Health Statistics and Epidemiology
Health Statistics – Health statistics include both empirical data and estimates related to health,
such as mortality, morbidity, risk factors, health service coverage, and health systems.
The production and dissemination of health statistics is a core WHO activity mandated to WHO
by its Member States in its Constitution. WHO programmes compile and disseminate a broad
range of statistics that play a key role in advocacy for health issues, monitoring and evaluation of
health programmes and provision of technical assistance to countries.
Epidemiology –is the study of the distribution and determinants of health -related states or
events in specified populations and the application of this study to the control of health problems.
A. Tools
1. Demography
a. Sources of Data - There are two sources of data for statistics. Primary, or
"statistical" sources are data that are collected primarily for creating official
statistics, and include statistical surveys and censuses. Secondary, or "non-
statistical" sources, are data that have been primarily collected for some
other purpose (administrative data, private sector data etc.).
b. Population size - In statistics, population refers to the total set of observations
that can be made. For example, if we are studying the weight of adult women,
the population is the set of weights of all the women in the world.
c. Compositional Data - In statistics, compositional data are quantitative
descriptions of the parts of some whole, conveying relative information.
Mathematically, compositional data is represented by points on a simplex.
Measurements involving probabilities, proportions, percentages, and ppm can
all be thought of as compositional data.
d. Distribution - It is often the case with medical data that the histogram of a
continuous variable obtained from a single measurement on different subjects
will have a characteristic `bell-shaped' distribution known as a Normal
distribution. One such example is the histogram of the birth weight (in
kilograms) of the 3,226 new born babies
2. Health Indicators
a. CRUDE BIRTH RATE is the number of resident live births for a specified
geographic area (nation, state, county, etc.) during a specified period (usually
a calendar year) divided by the total population (usually mid-year) for that
area and multiplied by 1,000
b. Crude Death Rate - is the total number of deaths to residents in a specified
geographic area (country, state, county, etc.) divided by the total population
for the same geographic area (for a specified time period, usually a calendar
year) and multiplied by 100,000.
c. Infant mortality rate (IMR) is the number of deaths per 1,000 live births of
children under one year of age. The rate for a given region is the number of
children dying under one year of age, divided by the number of live births
during the year, multiplied by 1,000.
d. Maternal Mortality Rate - The number of registered maternal deaths due to
birth- or pregnancy-related complications per 100,000 registered live births.
The maternal mortality ratio can be calculated by dividing recorded (or
estimated) maternal deaths by total recorded (or estimated) live births in the
same period and multiplying by 100,000.
e. Leading Causes of Morbidity
Acute Respiratory Infection - 1,289,168
Acute Lower Respiratory Tract Infection and Pneumonia - 586,186
Bronchitis/Bronchiolitis - 351,126
Hypertension - 345,412
Acute Watery Diarrhea - 326,551
Influenza - 272,001
Urinary Tract Infection - 83,569
TB Respiratory - 72,516
Injuries - 51,201
Disease of the Heart - 37,589
f. Leading Causes of Mortality
Heart disease: 647,457
Cancer: 599,108
Accidents (unintentional injuries): 169,936
Chronic lower respiratory diseases: 160,201
Stroke (cerebrovascular diseases): 146,383
Alzheimer’s disease: 121,404
Diabetes: 83,564
Influenza and pneumonia: 55,672
Nephritis, nephrotic syndrome, and nephrosis: 50,633
Intentional self-harm (suicide): 47,173
B. Philippine Health Situation
1. Demographic data is statistical data collected about the characteristics of the
population, e.g. age, gender and income for example.
2. A community health profile is made up of indicators of sociodemographic
characteristics, health status and quality of life, health risk factors,
and health resources that are relevant for most communities; these indicators
provide basic descriptive information that can inform priority setting and
interpretation of data
C. Epidemiology and the Nurse
1. Definitions and related terms
A nurse epidemiologist investigates trends in groups or aggregates and studies the
occurrence of diseases and injuries. The information is gathered from census data,
vital statistics, and reportable disease records. Nurse epidemiologists identify
people or populations at high risk; monitor the progress of diseases; specify areas
of health care need; determine priorities, size, and scope of programs; and
evaluate their impact. They generally do not provide direct patient care, but serve
as a resource and plan educational programs. They also publish results of studies
and statistical analysis of morbidity and mortality.
