ARBA MINCH UNIVERSITY
SHOOL OF PUBLIC HEALTH
EPIDEMIOLOGY AND BIOSTATISTICS UNIT
Mortality Frequency Measures and Sources of Data
BY MATHEWOS A. (MPH/EPIDEMIOLOGY AND BIOSTATISTICS)
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Learning objectives
At the end of this unit the student is expected to:
• Discus the measures of mortality rates:
– Crude death rates
– Category specific death rate
– Standardized death rate
• Discus the major sources of data
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Mortality Rates
••
Mortality is the fundamental factor in the dynamics
of population growth and causes of death.
• A mortality rate is a measure of the frequency of
occurrence of death in a defined population
during a specified interval.
• Mortality rate =x 10n
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Cont…
• Rates whose denominators are the total
population are commonly calculated using
either the mid-interval population or the
average population.
• This is done because population size fluctuates
over time due to births, deaths and migration.
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Cont…
Mortality in a population can be monitored
through a variety of measures:
1. Crude death rates
2. Category specific death rate
3. Standardized death rate
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Crude mortality rate
• The
crude mortality rate is the mortality rate
from all causes of death for a population.
• CDR =x 10n
• Expressed per number at risk (10n ),1,000 or
100,000.
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Disadvantages of CDR
• It does not take into account the fact that the
chance of dying varies according to age, sex, race,
socioeconomic class and other factors.
• It is not usually appropriate to use it for comparing
different time periods or geographical areas.
• Comparisons of mortality rates between groups of
diverse age structure are usually based on age
standardized rates.
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Category specific death rate
• Used to construct rates for specific segments of the
population
• we can compare among strata or between groups
(used especially for age, race, ethnicity, gender, causes
of deaths)
• It can be:
Age-specific mortality rates
Gender- specific mortality rates
Race-specific mortality rates
Cause-specific mortality rates
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Age-specific mortality rate
•
• An age-specific mortality rate is a mortality rate
limited to a particular age group.
• The numerator is the number of deaths in that
age group; the denominator is the number of
persons in that age group in the population.
• ASDR= =x 10n
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Age-specific mortality rate
• Some specific types of age-specific mortality
rates are:
Neonatal mortality rates,
Post neonatal mortality rates
Infant mortality rates.
Child mortality rates
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Neonatal mortality rate
• The neonatal period is defined as the period
from birth up to but not including 28 days.
• The numerator of the neonatal mortality rate
therefore is the number of deaths among
children under 28 days of age during a given
time period.
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Cont…
The denominator of the neonatal mortality rate, is the
number of live births reported during the same time
period.
NMR = Number of deaths of neonates
(less than 28 days) in a given interval x 1000
Number of live births
during the same interval
• Estimates events immediately after birth;
– congenital malformations,
– prematurity and
– low birth weight
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Cont…
• Example: In 1996 there were a total of 5000 live
births in “Zone B”. Two hundred of them died
before 28 days after birth.
• Calculate the Neonatal Mortality Rate (NMR).
NMR = 200/5000 X 1000 = 40 per 1000 live births
• That means out of 1000 live births in 1996, 40 of
them died before 28 days after birth.
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Post neonatal mortality rate
• The post neonatal period is defined as the period
from 28 days of age up to but not including 1 year
of age.
• The numerator of the post neonatal mortality
rate therefore is the number of deaths among
children from 28 days up to but not including 1
year of age during a given time period.
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Cont…
• The denominator is the number of live births
reported during the same time period
PNMR = # deaths from 28 days to, but not including
1 year of age, during a given time interval x 1000
Number of live births during the same interval
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Infant mortality rate
• The infant mortality rate is one of the most
commonly used measures for comparing health
services among nations.
• The numerator is the number of deaths among
children under 1 year of age reported during a
given time period, usually a calendar year.
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Cont…
• The denominator is the number of live births
reported during the same time period.
