Disease Measurement

Dr. Shirley I. M. dr. MKes

Measures of
Disease Frequency
The most basic measure of disease frequency is a simple
count of affected individuals
a simple count not enough, ex.:

3 cases of cancer per year from a city of 1,000 people is

very different than 3 cases per year from a city of
100,000 people

In epidemiology we must
know:
the size of the population from
which the affected individuals
come, and
the time period the information
was collected.

Basic Measure of Disease

Frequency
A rate is a number of events (births, cases of disease, or

death) in a given population over a given period or a given

point in time
Rate

an example: Incidence

Population at Risk : Part of the population that susceptible

to a disease
Three general categories of rates:
Birth rates
Morbidity(sickness) rates
mortality or fatalityu rates

Rate

basic measure in epidemiology

the frequency with which an event

occurs in a group of people

used to compare the occurrence of

disease in different groups

Example: Rates
Rate =

Number of events in a specified time period

Average population during the time period

***the measure of time is a critical part of a

rate!

Such as, the number of newly diagnosed

cases of breast cancer per 100,000
women during 1999.

Common Rates

mortality (death) rate is the number of

deaths in a defined group of people
during a specified time period.

birth rate is the number of live births in

a defined group of people over a
specified time period.

Incidence

a type of rate

the number of new cases that

develop in a group of individuals
during a specific time period

Incidence (cont.)
I=

number of new events during a period of

time
number of persons at risk during this time
period

 Incidence Rates

A special type of proportion that includes a

specific time period and population-at-risk

Numerator = the number of newly affected

individuals occurring over a specified time period

Denominator = the population-at-risk over the

same time period

There are two types of incidence rates..

Cumulative Incidence
Rate (CIR)
A measure of average risk

CIR answers the question: what is the probability or chance that

an individual develops the outcome over time

Also referred to as the risk or event rate

Common risks or CIRs

5-year breast cancer survival rate

Case-fatality rate

23% of neonates with bloody D and fever die (e.g., Africa)

In-hospital case-fatality (mortality) rate

94% (for local stage), 18% (for distant stage)

5% of hospitalized patients die at hospital X.

Attack rate

25% of passengers on a cruise ship got V&D

Mathew J. Reeves, Dept. of

Epidemiology, Mich State
Univ.

Incidence Density Rate

(IDR)

Defn: the speed at which a defined at-risk group or

population develops a new clinical condition or
outcome over a given time period.

IDR =

denominator is "person-time" or "population time

a measure of the instantaneous force or speed of

disease

IDR ranges from 0 to infinity (it is not a proportion!)

Number of newly disease individuals

Sum of time periods for all disease-free indv.-at-risk

The Concept of
person-time

the sum of the disease-free time experience for individuals at risk in

the population

Concept: 100 people followed for 6 months have same persontime experience as 50 people followed for a year.

How to calculate? (add up disease-free time)

100 x 0.5 = 50 person-years

50 x 1.0 = 50 person-years

100 subjects followed for 6 months

1 new case develops on day 1 of each successive month (i.e., 2 thru 6):
Person time is the sum of disease free-time for each month (1 thru 6)
= 100 + 99 + 98 + 97 + 96 + 95 = 585 months
IDR = 5/585 person-months or 8.54 per 1,000 person months

Person time can be measured with whatever scale that makes the most
sense i.e., person-days, person-weeks, person-months, person-years
(PY)

Incidence Density Rate

(IDR)
A measure of the speed
that disease is occurring

IDR answers the question: At what rate are new cases of disease
occurring in the population

Common IDRs

Mortality rate (Vital Statistics)

Disease Incidence Rates

Lung CA mortality rate = 50 per 100,000 PY

Breast CA mortality rate = 15 per 100,000 PY

IDR of neonatal diarrhea = 280 per 1,000 child weeks

Disease specific IDR rates

Calculated for specific sub-sets defined by age, gender or race

Black Men: Lung CA incidence rate = 122 per 100,000 PY
Wh. Female: Lung CA incidence rate = 43 per 100,000 PY

Mathew J. Reeves, Dept. of

Epidemiology, Mich State
Univ.

Concept of the
Prevalence Pool
New cases
(Incidence)
Recovery
rate

Death
rate

Mathew J. Reeves, Dept. of

Epidemiology, Mich State
Univ.

Relationship between Prevalence and

Incidence

Prevalence is a function of:

the incidence of the condition, and

the average duration of the condition

duration is influenced in turn by the recovery rate and

mortality rate

Prev ~ Incidence x Duration

This relationship explains why.

Arthritis is common (prevalent) in the elderly

Rabies is rare.
Influenza is only common during epidemics.

Mathew J. Reeves, Dept. of

Epidemiology, Mich State
Univ.

Example: Incidence
If there were 150,00 new cases of lung
cancer in the United States during
1997, the incidence rate would be:
(150,000/260,000,000) = 0.000058
0.000058 x 100,000 people
= 58 cases per 100,000 people, per
year

Prevalence
Definition: the proportion of a defined group or population
that has a clinical condition or outcome at a given point in
time

Prev = Number of cases observed at time t

Total number of individuals at time t

Example:

ranges from 0 to 1 (its a proportion), but usually referred

to as a rate and is often shown as a %

Of 100 patients hospitalized with stroke, 18 had ICH

Prevalence of ICH among hospitalized stroke patients =
18%

The prevalence rate answers the question:

what fraction of the group is affected at this moment in

time?

Factors that affect prevalence

Prolong disease
Increased new cases
In-migration of cases
Out migration of healthy individual
In-migration of susceptible individuals
Better diagnostic facilities

Case fatality
Measurement of disease severity
Case fatality rate:
Jumlah kematian karena suatu
penyakit/jumlah kasus penyakitnyang
sama pada periode yang sama

Mortality

Crude death rate/crude mortality rate

Jumlah kematian pada suatu waktu tertentu/
rata-rata total populasi selama periode tersebut

Death rate dapat juga diekspresikan untuk

kelompok yang lebih spesifik seperti umur,
jenis kelamin, ras
Jumlah kematian yg terjadi pada umur, jenis kel
tertentu dari populasi pada suatu wilayah dan
waktu tertentu/
Jumlah total populasi pada kelompok umur, jenis
kelamin yg sama pada wilayah yg sama dan
periode yang sama

Infant mortality rate

Number of children less than 1 year death
Jumlah lahir hidup dalam tahun yang
sama

Maternal mortality rate

Kematian maternal yang berhubungan
dengan kehamilan sampai dengan 42
hari post partum/
Total kelahiran hidup pada tahun yang
sama