Health Demographics

& Indices
Lecture Handouts
St. Luke’s College of Nursing
SY. 2017 - 2018
 Demography
The statistical science of Population

The study of human population, its

changes, and its implications
 Demographic Profile
Population Phenomena:
S_____
– Changes in frequency of members in a population over
time
e.g. growth rate by 1.72% in the last 5 years

C__________
– Characteristics of the Population
e.g. age, sex, marital status,
income, occupation, religion

D__________
– Geographic location
e.g. Rural or urban setting
 Population Composition
Sex Composition
Sex Ratio
Sex Structure

Age Composition
Median Age
Dependency Ratio

Age – Sex Composition

Population Pyramid
 Sex Ratio
Compares the number of males to the
number of females

e.g. Of the 92.1 million household population in the

Philippines, 46.4 million were males and 45.6 million were
female. (Age and Sex Structure of the Philippine Population,
2010)
“In 2012, there
46.4 M x 100 = were for
45.6 M every 100 females
in the Philippines”
 Sex Structure
Compares the sex ratio across different
categories/levels of another characteristic

e.g. Sex structure across urban-rural classification or

across different age groups

Source: Age and Sex Structure of the Philippine Population, 2010

 Median Age
The middle-most age in a population arranged
from youngest to oldest

Indicates whether the population is young or old

increasing median = increase in ;
decreasing median = increase in

e.g. Median age = 25 y.o.

“50 percent or half of the population is 25 y.o. or
below and the other half is over 25 y.o.”
 Age Dependency Ratio
Relates the size of the dependent segment of the
population to the (every 100 persons)
of the population
where:
Dependent = 0 – 14 + 65 above
Productive Age = 15 – 64
*index of age-induced economic drain on manpower resources,
assuming all 15 – 64 y.o. are economically productive
Age
Dependency
Ratio
 `
Age Dependency Ratio
e.g. Age Group Population
0 – 14 24,313,897
15 – 64 45,257,770
65 above 2,932,410
Source: Philippine Census, 2000

24,313,897 + 2,932,410 x 100 =

45,257,770

“In 2000, every 100 persons in the economically productive

age groups has to support approx. .”
 Population Pyramid
Graphic representation of the age and sex
composition of the population at the same time
 Population Pyramid
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

Broader base
and its sides Broad base Narrow base
bow in much and gently Beehive and sharp
more sharply sloping sides Bell-shaped shaped middle sides
- High Birth - High Birth - Low Death - Low Birth - Rapid
rate rate rate rate decline in
- Decreasing - High Death - More elderly - Low Death fertility
Median age rate people rate - Low Death
- Shorter Life - Low Median - High Median rate
expectancy Age Age
- High - Longer Life
Dependency expectancy
Ratio
 Other Population Composition
Life expectancy at Birth
Average number of years an infant is expected to live
under the mortality conditions for a given year

Marital Status

Religious composition

Educational Attainment

Economic Characteristics
Occupation
Income
 Population Distribution

Distribution of population according to place of residence

classified into rural and urban areas

Measures the average number of persons per unit area

or space

More specific measure of population density

total household members
Crowding Index =
number of rooms in the house
 Sources of Demographic Data
1. Census
2. Registration Systems
3. Surveys
 Census
Process of , and
demographic, economic
and social data pertaining to all persons in a
country at specified times

De Jure – assign individuals to the place of

their usual residence

De Facto – allocate individuals to the area

where they were physically present
 Registration Systems
Continuous recording systems of vital
events as they occur in the population.
*Vital Events:
- Birth
- Death
- Marriage
- Divorce
 Survey
Obtaining information from only a subset
of the entire population

e.g. National Demographic and Health Survey

National Nutrition Survey
Health Measures and Indicators

Lecture Handouts
St. Luke’s College of Nursing
SY. 2017 - 2018
 Measures of Frequency
Table 1. Deaths from cholera in the districts of London supplied by the
Southwark and Vauxhall and the Lambeth Companies, July 9 to August 26,
1854
Water Supply Number (%) of Population Death Rate for
Company Deaths from (1851) Cholera per
Cholera 1,000 Population
Southwark 844 (5%) 16,654 5.0
and Vauxhall
Lambeth 18 (0.09%) 19,133 0.9
Source: CDC, Principles of Epidemiology, 2nd Ed.

“For every 100 deaths in Southwark and Vauxhall,

approximately 2 deaths in Lambeth.”
 Measures of Frequency

a a
a+b

a a
b k
where:
a = no. of occurrence or people w/ the characteristic of interest
b = another set of occurrence or people apart from set a
k = denominator with the element of time
 Count

• Basic measurement of frequency

• Actual countable numeric value
e.g. 6 feet tall Count
43 Students
800 Cities
7 and a half days
where:
a = no. of occurrence or people w/ the characteristic of interest
 Ratio

• Expression of the relative frequency of

occurrence of two counts
e.g. Male to Female Ratio
Women to Child Ratio Ratio
Dependency Ratio

where:
a = no. of occurrence or people w/ the characteristic of interest
b = another set of occurrence or people apart from set a
 Ratio

Age
Dependency
Ratio
 Rate

• How fast the disease is occurring in

a population

• Expresses the relationship

between an event and a Rate
population at risk over a given
interval of time

where:
a = no. of occurrence or people w/ the characteristic of interest
b = another set of occurrence or people apart from set a
k = denominator with the element of time
 Rate

Type of Rates:
Crude Rate
Denominator = Total Population

Specific Rate
Denominator = Subgroup of the population

Adjusted or Standardized Rate

• Used to equalize differences in distribution
• Constructed to permit fair comparison
between 2 groups which differ in some
important characteristics
 Proportion

• Fraction (portion) of the population, meaning the

numerator is part of the denominator
• Total is equal to 1, or 100 if used as a percentage
• If data cannot be ascertained as to time, it is a
proportion
Proportion

where:
a = no. of occurrence or people w/ the characteristic of interest
b = another set of occurrence or people apart from set a
 Proportion

e.g. Get the proportion of HIV (+) in the

population of patients
Total Population 50
Tested ( + ) 20
Tested ( - ) 30

20 or 20 =
20 + 30 50

“In the given population of 50 patients, (20)

tested positive, while (30) tested negative.”
 Frequency Measures

Is numerator included in
the denominator?

