Biostatistics

(Vital Rates)
 Definition
It is the branch of medical statistics
concerned with registration and
presentation of vital events of human
life,
e.g. births & fertility, deaths, health
and diseases related subjects.
 Vital rates are indices of
• Health status of vulnerable groups & population.
• Community development.
• Health care delivery system.
1- Birth & fertility rates
2- Mortality rates
3- Morbidity rates
 1- Birth & fertility Rates
• Crud Birth rate.
• Fertility rates (indices):
– General Fertility rate (GFR).
– Fecundity rate.
– Age – specific F.R.
– Total F.R.
– Gross Reproductive R.
– Net Reproductive R.
 I- Crud Birth Rate (C.B.R.) (27.0‰)

It is calculated as:
No. of live births of a certain locality and year x 1000

Mid-year population of the same locality & year

Why it is high in developing countries?

1- High fertility motives:
2- Factors related to marriage:
• Young age of marriage
• Proportion of those married to total population in age of marriage is higher (63% -
67%)
 II-Fertility rates :
1- General fertility rate (GFR)
It is calculated as:
No. of live births of a certain locality and year x 1000

Females in childbearing period in same locality & year

It equals 108‰ in 2005 (4 –5 times B.R.)

-Advantage
More precise index than birth rate as female is child bearing consist ¼ - 1/5 the total population.

-Drawbacks
• All females in child bearing period are included and not only the married ones.
• It doesn’t take into consideration difference in age distribution in population of different Countries.
 2- Fecundity Rate

It is calculated as:

No. of live births of a certain locality and year x 1000

Married women in childbearing period in the same locality and year

 3- Age – Specific F.R.

It is calculated as:

No. of live births born to mothers of a certain 5 years age group

in a given locality and year x1000

Females in the same age group, locality and year

Advantage:
Better index than G.F.R as it considers the difference in age distribution of
females in population of different Countries.
 4- Total Fertility rate

Total F.R of any given age group = age-specific rate x 5.

Total fertility rate of all females of child bearing period (T.F.R) =

5 X (sum of 7 (5 years) age specific F.R.)
 5- Gross- Reproduction Rate

It is calculated as:

No. of female live births in a given locality and yearx1000

Females in child bearing period in the same locality and year

Drawbacks
Assuming that: Age – specific F.R. in a given year remains constant and none of
the women beginning the child – bearing period has died before reaching
menopause.
 6- Net Reproduction Rate
This corrects the drawbacks of G.R.R where deaths during child bearing period
are taken into consideration.

Net R.R = Age sp. Birth rate X probability of surviving from birth to age(X)

when (X) is the mid-point of age interval to which age – specific rate refers.
2- Death (mortality) statistics
1- Crud death rate
2- Specific death rates
A- Age specific death rate
B- Sex specific mortality rate
C- Mortality of disease
 Crude death rate (6.4‰)
= General death rate

It is the total number of deaths per 1000 population of a certain

locality (or country).

It is calculated as:

Total number of deaths of a certain locality

x1000
Mid – year population in the same locality
Factors affecting general General factors
death rate a- Related to community development.
• Socioeconomic factors.
• Insanitary environment.
Specific factors
• Poor living condition.
a- Community disease & accidents. • Malnutrition.
b- Effectiveness of available health • Education, culture, traditions, healthful
service. lifestyle.
b- Sex and age distribution of population e.g.
• High mortality rate in the two extremes.
• Higher mortality rate among males than
females.
 2- Specific Death Rates
It represents the number of deaths of a particular group of population per
1000 individuals of the group.

The group may be particular for age, sex, occupation and social or other
aspect.
 A- Age specific Death rates

1- Infant Mortality Rate (IMR) (23.5 ‰ in 2010)

(Infant is the baby in the 1st year of life):

No. of deaths of babies (< 1y of life) in certain locality and year X 1000

No of live births of the same locality and year

 Causes of infant
mortality in Egypt Underlying (predisposing) factors

Leading causes They are general socioeconomic factors, which

(The main causes responsible for the majority indirectly influence I.M through predisposing to
of deaths) morbidity:
– Acute respiratory infections → (30%).
– Preterm and low birth weight (LBW) →  Big family size and low percapita income.
30%.  Insanitary environment.
– Infective diarrhoeal diseases (gastro-  Inadequate nutrition of mothers & infants.
enteritis) → 25%.  Illiteracy & low education level.
– Other causes → 15%. e.g. congenital  Non-practice of birth control.
anomalies – Birth injuries – asphyxia  Serial order of infant.
other infections like tetanus, pertussis,
measles, PEM, accidents and Rh
incompatibility.
 Infancy period is classified
into :

1. Novonatal period → infant in the 1st

week of life.
2. Neonatal period → infant in the 1st
months of life.
3. Post-neonatal period → infant in the
next 11 months

0 Neonatal 1m. Post – neonatal 12m.

Infant
 a- Neonatal Mortality rate (28% of I.M)

