defined period such that deaths occurring beyond the
period could not be reasonably be directly related to the disease
under study.
It is used to determine how well the treatment of a certain disease
has succeeded or is succeeding.
Formula: CFR= total deaths from a particular cause during a specified time period/ total cases of the
same cause followed up during same time period
EX:
 VII. Infant Mortality Rate (IMR)
Considered 1 of the most sensitive indices of
the health conditions obtaining in a
population
Closely linked with preventable or
environmental factors
Infant deaths are associated with acute
communicable diseases and such factors as
poor environmental sanitation and personal
hygiene, in general, inadequate health service
 Formula:
Total deaths, less than 1 year of age, calendar year
IMR=
Total live births in same year

Note: infant deaths are not actually divided by the

actual population of that age because the census
date are obtained only for certain years and are likely
to fluctuate considerably between census years.
Thus, the number of live births provides a more
reliable and readily available figure for the
denominator
 Example:
There were 65,263 infant deaths reported for the
Philippines in 1975
Using the total number of live births for that year
(1,223,837), the infant mortality rate would be
65,263 1,223,837 x 1000 = 53.3 per 1000 live births
Because of the generally high mortality that occurs in
the 1st year of life, further division of the IMR into
the neonatal (1st month or 28 days of life) and post
neonatal (after the 1st month to 1 year of age)
mortality rates may be made
Calculation of these rates consists merely of
substituting the age group less than 1 yr. of age to
the two age group mentioned
 VIII. Fetal Death Rate (FDR)
Includes abortions and still births, are
generally attributed to prenatal causes and are
therefore influenced more by endogenous
than environmental factors
Defined by the World Health Organization as
death prior to complete expulsion or
extraction from the mother of product of
conception, irrespective of the duration of
pregnancy
Indicated by the fact that after such
separation, the fetus does not breathe nor
show any evidence of life such as beating of
the heart, pulsation of the umbilical cord or
definite movement of voluntary muscles
Formula:
Total deaths, 20 weeks of gestation and over, calendar year
FDR =
Total live births in same year
The appropriate denominator is the # of
conception or pregnancies which may be
directly arrived at by adding all fetal deaths
and live births
Since fetal deaths, particularly early fetal
deaths (or abortions) are seldom reported,
the use of live births has been universally
accepted
For the same reason, better figures are
obtained if the numerator is limited to fetal
deaths (or still births)
 Example:
If there were 245 fetal deaths and 35,960 live
births registered in Region XII, the fetal death
rate would be 245 35,960 x 1000 = 6.8 per
1000 live births
IX. Maternal Mortality Rate (MMR)
Measures the risk of dying from causes
associated with childbirth
Death of a mother directly due to pregnancy,
labor and puerperium within 90 days of
delivery
Deaths of mother or pregnant women not due
to causes previously mentioned are not
included in maternal deaths
 Formula:
Total deaths in a calendar year
MMR = x 1000
Total live births in same year

Ideally, denominator should be the # of pregnant

women during the year under review
In the absence of a system of reporting pregnancies,
the # of live births is used as a convenient
approximation of the # of pregnancies
 Example:
Maternal deaths for the Philippines totalled
1753 in 1975
Using the # of live births, the maternal
mortality rate would be 1753 1,223,837 x
1000 = 1.4 per 1000 live births
 X. Perinatal Mortality Rate (PMR)
Computation of this is now preferred over that
of still birth and neonatal death rates, as it has
been realized that many fetal deaths in the
late pregnancy and neonatal deaths in the 1st
week of life may be attributed to similar
underlying conditions/factors
To separate the two events gives incomplete
information so that certain factors may be
overlooked rather than identified
It is now accepted since maternity care is
concerned both in improving the welfare of
the fetus and insuring the birth of a healthy
child
Formula:
Fetal deaths, 28 weeks and over of gestation + early
neonatal deaths, 1 week of age, in calendar year
PMR = x 100
Total live births in same year
 Example:
If the total # of fetal and clearly neonatal
deaths for the Philippines is 13,764 and the
total # of live births is 1,223,837, the fetal
death rate would be 13,764 1,223,837 x
1000 = per 1000 live births
 1.Incidence Rate
2. Prevalence Rate

C. MORBIDITY/SICKNESS RATE
Generally set up for particular causes of illness
or disability or for groups of allied illnesses
 I. Incidence Rate
- measures the frequency of occurrence of
new cases
- formula:
=
No. of new cases during a specified time
xF
Population in the area during that time
 Examples of cases that are reported weekly and
annually in the Philippines
A. Cases of notifiable disease reported weekly by
health officers in their town/city are measures of
weekly incidence of such cases and the mid-year
population of that town/city constitutes the
denominator
Example:
the highest # of cases reported for influenza in 1975
was 8,672 which occurred on the 35th week
If the population was 42,517,300, the incidence rate
for that week would be 8,672 42,517,300 x
100,000 = 20 per 100,000 population
 Attack Rate
Refinement of the incidence rate
Used only for a limited population group and
time period
Using during an outbreak or epidemic
Formula:
No. of new cases of a disease in a time period
AR = Population at risk during that time period x 100
 II. Prevalence Rate
When chronic disease constitute the major medical
problem incidence rates cannot easily be obtained
since few such diseases are reportable
Thus, the prevalence rate is the more commonly
used morbidity measure in chronic disease
Measure of a status of s particular disease
within a given point or interval of time
 Formula:
No. of cases existing (old &
new) at a given time
Point Prevalence = Population surveyed during that
x 100

time

No. of cases existing (old & new)

at a given interval of time
Period Prevalence = Population surveyed during
x 100

that interval of time

 Example:
The total # of tuberculosis cases reported in
the Philippines for 1975 was 133,537
With a population of 42,527,300 the
prevalence rate would be 133,537
42,527,300 x 100,000 = 314 per 100,000
population