• IMR= Number of deaths under 1 year
during a given interval x 1,000
Number of live births
during the same interval
Used for international comparisons;
high rates indicate unmet public health needs and
poor socioeconomic and environmental conditions
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Child mortality rate
• The child mortality rate (under-5 mortality rate)
is based on deaths of children aged 1–4 years,
and is frequently used as a basic health indicator.
• Injuries, malnutrition and infectious diseases are
common causes of death in this age group.
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Cont….
• The under-5 mortality rate describes the
probability (expressed per 1000 live births) of a
child dying before reaching 5 years of age.
U5MR = No. of deaths of 0-4 years of age during a given time x 1000
Average (mid-year) population of the same age at the same time
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Cont…
• Example: In 1996 the total number of children under
5 years of age was 10,000 in “Zone C”.
• In the same year 200 children under five years of age
died. Calculate the under five-mortality rate (U5MR).
• U5MR = 200/10,000 x 1000 = 20 per 1000 under five
children That means in “Zone C”, out of 1000 under
five children, 20 died in 1996.
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Adult mortality rate
• The adult mortality rate is defined as the probability of
dying between the ages of 15 and 60 years per 1000
population.
• The adult mortality rate offers a way to analyze health
gaps between countries in the main working age groups.
• The probability of dying in adulthood is greater for men
than for women in almost all countries, but the
variation between countries is very large.
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Cause-specific mortality rate
• The cause-specific mortality rate is the mortality
rate from a specified cause for a population.
• The numerator is the number of deaths attributed
to a specific cause.
• The denominator remains the size of the
population at the midpoint of the time period.
CSDR= # Of deaths from a specified cause in a year x 100,000
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Maternal mortality rate
• The maternal mortality rate refers to the risk of mothers
dying from causes associated with delivering babies,
complications of pregnancy or childbirth.
• The numerator is the number of deaths assigned to
causes related to pregnancy during a given time period.
• The denominator is the number of live births reported
during the same time period.
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Maternal mortality rate
MMR = Number of deaths assigned to causes related to
pregnancy during a given interval x 100,000
Number of live births during the
same interval
Reflect health care access and socioeconomic
factors
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Proportionate mortality ratio
• Proportionate mortality describes the proportion
of deaths in a specified population over a period of
time attributable to different causes.
• Each cause is expressed as a percentage of all
deaths, and the sum of the causes must add to
100%.
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Proportionate mortality ratio
PMR = No. of deaths from a sp. Cause during a given time x 100
Total no. of deaths from all other causes in the same time
• What proportion of deaths as compared to other
causes of death is due to disease X ?
• For example when we say the proportionate mortality
ratio for HIV/AIDS is 30 %, this means out of 100 total
(of all) deaths 30 of them died from HIV/AIDS.
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Case fatality rate
• The case-fatality rate is the proportion of
persons with a particular condition (cases)
who die from that condition.
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Case fatality rate
Example: Of the 11 neonates who developed
listeriosis, two died.
The case-fatality rate is calculated as: Case-
fatality rate =2 deaths/ 11 cases × 100 = 18.2%
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Example
In 1996 there were 1000 tuberculosis patients in
one region. Out of the 1000 patients 100 died in the
same year. Calculate the case fatality rate of
tuberculosis.
• CFR = 100/1000x 100 = 10 %
• That means 10% of tuberculosis patients will die
once they develop the disease
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Sex-specific mortality rate
• A
sex-specific mortality rate is a mortality rate
among either males or females.
• Both numerator and denominator are limited to
the one sex.
SSDR= = x 10n
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Race-specific mortality rate
• A race-specific mortality rate is a mortality
rate limited to a specified racial group.
• Both numerator and denominator are limited
to the specified race.
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Combinations of specific mortality rates
• Mortality rates can be further refined to
combinations that are cause-specific, age-
specific, sex-specific, and/or race-specific.
