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 rates 2-
Mortality rates 3-
Morbidity rates
1- Birth 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%)
Example
Some vital statistics for specific population for the year 2015 are:
Midyear population: 10,000
Live births: 500
Calculate Crude birth rate .
answer
Crude birth rate =
No. of live births of a certain locality and year x 1000
Mid-year population of the same locality & year
=(500*1000)/10000=50 per 1000
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.
Example
Some vital statistics for a specific population for the year 2011 are:
Total population: 10,000
Live births: 700
Females in childbearing period in same locality & year:3500
Calculate General fertility rate (GFR)
Answer
General fertility rate (GFR)=
No. of live births of a certain locality and year x 1000
Females in childbearing period in same locality & year
=(700*1000)/3500=200 per
1000
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 factors
a- Related to community development.
general death rate
Socioeconomic factors.
Insanitary environment.
Specific factors Poor living condition.
Malnutrition.
a- Community disease: Education, culture, traditions, healthful
Nature, morbidity rates, lifestyle.
sequalae, pregnancy. b- Sex and age distribution of population
Accidents. e.g.
b- Effectiveness of available High mortality rate in the two extremes.
health service. 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,
(The main causes responsible for the which indirectly influence I.M through
majority of deaths) predisposing to morbidity:
Big family size and low percapita
Acute respiratory infections → income.
(30%). Insanitary environment.
Preterm and low birth weight (LBW) Inadequate nutrition of mothers &
→ 30%. infants.
Infective diarrhoeal diseases (gastro- Illiteracy & low education level.
enteritis) → 25%. Non-practice of birth control.
Other causes → 15%. e.g. congenital Serial order of infant.
anomalies – Birth injuries – asphyxia
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 Post – neonatal
1m. 12m.
Infan
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.
Premature rupture of membranes.
Asphyxia (inutero).
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.
At benha city in 2015 some statstics were
No. of deaths from 1 month to 1 year of age= 700
No. of live births =15000
No. of deaths of foetus after 28th weeks of pregnancy =500
No. of deaths of infants during the 1st m. of life =1500
No. of deaths of infants during the 1st week of life =400
No. of deaths of children aged 1-4 y=900
No. of children aged 1-4 y=12000
Calculate
1-neonatal mortality rate
2-Post neonatal mortality rate
3-Still birth rate
4- Perinatal mortality rate
5- pre-school child Mortality rate
1-neonatal mortality rate=
No. of deaths of infants during the 1st m. of life in certain locality &
year X 100
No. of live births of the same locality and year
=(1500*100)/15000=10%
2-Post neonatal mortality rate =
No. of deaths from 1 month to 1 year of age in certain locality & year
X 100
No. of live births of the same locality and year
=(700*100)/15000=4.6%
3-Still birth rate =
No. of deaths of foetus after 28th weeks of pregnancy in certain locality
& year X 100
No. of LIVE births+ No. of stillbirths of the same locality and year
=(500*100)/(500+15000)=3.2%
4-Perinatal mortality rate=
No. of deaths occurs in the perinatal period in certain locality & year X 100
No. of live births + No. of still births in the same locality and year
=(900*100)/(500+15000)=5.8%
pre-school child Mortality rate =
No. of deaths of children aged 1-4 y in a certain locality & year X 100
No. of children of the same age group in the same locality and year
=(900*100)/12000=7.5%
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
Case fatality rate 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
Example
Some vital statistics for the island of Summerton for the year 2015
are:
Midyear population: 16,500
No of deaths due to Sepsis : 300
Total (cumulative) cases of Sepsis:5,000
Calculate Case fatality rate
Answer
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
=(300*100)/5000=6 %
2- Mortality rate (cause specific mortality rate):
No. of deaths of a particular disease in certain locality & year
= x 100
population at risk
Example
Some vital statistics for the island of Summerton for the year 2015
are:
Midyear population: 16,500
Total deaths: 500
Pneumonia cases: 13
Deaths due to pneumonia: 200
Calculate The cause-specific fatality rate due to pneumonia
Answer
The cause-specific fatality rate due to pneumonia =
No. of deaths of a particular disease in certain locality & year *100
population at risk (mid year population)
=(200*100)/16500=1.2 %
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.