No. of deaths of infants during the 1st m. of life in certain locality & year X 1000

No. of live births of the same locality and year

Causes related to pregnancy & labour mainly:

– Preterm & L B W → 50%.
– Birth injuries.
– Asphyxia neonatorum.
– Congenital anomalies.
– Infection e.g. congenital syphilis, A R I, tetanus & diarrheal diseases.
 b- Post neonatal mortality Rate: (72% of I.M) =

No. of deaths from 1 month to 1 year of age in certain locality & year X 1000

No. of live births of the same locality and year

Causes related to environment (mainly):

• Infections: ARI, Diarrheal diseases, pertussis & measles.
• Accidents.
• Preterm, LBW, congenital malformation.
 pre-school child Mortality (Child 1-4 Years Mortality
rate )

No. of deaths of children aged 1-4 y in a certain locality & year X 1000

No. of children of the same age group in the same locality and year

Causes:
1- Infections: (Leading cause)
ARI.
Diarrheal diseases.
Other infections.
2- Accidents → home & traffic.
3- Other causes as RHD & severe nutritional deficiency.
 Still Birth Rate (10‰ in 2000)
(Late foetal Mortality R.)
No. of deaths of foetus after 28th weeks of pregnancy in certain locality & year X 1000

No. of LIVE births+ No. of stillbirths of the same locality and year

Causes:
• Causes of intrauterine death of foetus:
– Exposure of the foetus to adverse intrauterine factors causing congenital anomalies: e.g. Radiation, infections,
cigarette smoke teratogenic drugs, live vaccine.
– Hypertensive diseases of pregnancy → especially pre eclampsia & eclampsia.
– Uncontrolled diabetes mellitus.
– Premature separation of placenta.
– Accidental trauma, chemical poisoning & asphyxia.
– RH incompatibility
• Causes of Intranatal foetal death:
– Birth injuries especially CNS, Viscera & cervical tear.
 Perinatal Mortality (14.3‰)

No. of deaths occurs in the perinatal period in certain locality & year X 1000

No. of live births + No. of still births in the same locality and year

the perinatal period (the period around labour, from 28th week of pregnancies to
the end of 1st week after births.

Perinatal M.R = Still birth R. + novonatal M.R .

Perinatal M.R is an index of maternal care and early neonatal care.

Sex specific mortality rate e.g.: (Maternal Mortality
Ratio; MMR)0.8– 0.4%:

No. of deaths of mothers due to causes related to pregnancy ,

labour & purperium in certain locality and yearx1000

No. of live births in the same locality and year

 Mortality of Diseases

1- Case fatality rate:

No. of deaths of a particular disease in certain locality & year

= x 100
No. of reported cases of the disease in the same locality & year
In out break:

No. of deaths of a particular disease during definite period & in confined community

= x 100
No. of diagnosed cases during that period in this community
2- Mortality rate (cause specific mortality rate): for chronic :

No. of deaths of a particular disease in certain locality & year

= x 100
population at risk
3- Proportionate Death rate :

It is the percent proportion of the number of deaths of a particular disease to total

deaths in certain locality & year.

No. of deaths of a particular disease in certain locality & year

= x 100
total deaths in the same locality and year

So, the causes of death can be arranged by their magnitude, and leading causes (major causes) of death
can be found.
 3- Morbidity statistics
1- Incidence rate
2- Prevalence rate
 Incidence rate
Used for acute & chronic diseases

Incidence rate of acute disease

No. of reported cases of a particular disease during a given time x100000

Population at risk
Incidence of chronic diseases

No. of new cases of a particular disease reported during a given time x 100000

Population at risk
Prevalence rate: used for chronic diseases.

No. of total cases of disease diagnosed by survey study during a defined period
of time X100000

population examined (at risk)during this period

 Case 1: These are the demographic & statistical data of a given country in
year 2018:
1. Midyear population……..20 million
2. Females in child bearing period……5 million
3. Male: female ratio………….1:1
4. Live births………………….2400000
5. Total deaths……………….150000
6. Deaths below 1 year…….2400
7. Maternal deaths………..240
8. Cases of cancer prostate under follow-up were 2000 of which 500 cases
died by the end of that year.
 Calculate after mentioning the used rate formula
a. Infant mortality rate
b. Maternal mortality ratio
c. Prevalence rate of cancer prostate
d. Case fatality rate of cancer prostate
 Case 2: During conducting the national census of 2007, the following demographic &
statistical data were collected
 Midyear population………………...80 millions
 Females in child bearing period……20 millions
 Male: female ratio………………….1:1
 Live births………………………….1.5 million
 Total deaths………………………...200000
 Deaths below 1 year………………..24000
 Maternal deaths…………………….900
 Cases of cancer breast under follow-up were 2000 of which 1255 cases died by the end of
that year.
 : Calculate

1. General fertility rate

2. Crude death rate
3. Infant mortality rate
4. Maternal mortality ratio
5. Case fatality of cancer breast
6. Proportionate death rate of cancer breast