Measuring health and disease
in epidemiology
HSS 3110 B Epidemiology (3 units)
Lecture 6: 28 feb 2025
Measures of health (also known as population health metrics) refers to
the quantifiable indicators used to assess the overall well-being and
health outcomes of a population or group of people.
Measures Measures of health are crucial for identifying disease patterns and
burdens, evaluating interventions, and shaping public health policies.
Different indicators capture various aspects of population health status
of health e.g. prevalence of diabetes, HIV mortality rates, DALYs attributable to
cancer.
The indicators can be broadly classified into measures of morbidity and
Definition mortality, and measures of association.
A large number of metrics are in use (can get overwhelming unless studied
and classifed systematically).
Measures Measures of disease frequency (prevalence, incidence)
Mortality measures (crude mortality rate, standardised mortality rate,
of health
infant mortality rate, maternal mortality rate, case fatality rate).
Summary measures (disability-adjusted life years, quality-adjusted life
years.
examples
Measures of impact (attributable fraction, population attributable
fraction.
Measures of association (odds ratio, risk ratio, risk difference)
measures of health measures allow us to:
Describe Quantify the Compare health Compare health
health status burden of status of across status of across
of populations disease populations time
In the Philippines, the In Nigeria, the prevalence Infant mortality rate in Since 1980, the rate of HIV
prevalence of dengue fever is of malaria is approximately India is approximately 28 infection has declined by
approximately 270 cases per 38% among children under deaths per 1,000 live approximately 25% in
100,000 people annually, five years old. births, which is Canada, compared to a
representing a significant public considerably higher than global decline of
health challenge. the rate in the United approximately 11% over
States (5.4 deaths per the same period.
1,000 live births)
measures of health measures allow us to:
Assess risk Evaluate the Guide clinical Setting priorities
factors of effectiveness of decision-making for health
disease/health interventions. interventins
events
In year 2000, more than 1 in In Mexico , a national Treating 10 latent TB cases In Sub-Saharan Africa:
every 10 cardiovascular diabetes awareness campaign with isoniazid preventive Malaria contributes to 10%
deaths in the world were led to a 5% reduction in the therapy prevents one of DALYs lost, while
attributable to smoking. incidence of diabetes cases active TB case, whereas 20 diabetes accounts for 3%.
annually between 2015 and cases must be treated with This justifies prioritizing
2020 , showing concrete rifampin to achieve the vector control programs
evidence the campaign’s same outcome. over expanded diabetes
effectiveness. screening.
Measures
These measures tell us how prevalent
(common) a disease is in a population
of disease
over a specific period of time e.g.
prevalence, incidence. Incidence, which
frequency
considers the new cases only, compared
to total existing cases, helps quantify how
often a certain health event occurs in a
population.
Prevalence: the proportion of individuals in a Incidence: the number of new cases of a condition
population who have a particular condition at a that occur in a population over a specified period of
specific point in time. time.
e.g. if a community of 10k people has 200 cases of e.g. if 80 of those 200 diabetes cases on 1 January
diabetes on January 1, 2025, the point prevalence is 2025 were new (since 1 January 2024), the
200 ÷ 10k = 0.02 or 2%. incidence would be 80 ÷ 10k = 8/1000 individuals.
Three common types: point prevalence, period Two common types: cumulative incidence or risk, and
prevalence, lifetime prevalence. incidence rate (person-time incidence rate)
Number of existing cases Number of new cases
Prevalence = Incidence =
Total population at risk Total population at risk at start of period
ref
The
epidemiological
bathtub:
relationship
between
Incidence and
prevalence ref
similar time-trends between Incidence and Prevalence
Less similar time-trends between Incidence and Prevalence
Global
prevalence,
incidence, death
and DALY rates
from liver cancer
1980 - 2021
ref
Comparison of
prevalence,
incidence, death
and DALY rates
from liver cancer
1980 - 2021
Comparison of
prevalence,
incidence, death
and DALY rates
from HIV
1990 - 2021
https://vizhub.healthdata.org/gbd-compare/
https://vizhub.healthdata.org/gbd-compare/
Measures of Mortality
Crude death rates: Total deaths in a population in a given time period (usually per year).
CDR = (Total deaths during a year/ Mid-year population) * 1000
Cause-specific death rate: Number of deaths from a particular cause divided by the total population
Age-specific death rates: Death rate for a specific age group.
ASDR = (Deaths in age group / Population in age group) * 1000
Infant mortality rate (IMR): Deaths of infants under one year per 1,000 live births.
IMR = (Deaths under age 1 / Live births) × 1000
Maternal Mortality Ratio (MMR): The number of maternal deaths per 100,000 live births due to complications related to pregnancy or
childbirth.
MMR = (Maternal deaths / Live births) × 100,000
Standardized mortality ratios: Ratio of observed deaths in a study population to expected deaths based on standard population rates.
SMR > 1.0 indicates excess deaths in a population.
SMR = (Observed deaths / Expected deaths) * 100
Case-fatality rate (CFR): Proportion of individuals with a specific condition who die from it within a given time period.
