Tutorial 2

Overview
Epidemiological principles and methods are used to describe the frequency and the
determinants of disease, injury and death occurrence. In this chapter you will learn
about the epidemiological measures that are used to quantify the frequency of
morbidity and mortality in a population.

Objective
After this session, students were expected to better able to:
1. Define and calculate crude and specific mortality rates
2. Explain the limitations of comparing crude rates between populations and the
methods to overcome these limitations.

Activity 1.
Definitions:
Infant Mortality rate: The rate of death for children less than one year of age
during a specified year. The denominator is the total number of live births during
the same year.
Neonatal Mortality rate: The rate of death of children less than 28 days of age
during a specified year. The denominator is the total number of live births during
the same year.
Post-neonatal Mortality rate: The rate of death of children aged 28-364 days
during a specified year. The denominator is the total number of live births during
the same year.
Neonatal Mortality + Post neonatal Mortality = Infant Mortality

In country U during the same year, there were 3,978,497 live births and 2,626, 418
people died, of whom 23,215 were infants under the age of one (67,7% of these infant
deaths occurred during the neonatal period). Calculate and interpret:
1. The infant mortality rate:
Infant mortality rate = 23,215/3,978,497=5.83/1000 kelahiran hidup per year
2. The neonatal mortality rate:
Neonatal mortality = 67,7 % x 23,215 = 15,717 infants
Neonatal mortality rate = 15,717/3,978,497 = 3.95/1000 kelahiran hidup per year
3. The post-neonatal mortality rate:
Post neonatal mortality = 23,215 15,717 = 7,498 infants
Post neonatal mortality rate = 7,498/3,978,497 = 1.88/1000 kelahiran hidup per year

The infant mortality rate adalah penjumlahan dari neonatal mortality rate dan post neonatal
mortality rate.
 In country U during the same year, there were 7,051,025 male population and the
number of deaths of male were 51,289. Among male death from 12,566 were caused by
heart disease and 12,053 were cancer.
Calculate and interpret:
1. The crude death rate from all causes for male
The crude death rate = number of deaths/population
The crude death rate for male = 51,289/7,051,025 = 7.27/1000 male population per
year
2. The death rate from cancer among male
Death rate from cancer = number of deaths from cancer / population
= 12,053/7,051,025 = 1.71 /1000 male population per year
3. The proportion of all death among male due to heart disease and cancer
Proportion of death were caused by hearth disease and cancer =
number of deaths were caused by hearth disease and cancer
number of all male deaths
= (12,566 + 12,053) / 51,289 = 4,8/10 male deaths

Activity 2

Table 1. All cause and unintentional injury mortality and estimated population by age
group, for both sexes and for males alone, United States 2002.

Table 1 above provides the number of death from all causes and from accident
(unintentional injuries). Please review the following rates, calculate them and determine
what kind of mortality specific rate.
1. Unintentional injury specific mortality rate for the entire population
Specific mortality rate caused by unintentional injury = total kasus kematian karena kecelakaan
jumlah populasi
= (106,742) / (288,357x1000) = 3.7 /10000 penduduk per tahun

2. All cause mortality rate for 15-24 years old

Mortality rate for 15-24 years old = number all causes and from accident for 15-24 years old
total population for 15-24 years old
= (33,046 + 15,412) / (40,590 x 1000) = 1.19 /1000 penduduk usia 15-24 thn
 3. All cause mortality rate among males
= (1,199,264 + 69,257)/ (141,656 x 1000) = 8.95/1000 penduduk laki laki
4. Unintentional injury specific mortality rate among 45-54 years old males
=10,492 / (19,676 x 1000) = 0.53 / 1000 penduduk laki2 usia 45-54 tahun

Mortality specific rate adalah angka kematian menurut spesifikasi tertentu, bisa berdasarkan
usia, berdasarkan penyebab kematian, atau berdasarkan jenis kelamin.

Activity 3
Four different country level data about breast cancer specific death and total population
shown below.
1.Please calculate the breast cancer specific death rate between country
2.Determine which country had the highest death rate
Country Total Population Total death caused Breast cancer
by breast cancer specific death rate
specific death (per 100.000
people)
Country A 7,890,900 338 4.28
Country B 6,400,124 225 3.52
Country C 1,809,000 115 6.08
Country D 2,400,557 201 8.37
Answer :
a) Spesifik Death Rate the breast cancer in Country A
= 338/7,890,900 = 4.28 per 100,000 people
b) Spesifik Death Rate breast cancer in Country B
= 225/6,400,124 = 3.52 per 100,000 people
c) In Country C
SDR = 115/1,890,000 = 6.08 per 100,000 people
d) In Country D
SDR = 201/2,400,557 = 8.37 per 100,000 people
Country D had the highest death rate.
Activity 4

A total of 1,176,453 deaths (all causes in the whole population) were reported in country
X in 2003. The mid-year population in 2003 was estimated to be 198,812,000. HIV-
related deaths and mid-year population by age group are given in below table

Calculate the crude death rate (from all causes) in country X in 2003.

Now complete above table by answering the following questions:

1.Calculate the crude HIV-related death rate in country X in 2003 in the whole
population.
CDR = 11,406/198,812,000 = 5.74/100,000 population
2.Calculate the age-specific HIV-related death rate among 514-year-olds and
among 3544-year-olds.
ASDR (5-14 years olds) = 30/28,146,000 = 0.11/100,000 population
ASDR (35 44 years olds) = 4,096/29,305,000 = 14/100,000 population

HIV-related deaths and mid-year population by age group in Country Y in 2003 are given
in table below
a. Calculate the age-specific HIV-related death rates for country Y in 2003, and
complete table above

AGE Age specific death rate (per

100,000 population)
0-4 336/33,600,000 = 1
5-14 87/62,400,000 = 0.14
15-24 499/38,400,000 = 1.3
25-34 4454/38,400,000 = 11.6
35-44 3360/24,000,000 = 14
45-54 1516/19,200,000 = 7.9
55+ 504/24,000,000 = 2.1

The HIV-specific death rate for country Y in 2003 was 4.5 per 100,000 populations.
Your calculation for Question 2 should have given you the HIV-specific death rate in
country X in 2003 as 5.5 per 100,000 populations.
b. Can you conclude that a person living in country X has a risk of dying from HIV that is
1.2 times (5.5/4.5 = 1.2) as high as a person living in country Y? Yes, I can.
c. Discuss the limitations of the comparison in Question c above and outline two ways
to overcome them.

1. Angka kematian tertinggi ada pada usia produktif yaitu 25-34 tahun dan 35-44
tahun
2. Langkah yang perlu diambil antara lain :meningkatkan screening HIV Aids pada
orang orang dengan usia produktif tersebut dan kepada orang yang rentan
penularan.
3. Memberikan penyuluhan komunitas kepada orang yang rentan tertular,
keluarga, anak sekolah, karyawan perusahaan, dll.
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