Data and Additional

Measures of Disease
Occurrence

Epidemiology
June 26, 2019
Learning Objectives

• State three factors that affect the quality of epidemiologic data

• List four data sources that are used in epidemiologic research
• Calculate two epidemiologic measures
• State one source of epidemiologic data available from an international
organization
 List of important terms used
Criteria for data quality Data sources
Appropriate uses of data
Availability of data
Completeness of data
Content of the data
Representatives of data
Sources of data
Health status measures
Health insurance Crude Birth rates
programs Fetal death rates
Registries General fertility rates
Specialized morbidity Infant Mortality rate
surveys Life expectancy
Surveillance programs, Maternal Mortality
reportable disease
statistics
US Census
Vital events
Online sources for retrieval of Epidemiologic
Information
• Center for disease control and prevention
• MEDLINE, National library of Medicine
• The American Public Health Association
• World health OrganizationSTatistical Information
(WHOSIS)
• Department of Health
Factors that Affect Epidemiologic Data

• Nature of the Data including the sources and

content
• Availability of data
• Completeness of the population coverage
• Appropriate and inappropriate uses of the data
The Vital Registration System and Vital Events

• VITAL EVENTS
• Deaths, births, marriages, divorces and fetal deaths
• The Local Registrar Office is the responsible agency that records vital events
and submits to NSO
•Deaths
• Name, Age, Address, Civil Status, Informant
• Immediate cause of death
• Antecedent Cause of Death
• Underlying Cause of Death
• Other Condition that may contribute to death

• Signed by Attending Physician

• Reviewed by CHO
• Death Certificate is an official document setting
forth particulars relating to a dead person, including
the name of the individual, the date of birth and the
date of death.
• Births
• Includes live births, fetal deaths
• Birth data are used for calculation of birth rates, codition
that may affect the neonates, conditions during
pregnancy, congenital malformations, obstetrics
procedures, , birth weight, length of gestation and
demographic background of the mother.
Data from PH Surveillance Program

PH Surveillance
Refers to the systematic and continuous gathering
of information about the occurrence of disease and
other health phenomena
Personnel analyzes and interpret the data they
have collected and distribute the data and
associated findings to planners, health workers and
members of the community
Operate at a local, regional, national and
international level
•Syndromic surveillance

• Desribes related health data that Precede diagnosis

and signal a sufficient probability of a case or an
outbreak to warrant further public health response
• For detecting outbreak associated with bioterrorism
•Syndromic report –

• refers to the notification of a health event under

surveillance for which the case definition is based
on a syndrome not on a definite disease (e.g.
acute hemorrhagic fever syndrome, acute
respiratory syndrome).
Examples of Surveillance System
1. Communicable and Infectious diseases
2. Non-communicable diseases
3. Risk Factors for Chronic Diseases

PHILIPPINES : Phil. IntegratedDisease

Surveillance and Response
Reportable and Notifiable Disease Statistics

• by legal statute,a must for physicians and other

health care providers to report cases of certain
diseases to health authorities
• Infectious and communicable that might endanger
a population
• Ex.: STDs, Rubella, Measles, Tetanus, Plague, and
foodborne diseases
• Notifiable Disease - refers to the disease that, by
legal requirements, must be reported to the public
health or other authority in the pertinent
jurisdiction when the diagnosis is made.
• Outbreak – synonymous with epidemic; when used
in a sentence, refers to an epidemic limited to
localized increase in the incidence of a disease, e.g.,
in a village, town, or closed
•Integrated Disease Surveillance and
Response

• refers to the process of coordinating, prioritizing, and

streamlining of core surveillance activities (e.g., data
collection, reporting, laboratory and epidemiological
confirmation, analysis, feedback), support functions (e.g.,
training, monitoring, financial and logistics) and response
(e.g., epidemic investigation) with the aim of making the
system more efficient and effective in providing timely,
accurate and relevant information for action.
• It is a process of coordinating, prioritizing, and
streamlining of multiple disease surveillance
systems into a unified national disease surveillance
system that combines core surveillance activities
and support functions into a single integrated
activity for the purpose of making the system more
efficient and effective in providing timely, accurate
and relevant information for action.
•Epidemiology and Surveillance Unit

• refers to the unit established in the Centers for

Health Development (CHD), Provincial Health
Offices (PHO), City Health Offices (CHO) and Rural
Health Units (RHU) that provide services on
public health surveillance and epidemiology.
•Notifiable Disease Reporting System (NDRS)