2. Natural history of a disease - Natural history of disease refers to the progression
of a disease process in an individual over time, in the absence of treatment.
The process begins with the appropriate exposure to or accumulation of factors
sufficient for the disease process to begin in a susceptible host. For an infectious
disease, the exposure is a microorganism. For cancer, the exposure may be a
factor that initiates the process, such as asbestos fibers or components in tobacco
smoke (for lung cancer), or one that promotes the process, such as estrogen (for
endometrial cancer).
After the disease process has been triggered, pathological changes then occur
without the individual being aware of them. This stage of subclinical disease,
extending from the time of exposure to onset of disease symptoms, is usually
called the incubation period for infectious diseases, and the latency period for
chronic diseases. During this stage, disease is said to be asymptomatic (no
symptoms) or inapparent. This period may be as brief as seconds for
hypersensitivity and toxic reactions to as long as decades for certain chronic
diseases. Even for a single disease, the characteristic incubation period has a
range. For example, the typical incubation period for hepatitis A is as long as 7
weeks. The latency period for leukemia to become evident among survivors of the
atomic bomb blast in Hiroshima ranged from 2 to 12 years, peaking at 6–7 years.
(44) Incubation periods of selected exposures and diseases varying from minutes
to decades
3. Epidemiological Triangle - Among the simplest of these is the epidemiologic
triad or triangle, the traditional model for infectious disease. The triad consists of
an external agent, a susceptible host, and an environment that brings the host
and agent together. In this model, disease results from the interaction between the
agent and the susceptible host in an environment that supports transmission of the
agent from a source to that host.
Agent originally referred to an infectious microorganism or pathogen: a virus,
bacterium, parasite, or other microbe. Generally, the agent must be present for
disease to occur; however, presence of that agent alone is not always sufficient to
cause disease. A variety of factors influence whether exposure to an organism will
result in disease, including the organism’s pathogenicity (ability to cause disease)
and dose.
Host refers to the human who can get the disease. A variety of factors intrinsic to
the host, sometimes called risk factors, can influence an individual’s exposure,
susceptibility, or response to a causative agent. Opportunities for exposure are
often influenced by behaviors such as sexual practices, hygiene, and other
personal choices as well as by age and sex. Susceptibility and response to an
agent are influenced by factors such as genetic composition, nutritional and
immunologic status, anatomic structure, presence of disease or medications, and
psychological makeup.
Environment refers to extrinsic factors that affect the agent and the opportunity
for exposure. Environmental factors include physical factors such as geology and
climate, biologic factors such as insects that transmit the agent, and
socioeconomic factors such as crowding, sanitation, and the availability of health
services.
4. Epidemic process and investigations - is a set of procedures used to identify the
cause, i.e. the infectious agent, responsible for the disease. It is also used to
identify the people affected, the circumstances and mode of spread of the disease,
and other relevant factors involved in propagating the epidemic.
Steps:
1. Establish the existence of an outbreak
2. Verify the diagnosis or causes
3. Define and identify cases:
a.Use a standard case definition
b.Identify and count cases
4. Perform descriptive epidemiology, i.e. collect data on the age, sex, etc. of the cases
and analyse the data to see if useful patterns emerge
5. Develop hypotheses to explain the occurrence of the epidemic:
a.Evaluate the hypotheses
b.Reconsider/refine the hypotheses
6. Carry out additional studies to confirm or reject the explanations for the epidemic:
a.Additional epidemiological studies
b.Other types of studies, e.g. laboratory tests, environmental investigations
7. Implement control and prevention measures
8. Communicate findings to higher levels in the health system, community leaders
and other local stakeholders.