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Table 1: Crude and age-specific mortality rates from
cancer in U.S, 1980
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Examples
Calculate the following using the information from
above table:
1. Crude 1980 cancer mortality rate.
2. The death rate from cancer for those under 5
years of age
3. Age-specific cancer death rates
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Answers
1. Crude 1980 cancer mortality rate
= 416,481/226,546,000/1 year
= 183.8 /100,000/year
2. The death rate from cancer for those under 5
years of age : Cancer mortality rate (< 5 years)
=686/16,348,000/1year
= 4.2/100,000/year
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Cont…
3. Age-specific cancer death rates refer to the
numbers of deaths due to cancer occurring
among individuals in each specified age category
divided by the total number of persons in that
stratum.
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Exercise:
Using the motor vehicle injury (MVI) data in table
below, calculate:
a. MVI-related mortality rate, all ages
b. MVI-related mortality rate (0-4)
c. MVI-related mortality rate(15-24)
d. Pneumonia and influenza A related mortality rate,
all ages
b. MVI-related mortality rate for persons under age
65 years
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Examples
• A total of 2,123,323 deaths were recorded in the
United States in 1987. The mid-year population
was estimated to be 243,401,000. HIV-related
mortality and population data by age for all
residents and for black males are shown in Table
2.9. We will use these data to calculate the
following four mortality rates:
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Cont…
a. Crude mortality rate
b. HIV-(cause)-specific mortality rate for the entire
population
c. HIV-specific mortality among 35- to 44-year-olds
d. HIV-specific mortality among 35- to 44-year-old
black males
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Table 2.9 HIV mortality and estimated population by age group
overall and for black males, United States, 1987
All Races, all ages Black Males
Age Group HIV Deaths Population HIV Deaths Population
(years) (× 1,000) (× 1,000)
0-4 191 18,252 47 1,393
5-14 47 34,146 7 2,697
15-24 492 38,252 145 2,740
25-34 5,026 43,315 1,326 2,549
35-44 4,794 34,305 1,212 1,663
45-54 1,838 23,276 395 1,117
≥55 1,077 51,855 168 1,945
Unknown 3 1
Total 13,468 243,401 3,301 14,104
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Answers
a. Crude mortality rate =
Number of deaths in the U.S. × 100,000
Total population
2 123 323 × 100,000
243 401 000
= 872.4 deaths per 100,000 population
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Cont…
b. HIV (cause)-specific mortality rate for the
entire population
= Number of HIV deaths × 10n
Population
= 13 468/243 401 000 × 100,000
= 5.5 HIV-related deaths per 100,000
population
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Cont…
c. HIV-related mortality rate among 35- to 44-year-
olds (cause-specific and age-specific mortality
rate)
= Number of HIV deaths in 35 - to 44 - year – olds × 10n
Population of 35 - to 44 - year - olds
=4 794/34 305 000 × 100,000
= 14.0 HIV-related deaths per 100,000 35- to 44-
year-olds
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Cont…
d. HIV-related mortality rate among 35- to 44-year-
old black males (cause-, age-, race-, and sex-
specific mortality rate)
= Number of HIV deaths in 35 - to 44 - year - old black males × 10n
Population of 35 - to 44 - year - old black males
= 1 212/1 663 000 × 100,000
= 72.9 HIV-related deaths per 100,000 35- to 44-
year-old black males
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Exercise
In 1987, a total of 12,088 HIV-related deaths
occurred in males and 1,380 HIV-related deaths
occurred in females . The estimated 1987 midyear
population for males and females was
118,531,000 and 124,869,000, respectively.
a. Calculate the HIV-related death rate for males and for females.
b. What type of mortality rates did you calculate in step a?
c. Calculate the HIV-mortality rate ratio for males versus females.