YES
Is time included in
denominator?

YES NO NO
MEASURE: R_ _ _ P_ _ _ _ _ R_ _ _
 Health Indicators

• Describe & summarize various aspects of health

status of the population
• measures (expressed as Ratios,
Proportions or Rates)
• Used for:
1. Determining factors that may contribute to
causation and control of diseases
2. Identifying public health problems and needs
3. Indicating priorities for resource allocation
4. Monitoring implementation of health programs
5. Evaluating outcomes of health programs
 Health Indicators

Fertility Indicators Mortality Indicators

1. Crude Death Rate
1. Crude birth Rate
2. Cause-of-Death Rate
2. General Fertility
3. Specific Mortality Rate
Rate
4. Infant Mortality Rate
5. Maternal Mortality Ratio
Morbidity Indicators 6. Under-Five Mortality
1. Prevalence Ratio
7. Proportionate Mortality
2. Incidence Ratio
3. Attack Rate 8. Case Fatality Rate
 Fertility Indicators

Crude Birth Rate (CBR)

Measures how

General Fertility Rate (GFR)

Same as CBR, but it is more specific since it uses
reproductive age (aged 15-44 yrs) as denominator
 Mortality Indicators

Crude Death Rate (CDR)

Measures how

F = any factor
by 10’s
Cause-of-Death Rate
Mortality rate from specific disease or condition

Specific Mortality Rate (SMR)

Measures the force of mortality in specific subgroups of the
population
 Mortality Indicators: SMR
Sample Variations:
Age specific
e.g. geriatric (60 y.o. and above)
Sex specific
e.g. males
Age-sex specific
e.g. female teenagers (13 – 19 y.o.)
Occupation specific
e.g. Farmer
Clinical Instructors
Congressmen
 Mortality Indicators
Infant Mortality Rate (IMR)
Useful indicator of a particular location’s (country, community)
level of health and development

Maternal Mortality Ratio (MMR)

Measures the occurrence of maternal deaths

Under-Five Mortality Ratio

Measures the risk of a child born in a specific year or period
dying before reaching the age of five
 Mortality Indicators: IMR

May be subdivided into:

Neonatal Mortality Rate
Measures deaths in the first 28 days of life

Post-neonatal Mortality Rate

Measures deaths after 28 days of life before one year
 Mortality Indicators

Proportionate Mortality Ratio (PMR)

Measures the proportion of total deaths occurring in a
particular population group or from a particular cause

Case Fatality Rate (CFR)

Indicates the
 Morbidity Indicators: Prevalence

Measures the proportion of existing cases

(prevalent) of a disease in the population

Provides an indication of the amount of disease

prevailing in a population at a specific point in
time

Assessment of the of a particular

disease or health problem in a population
 Morbidity Indicators: Prevalence

e.g.
n = 12 Time = Today

3
x 100 =
12

With Disease/Characteristic of Interest

Without Disease/Characteristic of Interest
 Morbidity Indicators: Incidence

Measures the occurrence of disease (new cases)

that have occurred among the initial disease-free
individuals over a period of time

Start: disease free individuals

End: count the number of affected individuals (follow up)

Etiologic studies – direct indicator measure on how

high the risk of getting the disease over a period of
time in a certain population.
*Therefore, high incidence means
.
 Morbidity Indicators: Incidence

e.g.
n=9 observation period = 1 month

4 x 100 =
9

Developed the Disease/Characteristic of Interest

Did not develop Disease/Characteristic of Interest
 Morbidity Indicators: Attack Rate

Incidence measure during a disease

outbreak
Measured as a proportion
Start and end: Period of epidemic
 Other Health Indicators

Low Birth Weight Percentage

 Other Health Indicators

Occupancy Rate
Inpatient Days of Care
Bed Days Available
where:
Inpatient Days of Care - Sum of each daily inpatient census for
the year. To arrive at this total, you would simply add together
each daily census for the 365 days in the year.

Beds Days Available - The maximum number of inpatient days

of care that would have been provided if all beds were filled
during the year. To compute, multiply the bed capacity
(assuming no change in bed capacity the entire year) by 365
days.
 Other References
Lecture presentation on Summarizing and Presenting Vital Statistics
and Health Parameters for Biostatistics by H. Ho, 2010.

Lecture notes on Demography: Population Characteristics for

Biostatistics 201 from DEBS UPM-CPH, 2013.

Lecture notes on Health Indicators for Biostatistics 201 by M.P. Borja,

2013.

Lecture notes on Basic Concepts in Epidemiology for Epidemiology

201 by P.A. Pinlac, 2014.

Lecture notes on Measures of Disease Frequency for Epidemiology

201 by M.C. Tolabing, 2014.

Lecture notes on Epidemiology of Non-Communicable Diseases for

Epidemiology 201 by P.A. Pinlac, 2014.