CFR = (Total deaths from a disease / Total cases from the disease) × 100
Measures of These measures quantify the relationship between exposures
association
and outcomes.
Odds ratio: The ratio of the odds of disease in the exposed group to
the odds in the unexposed group.
Relative Risk: The ratio of the risk of disease in the exposed group to
the risk in the unexposed group.
Measures of
These measures help identify the
proportion of disease burden that can be
impact
attributed to a specific factor, the
effectiveness of interventions, and the
number of individuals who need to be
treated to prevent one adverse outcome.
Attributable fraction: The proportion of disease cases among exposed individuals that can be attributed to the exposure. It is used to estimate
the proportion of disease cases that could be prevented if the exposure were eliminated in the exposed group.
Formula of AF = [(Risk in the exposed - Risk in the unexposed)/Risk in the exposed] * 100%
Example interpretation: 75% of cancer cases among smokers are due to smoking.
Population attributable fraction: measures the proportion of disease cases in the entire population that can be attributed to a specific
exposure.
Formula of PAF = [(Risk in the population - Risk in the unexposed)/Risk in the population] * 100%
Example interpretation: 60% of cancer cases in the total population are due to smoking.
Number needed to treat (NNT): The number of people who need to receive an intervention to prevent one additional adverse outcome due
to that condition.
Formula of NNT = 1 ÷ Absolute risk reduction (or risk difference)
Example: If a new diabetes medication reduces the risk of heart attack from 10% to 5% in high-risk patients: NNT = 1 ÷ (0.10 - 0.05) = 1 ÷
0.05 = 20
Interpretation: We need to treat 20 patients with the medication to prevent one heart attack.
Does birth weight have anything to do with not obtaining a
college degree?
Calculate AF to measure the proportion of non-college attainment among those born
with LBW.
RR= = 1.8
341/(59+341)
757/(843+757)
Calculate PAF to measure the proportion of non-college attainment in the entire
population that is due to LBW.
P = proportion of LBW babies
= 400/2000
= 0.2
Composite Measures of
Health
/Summary measures
Disability-adjusted life years
DALY quantifies the total burden of disease by combining years of life lost (YLL) due to premature mortality and years lived
with disability (YLD).
DALY = YLL + YLD
ref
ref
Quality-Adjusted Life Years
QALY measures the quality and quantity of life lived,
adjusting for the impact of disease or disability. If an individual lives in perfect health but only
for half a year, that person will have:
QALYs = Years of Life * Quality of Life Weight 0.5 Years of Life x 1 Utility Value = 0.5 QALYs
QALY ranges from 0 (death) to 1 (perfect health)
Figure 1 A schematic representing a QALY
calculation for a comparison of two
treatments. The QALYs are calculated by
multiplying each utility value by the amount
of time an individual spends there, which
incorporates changes in both the quantity
and quality of life. The health utility value is
measured from 0 (representing death) to 1.0
(representing full health). The area under the
curve represents QALYs. In this case, the new
treatment provides benefit in terms of better
utility and increased survival. The difference
in the coloured areas under each curve
represents the additional QALYs gained by
providing the new treatment instead of the
conventional treatment.
ref
ref
Lung cancer No Lung Cancer Total
Smokers 200 300 500
Non-Smokers 50 450 500
Total 250 750 1000
1. What is the OR lung cancer in smokers compared to non-smokers?
2. What is the RR of lung cancer in smokers compared to non-smokers?
3. What fraction of lung cancer cases among smokers is attributable to smoking?
4. What fraction of lung cancer cases in the entire population is attributable to smoking?
Lab Smokers
Lung cancer No Lung Cancer
200 300
Total
500
assignment 7 Non-Smokers
Total
50
250
450
750
500
1000
Submission deadline: 1. What is the OR lung cancer in smokers compared to non-
21 Feb 11:59 PM smokers?
2. What is the RR of lung cancer in smokers compared to non-
Any submissions with a delay of smokers?
1-3 days will incur a loss of 1 3. What fraction of lung cancer cases among smokers is
mark, and delays of more than 3 attributable to smoking?
days late will receive 0 marks. 4. What fraction of lung cancer cases in the entire population
is attributable to smoking?
Gold, M. R. et al. (2002). HALYS and QALYS and DALYS, oh my:
Similarities and differences in summary measures of population health.
Annu Rev Public Health, 23, 115-134.
Chan, S. L. et al. (2024). Frameworks for measuring population health: A
scoping review. PLoS One, 19(2), e0278434.
FURTHER Mathers, C. D. et al. (2003). Population health metrics: Crucial inputs to the
READING development of evidence for health policy. Population Health Metrics, 1, 6.
Devleesschauwer, B., Havelaar, A. H., Martens de Noordhout, C.,
Haagsma, J. A., Prat, N., Dorny, P., Duchateau, L., Torgerson, P. R., Van
Oyen, H., & Speybroeck, N. (2014). Calculating disability-adjusted life
years to quantify the burden of disease. International Journal of Public
Health, 59(3), 565-569.
Disability-Adjusted Life Years: An Indicator to Measure Burden of Disease in
Ouébec (www)
THANK YOU!
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cscer.ca
