Measurement in Epidemiology

1. Measures of Disease frequency - Incidence - Prevalence - Standardize disease frequency 2. Measures of Mortality - Case fatality rate - Crude death rate , Specific death rate

3. Measures of Association - Correlation coefficient - Relative risk - Odds ratio

4. Measure of Potential impact - Etiologic Fraction in exposed population - Prevented Fraction in population

General measurements

1 Ratio

----- a: b

number of sick persons : number of healthy persons , sex ratio M : F = 2 : 3 2. Proportion ----- a / ( a + b) number of sick person : (number of sick+healthy persons) sex proportion M = 2 / 3 3 Rate ----- a / person time number of sick persons (number of persons x time exposure)

Measures of Disease Frequency

1. Incidence risk = cumulative incidence
Is a measure of the occurrence of new cases in the population.
More precisely risk is the proportion of unaffected individuals who, on average, will contact the disease of interest over a specified period of time. Incidence risk = New cases over a period of time x 10 n

Population at risk

2. Incidence rate
The incidence rate like risk , reflects occurrence of new cases of disease. This rate measures the rapidity with which newly diagnosed disease develops

To estimate the incidence rate, one observes a population, count the number of new cases of disease in population (A), and measures the net time, called person-time (PT), that individuals in the population at risk for developing diseases are observed. A subject at risk or disease followed for 1 year contributes 1 person-year of observation. Incidence rate = New cases Person-time

Onset
Px A Diagnosis Diagnosis

End
Death

B
C

D
E

F
0 2 4 Observation ( year) 6

From the above figure : Patient A developed the disease 2 year after entry into the study. Since subjects contribute person-time only while eligible to develop the disease, the person-time for patient A was 2 year, patient B,C,D,E,and F contribute 2,3,7,2, and 6 year respectively. Patients A and C develop disease. Thus number on new cases = 2, total person time = 2+2+3+7+2+6= 22 person year. Incidence rate = 2 / 22 = 0.09 cases / person-year.
1. Person time = (average size of population at risk) X (Length of observation)

2. Person time = (size of entire population) x (length of observation)

Incidence : some considerations

To determine incidence, it is necessary to follow prospectively a defined group of people and determine the rate at which new cases of disease appear

Certain basic requirements must be met if incidence rate are to be calculated:

1. Knowledge of the Health status of the study population

2. Time of onset
3. Specification of Numerator

number of persons vs. number of conditions

4. Specification of Denominator

number of persons VS. number of person times

5. Period of observation

3. Prevalence
Prevalence indicates the number of existing cases in population Specifically, the point prevalence (P) is a the proportion of a population that has the disease of interest at particular time. Eq. On a given day Prevalence rate = number of cases x 10 n Number of persons in the population

a Point prevalence rate

= number of existing cases of a disease at a point in time x 10 n Number of persons in the population

b Period Prevalence rate

= number of cases during a period or interval x 10 n Average number of persons in the population

Px

A C1 B C2

D
E

F
0 5 10 15 20 25 30

Observation ( day)

From the above diagram :

1. New cases : A, B, C1,C2 if C1 sudah sembuh , E 2. Old cases : D, F, C2 if C1 belum sembuh

3. Incidence 4. Prevalence - Point ------- > ex. - Periode

Measurement of Mortality 1. Crude death rate

CDR = number of deaths x 10 n number of population

2. Specific death rate a. Age specific death rate

ASDR = number of death in a age specific x 10 n number of population in a age specific

Ex: Age specific : early neonatal, neonatal, infant, etc b. Cause specific death rate Ex: - Maternal mortality rate - Tuberculosis mortality rate

3. Case fatality rate

CFR indicates the fatality of any disease CFR = number of deaths caused disease X number of cases disease X

Measurement of Association
1 Value of R for Continuous data 2 Correlation Coefficient from result of Chi Square test Phi Coefficient = V X2

3 RR ( relative risk) =

a/ a+b : c/c+d

a/a+b x c+d/c = a (c+d)

c (a+b)
Disease + + Expose c a+c d b+d c+d a+b+c+d ---------------------------------------a b a+b Total

4 Odds ratio = odds of case exposure

odds of control exposure
Expose
+ + Disease c a+c d b+d c+d a+b+c+d a b a+b

Total

----------------------------------------

odds of case exposure =

exposed cases all cases / unexposed cases = a all cases a+ b : b a+ b = a/b

odds of control exposure =

exposed control / unexposed control = c : d

all controls all controls c + d c+ d

= c/d

Odds ratio = a/b : c/d = ad/ bc

WHAT IS THE MEANING OF RR or OR ? RR or OR = 1 paparan mempunyai risiko yg sama (secara statistik tdk signifikan)

RR or OR > 1
RR or OR < 1

paparan merupakan f. risiko

paparan merupakan f. pencegah

See Confidence Interval

RR = 1 THE EXPOSURE .

RR or OR and the 95% Confidence Interval

9.0 RR or OR = 6.0 95% CI = 1.2 9.0 Significant 6.0

6.0
5.0 1.2

Value 1

0.2 0. 5 0.5 RR or OR = 5.0 95% CI = 0.5 6.0 Not significant 0.9 RR or OR = 0.5 95% CI = 0.2 0.9 Significant

Measure of Potential impact = Potential for Prevention

1. Attributble Risk for the Exposed Group

= Incidence in Exposed group Incidence in non exposed group Ex : Incidence CHD among smokers = 28.0/1.000 Incidence CHD among non smokers = 17.4 /1.000 Attributable risk for smokers group = 28.0/1.000 17.4/1.000 = 10.6/1.000 -- if we had an effective smoking cessation campaign, we hope to prevent 10.6 of the 28/1.000 incidence cases of CHD that smokers experience

2 Proportion of the risk in exposed persons

3. Attributable Risk for the Total Population 4 Proportion of the incidence in the Total Population that is attibutable to the exposure