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Exercise
The following information is about kebele X which was collected
for the year 1999:
– Total average population = 40,000
– Total number of live births = 4000
– Total number of deaths = 400
– Total number of deaths before the age of 28 days =50
– Total number of infant deaths = 200
– Number of women who died from pregnancy related causes =
160
– New cases of tuberculosis = 100
– All cases of tuberculosis = 300
– Deaths from tuberculosis = 60
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Exercise
Based on the above information calculate the
following.
1. The incidence rate of tuberculosis.
2. The period prevalence rate of tuberculosis.
3. The case fatality rate of tuberculosis.
4. The Neonatal mortality rate.
5. The infant mortality rate.
6. The maternal mortality ratio
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Sources of Data
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Sources of Data
• There are different sources of data on health and
health related conditions in the community.
• Each source has advantages and limitations.
• The information obtained from these sources is
used for:
– health planning,
– programming and
– evaluation of health services..
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Cont…
• The major sources are the following.
– Census
– Vital statistics:
– Health Service Records
– Health Surveys
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Census
• Census is defined as a periodic count or
enumeration of a population.
• Census data are necessary for accurate
description of population’s health status and
are principal source of denominator for rates
of disease & death.
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Cont…
• It provides information on:
– Size and composition of a population
– The trends anticipated in the future.
• Data was collected on:
– Age, sex and size of the population
– Mortality, fertility
– Language, ethnicity
– Housing
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Cont…
• From these data different health indices could
be calculated.
– Crude birth rate,
– crude death rate,
– age specific mortality rate and
– sex specific mortality
• Aate are some of the examples of the
indicators that could be calculated.
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Limitation
• Conducting nationwide census is
– very expensive and
– it generates a large amount of data which takes a
very long time to compile and analyze.
– It is carried in intervals of many years.
• Therefore it can’t assess yearly changes.
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Vital statistics
• This is a system by which all births, deaths,
marriage and divorce occurring nation wide are
registered, reported and compiled centrally.
• Certificate is issued for each .
• It is the source of information for the
calculation of birth and death rates.
• When it started in Ethiopia ?
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Characteristics
The main characteristics of vital statistics are:
– Comprehensive – all births, deaths ,marriage and
divorce should be registered.
– Compulsory by law – should be enforced by law.
– Compiled centrally- so that it can serve as a
source of information.
– Continuous – it should be an ongoing process.
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Health Service Records
• All health institutions report their activities to
the Ministry of Health through the regional
health bureaus.
• The Ministry compiles, analyzes and publishes
it in the health service directory.
• It is therefore the major source of health
information in Ethiopia
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Advantages
• Easily obtainable
• Available at low cost
• Continuous system of reporting
• Causes of illness and death available.
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Limitations
• Lack of completeness – health service
coverage is low.
• Lack of representativeness – a small
proportion of diseased population seeks
medical advice. Those patients who remained
at home are not reported.
• Lack of denominator – catchment area is not
known in the majority of cases.
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Cont..
• Lack of uniformity in quality.
• Diagnosis varies across the level of health
institutions.
• Lack of compliance with reporting.
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Health Surveys
• Health surveys are studies conducted on a
representative sample population to obtain
more comprehensive data for monitoring the
health status of a population.
• There are two types of health surveys:
1. Surveys of specific diseases
2. Surveys of general health status
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Surveys of specific diseases
• Surveys of specific diseases: These are studies
conducted on each specific disease.
– Examples are:
– EPI target diseases
– Diarrheal Diseases
– HIV/AIDS
– Trachoma
– Tuberculosis / Leprosy
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Surveys of general health status
• Surveys of general health status: These are
studies on general health status of the
population.
• They are based on interview, physical
examination and laboratory tests.
• They are expensive.
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Advantages
• Advantages of surveys based on interview:
• They are more representative of the health
condition of the community.
• The denominator is known.
• Data are more uniform in quality.
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Limitations
• Data accuracy is dependent on the memory
and cooperation of the interviewee.
• Surveys are expensive
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THANK YOU
VERY MUCH
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