Measures of Morbidity

James Maxwell, physicist (18311879)

We owe all the great advances in knowledge to those who endeavour to find out how much there is of anything. James Maxwell, physicist (18311879)

William Thomson, engineer, mathematician, and physicist (18241907)

If you can measure that of which you speak, and can express it by a number, you know something of your subject, but if you cannot measure it, your knowledge is meager and unsatisfactory. William Thomson, engineer, mathematician, and physicist (18241907)

 Sources of data for illness

Measures of Morbidity
Incidence Prevalence

Incidence
Measured by incidence rate: the number of new cases of a disease that occur during a specified period of time in a population at risk for developing the disease.

Incidence rate
Cumulative Incidence Incidence density

Cumulative Incidence
(Number of new cases during a given period of time/Population at risk during the same time period) x 1000

Example
Among 60 people attending a 12-month residential detoxification program in Mysore, 50 tested HIV negative at the start of the program in January 1998. At the end of the program in December 1998, 3 of the 50 participants tested positive for HIV. Calculate the cumulative incidence.

Incidence Density
Number of new cases during a given period Total person-time of observation

Uses of Incidence rates

Measures the risk of acquiring the disease To identify the cause or etiology of disease To explore the relationship between an exposure and the risk of disease

Prevalence
Measured by Prevalence Rate Divided into two types: 1. Point prevalence rate 2. Period prevalence rate

POINT PREVALENCE RATE

Proportion of individuals in a specified population at risk who have the disease of interest at a given point in time.

PERIOD PREVALENCE RATE

Proportion of individuals in a specified population at risk who have the disease of interest over a specified period of time. Annual prevalence rate
(When the type of prevalence rate is not specified it is usually point prevalence)

Relation between Incidence and Prevalence

 When Insulin was introduced for the first time, what happened to the prevalence of diabetes?

Relation between Incidence and Prevalence

Prevalence = Incidence Duration of disease

P= I x D

City Mysore Mandya

Population screened 1000 1000

Positive CXR for TB 100 60

City Mysore Mandya

Population screened 1000 1000

Positive CXR Prevalence Incidence for TB 100 100 4 60 60 20

City

Prevalence Incidence Duration

Mysore Mandya

100 60

4 20

25 years 3 years

Uses of Prevalence rates

Measures -burden of disease in a community. Eg: How many people in the community have arthritis? To determine -how many clinics are needed -what types of rehabilitation services are needed -how many and what types of health professionals are needed. Needed for planning health services. To make future projections and To anticipate the changes

Exercises-1
In 2005 all the children in Government schools of Nanjangud were examined for evidence of leprosy. The procedure was repeated again in 2006. The following were the results: 2005:
a. No. of children on the rolls- 52,600 b. No. of children examined 48,000 c. No. of children found to have active leprosy - 288

Exercise 1 contd
2006:
d. No. of children on rolls 54,000 e. No. of children examined for the first time- 6,000 f. No. of active cases among the above 46 g. No. of children re-examined - 40,000 h. No. of old cases among them (i) Active 40 (ii) Inactive 200 i. No. of new cases among the re-examined - 80