Measures of health- indicators of burden of disease

Understand, interpret and be able to calculate prevalence and incidence as a measure of disease
frequency in populations
Health: state of complete physical, mental and social wellbeing (as opposed to 'not diseased')
What are we measuring
!utcome as classified by diagnostic criteria and case definition
standard set of diagnostic criteria- who is classified as healthy? Who is diseased?
unambiguous
e"g" clinical, lab findings, person, time, place
Who are we measuring
#opulation at ris$ (susceptible to outcome defined by demographic, geographic,
environmental factors)
Why are we measuring it
%dentification& 'is there a problem' 'who is vulnerable'
'ompare populations
(heory and hypothesis testing
'ourse of action
#rogress (is action wor$ing)
)!W *! W+ M+,-U.+
#revalence& proportion of individuals in a population who have a disease/outcome at a specific
point/period in time
#oint prevalence (all who have outcome at point in time)
#eriod prevalence (within defined time period)
%ncidence& number of NEW health related events in a defined population within a specified period
of time
'umulative incidence& proportion of people who develops the disease within a time period
(/) function of underlying incidence rate or length of follow up
%ncidence rate& how quic$ly people are developing disease
function of speed at which new cases are occuring
e0pressed as a function of time (person-years)
1person-years= the PRODUCT of the amount of time and the numer of memers o a
population who ha!e een affected y the condition
incidence = "#
person-months = $%&%'%("%() = *+
incidence rate- ",*+ per person month
-",*+./(" per person year
%nfluences on prevalence and incidence&
.elationship depends on how long the disease persists before 'U.+ or *+,()
(if cured, or dead, prevalence decreases" %ncidence shouldn't change)
#revalence 2 %. 3 average duration of disease
,ssuming&
stationary population
prevalence of disease rare (456/)
(he %7'%*+7'+ of ,%*s has decreased, due to preventative health campaigns
(he #.+8,9+7'+ of ,%*s have increased, since people are surviving longer
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long duration
increase in incidence
in-migration of cases
in-migration of susceptile,at ris: -? ecause they turn into cases.
out-migration of healthy people
impro!ed diagnostics,etter reporting,looser case definition
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shorter duration
high case-fatality
decrease in incidence
in-migration of healthy people
out-migration of cases
impro!ed cure rate
Understand the use of other basic measures of disease such as means, *,9:s
%mportance of standardising descriptive measure agains demographic factor $nown to influence
outcome (age, gender, ethnicity)" ,llows for comparison across populations"
!ther measures&
Mortality (number of deaths in a period;population at ris$ over period)
-urvival rate (no" patients still alive from diagnosis to end of a given period;total number
patients diagnosed at -(,.( of period)
(otal health measures (overall health of population)&
7urden of disease--; impact of moridity and mortality on population
9ife e0pectancy (no" years e0pected to live at given age)
calculated using age-specified mortality rate at 'U..+7( time
separate for male and females
e"g" life e0pectancy at birth lower than life e0pectancy of <6 year old
(survived childhood diseases, the longer you live the longer you are e0pected to live)
*isability-free e0pectancy (*=9+0)
no" years e0pected to live without some $ind of disability at a given age (gets shorter as person
ages)
>uality-ad?usted life years (>,9:)
/ of year lived with >o9 @0 life e0pectancyA
)ealth-ad?usted life e0pectancy (),9+)
'ombination of 9+ and >,9:
B life e0pectancy at birth ad?usted for time spent in poor health