Download - 3) Measurement of Mortality and Morbidity
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Morbidity and Mortality Measurements in a Population
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WHY IMPORTANT FOR MEDICAL DOCTOR? WHY IMPORTANT FOR MEDICAL DOCTOR?
AS A CLINICIANAS A CLINICIAN::1.1. Patient DiagnosisPatient Diagnosis2.2. Determine TherapyDetermine Therapy
1.1. Estimate PrognosisEstimate Prognosis2.2. Trend of mortalityTrend of mortality
PREVALENCEINCIDENCEMorbidity
MortalitySURVIVAL RATECASE FATALITY RATE
Greenberg, Epidemiologic Measures, pages 15-23
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As a public health doctorAs a public health doctor
1. Diagnose community health problems1. Diagnose community health problems2. Intervention/program evaluation2. Intervention/program evaluation3. Program Management3. Program Management4. Compare community health status4. Compare community health status
ABSOLUTE, RATIO, PROPORTION, RATE
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TYPES OF MEASUREMENTTYPES OF MEASUREMENT
ABSOLUTE/FREQUENCY, RELATIVE ABSOLUTE/FREQUENCY, RELATIVE (RATIO, PROPORTION, RATE)(RATIO, PROPORTION, RATE)
CRUDE, SPECIFIC, ADJUSTEDCRUDE, SPECIFIC, ADJUSTED
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ABSOLUTEABSOLUTE(Frequency of numerator)(Frequency of numerator)
Logistic planningLogistic planning
Diagnose community health Diagnose community health problem problem
Evaluate programEvaluate program Etiology StudyEtiology Study
Ok X
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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
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PROPORTIOPROPORTIONN
Def: comparison between two number in Def: comparison between two number in which the numerator is part of the which the numerator is part of the denominatordenominator
Example:Example:– AIRT Proportion from total clinic visitsAIRT Proportion from total clinic visits– TBC proportion from total TBC and HIV in USATBC proportion from total TBC and HIV in USA
Interpretation: ……….Interpretation: ……….
X X + Y
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* IN* INCCIDENIDENCECE* PREVALEN* PREVALENCECE
- - What? (What? (DefiniDefinition) tion) - - How to measure ?How to measure ?- - What for? (usageWhat for? (usage))
X X + Y
RATERATE
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RATE• A proportion when the denominator is
population “at risk”.• Rate always proportion but not all Rate always proportion but not all
proportion is rate.proportion is rate.Example:
– Crude death rate– Cause specific death rate– Infant mortality rate– Fetal death rate
X X+Y
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“RATE” CONDITIONNumerator/ Denominator, Constant, Time
1 2 5 4 3
1. Numerator and denominator have similar characteristics
2. Denominator is population at risk3. Presented in a unit of period4. Stated in a constant of round number (kelipatan 10)6. Denominator is population at certain
geographic area
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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
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Figure-1
1/1/06 31/12/06500
people
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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
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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 (Jumlah kejadian)
Sampel 500 pop at risk
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Gonorrhea
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Case 1
Case 2
Case 3
Case 4
1500 population “at risk”
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Method 2. Secondary DataNumerator (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 Census2. Estimation of number of population based on
population growth rate and census3. Population Registration or vital statistic.
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Method 3: By formula
Prevalence depend on:1.Previous incidence.2.Duration of illness.
P ≈ I x d Only for Chronic Disease
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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”
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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
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- Point Prevalence- Period Prevalence
1/1/06 31/12/06
500 people
1/6/06
PREVALENCE RATE
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Incidence PrevalenceRisk 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