Case study
There are 2.5 million people aged 75-84 in Country X, which has a total population of
25 million. 4000 people died of influenza and pneumonia in Country X in 2011. 2,540 of
these deaths occurred in the 75-84 age group. What is the 2011 mortality rate for
influenza and pneumonia among people in Country X aged 75-84?
a-101,6 per 100,000 population
b-16 per 100,000 population
c- 160 per 100,000 population
d-10.6 per 100,000 population
answer
mortality rate for influenza and pneumonia among people in Country X aged 75-84=
No. of deaths of a particular disease in certain locality & y*100000
Population at risk
=(2540/2.5 million)*100000=101.6 deaths per
100,000 population
Case study
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......................................200,000
Deaths below 1 year........................24,000
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- Infant mortality rate
3- Crude death rate
4- Maternal mortality ratio
5- Case fatality of cancer breast
6- Proportionate death rate of cancer breast
answer
No. of live births of a certain locality and year x 100
1-General fertility rate=
Females in childbearing period in same locality & year
= (1.5 million ⁄ 30000) *100 = 7.5 %
2- Infant mortality rate = 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
= (24000/1.5 million) *100 =16%
3- Crude death rate= Total number of deaths of a certain localityx100
Mid – year population in the same locality
=(200,000 million ⁄ 80 million) *100
= 0.25 %
4- Maternal mortality ratio=
No. of deaths of mothers due to causes related to pregnancy ,
labour & purperium in certain locality and yearx100
No. of live births in the same locality and year
=(900/1.5 million)*100=0.06%
5- Case fatality of cancer breast=
No. of deaths of a particular disease in certain L&y*100
No. of reported cases of the disease in the same L&y
=(1255/2000)*100=62.75%
6- Proportionate death rate of cancer breast=
No. of deaths of a particular disease in certain locality & year*100
total deaths in the same locality and year
=(1255/200000)*100=0.62%
3- Morbidity statistics
1- Incidence rate
2- Prevalence rate
Incidence rate
Used for acute & chronic diseases
Incidence rate of acute disease
No. of reported (new)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
Example
In 2003, about 500 new cases of acquired immunodeficiency syndrome (AIDS)
were reported in the country X. The estimated mid-year population of the
country in 2003 was approximately 30,000. Calculate the incidence rate of AIDS
in 2003.
Numerator = 500 new cases of AIDS Denominator = 30000 estimated mid-year
population Incidence rate = (500 ⁄ 30000) *100 = 1.6 % Alternatively can be
expressed as 16 new cases of AIDS per 1000 population.
Incidence rate = No. of new cases of a particular disease reported during a given time x 1000
Population at risk
= (500 ⁄ 30000) *1000= 16 new cases of AIDS per 1000
population
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
Example
Calculating Prevalence In a survey of 1000 women
who gave birth in a town X, at a given time, a total of
50 women had preterm labor. Calculate the
prevalence of preterm delivery in this group.
No. of total cases of disease diagnosed by survey study during a defined period of time X100
Prevalence=
population examined (at risk)during this period
surveyed Prevalence = (50 ⁄ 1000 )× 100 = 5%
Example
Some vital statistics for the island of Summerton for the year 2015
are:
Midyear population: 16,500
New Sepsis cases: 300
Total (cumulative) cases of Sepsis:5,000
Live births: 500
Deaths due to heart disease: 57
Total deaths: 500
Calculate prevalence and incidence of sepsis in the island of
Summerton .
answer
Prevalence rate=
No. of total cases of disease diagnosed by survey study during a defined
period of time X100
population examined (at risk)during this period
=(5000*100)/16500=30.3%
Incidence rate of acute disease
No. of reported (new)cases of a particular disease during a given time
x100
Population at risk
=(300*100)/16500=1.8%
Example
In a population of 500,000 people, 18,000 have been diagnosed with
diabetes. What is the diabetes prevalence rate per 100,000 people?
a-.18
b- 18,000
c-3,600
d-,036
Prevelance =
No. of total cases of disease diagnosed by survey study during a defined
period of time X100
population examined
=(18000*100)/500000=3.6%
Attack rate
used to detect incidence of acute diseases during
outbreak or epidemic .
No. of new cases of a particular acute disease reported during a given time and
place during epidemic or outbreak x 100
Population at risk in certain time and place
Example
In an outbreak of gastroenteritis among people who ate meals at a
hotel, 99 persons ate raw salad, 30 of whom developed
gastroenteritis. Calculate the attack rate of gastroenteritis among
persons who ate salad.
Numerator = 30 persons who ate Salad and developed
gastroenteritis Denominator = 99 persons who ate salad Food
persons who ate Salad and developed
gastroenteritis x 100
attack rate= persons who ate Salad food
attack rate = (30 ⁄ 99) × 100 = 0.303 × 100 = 30.3%
REMEMBER:
While calculating rates, there are different possible denominators (i.e. population at
risk,midyear population, total population, etc.).
Be sure to use what is the best available choice for each of the rate calculations.
All rates need to include a multiplier.