• refers to the component of the Field Health Service

Information System (FHSIS) that provides the Department
of Health (DOH) with field-based surveillance and
program management information on the different public
health programs. It monitors 17 diseases and 7
syndromes. Data are generated from the barangay health
stations, rural health units and municipal or city health
centers.
•National Epidemic Sentinel Surveillance System
(NESSS)

• refers to the hospital-based surveillance system that

monitors 15 diseases with outbreak potential that
are either laboratory-confirmed (e.g. cholera,
hepatitis A, hepatitis B, malaria, measles, typhoid
fever) or clinically-diagnosed (e.g., dengue,
diphtheria, leptospirosis, meningococcal disease,
nonneonatal tetanus, neonatal tetanus, pertussis,
rabies).
Behavioral Risk Factor Surveillance

• Program used by the US to monitor at the state

level behavioral risk factors that are associated with
chronic diseases.
• State-based system of health surveys that collects
information on health risk behaviors, preventive
health practices and health care access primarily
related to chronic disease and injury.
Case Registry

• A centralized database for collection of information

about a disease.
• Registry, maintained for many type of conditions
including cancer are used to track patients and to
select cases for case-control studies
Examples :

•NHTS ( National Household Targeting System)

•TCL (Target Client List)
•FHSIS
•NSO
Purpose of State Registry

• Monitor cancer trends over time

• Determine cancer or disease patterns in various
populations
• Guide planning and evaluation of cancer or any
disease control programs
• Help set priorities for allocating health resources
• Advance clinical, epidemiologic and health services
research
• Provide information for a national database of
disease incidences
Additional Measures of Disease Occurrence

• Life Expectancy
• Causes of Death
• Maternal Mortality
• Infant Mortality Rate
• Fetal Mortality
• Birth Rates
• General Fertility Rate
• Perinatal Mortality
Life Expectancy

• Refers to the number of years that a person is

expected to live at any particular year

• Life expectancy at birth represents the average

number of years that a group of infants would live if
the infants were to experience throughout life the
age specific deaths rates present in the year of
birth.
Causes of Death

•To determine the leading causes of deaths

•The NSO provides the data through death
certificates
Maternal Mortality

•Encompases maternal deaths that result

from causes associated with pregnancy
•Factors related to maternal mortality
• Race
• Insufficient health care access
• Social disadvantages
MMR

MMR = Number of deaths

_________________ X 100, 000 live births
Number of live births
(during a year)
Infant Mortality Rates

•Defined as the number of infant deaths

among infants 0-365 days during a year
divided by the number of live births during
the same year (expressed as the rate per
1,000 live births)
•Related to inadequate health care and poor
environmental conditions
 IM

NO. Of Infant death 0-12 months

IM = _____________________________ X 1,000

No. Of livebirths during the year

EX. In the US in 2005, Infant death were 28, 384 with a

live birth of 4, 138, 573. what is the Infant mortality rate
Fetal Mortality

•Defined as the death of the fetus when it is in

the uterus and before it has been delivered.

•2 measures
• Fetal Death Rate
• Late fetal death rate
Fetal Death Rate

No. Of fetal death after 20 wks or more AOG

= ________________________________________ X 1,
000

No. Of live births + No. Of fetal death after

20 wks or more AOG
Late Fetal Death Rate

No. Of fetal death after 28 or more wks AOG

= ________________________________________ X
1,000

No. Of live births + No. Of fetal death after

28 wks or more AOG
Birth Rates

•Crude Birth Rates

• Refers to the number of live births during a
specified period such as a year per the resident
population at the midpoint of the year.
• Birth rates affects the total size of the population
General Fertility Rates

•Related to birth rates

•Refers to the number of live births reported
in an area during a given time interval
divided by the number of women age 15 to
44 years in the area
•Also known as Fertility rate
Perinatal Mortality

•Takes into account both late fetal deaths and

death among newborns
•Defined as the number of the late fetal death
after 28 wks AOG plus infant deaths within 7
days of birth divided by the number of live
births plus the number of late fetal deaths
during a year (expressed as rate per 1,000
live births and fetal death)
 PMR

number of the late fetal death after 28

wks AOG plus infant deaths within 7 days of birth
= _____________________________________________ X 1000

number of live births plus the number of late fetal

deaths during a year
Conclusion

•Epidemiology is a quantitative discipline that

requires data for descriptive and analytic
studies. A central concern of epidemiology is
data quality which can be assessed by
applying criteria .