1. Health Statistics including Medical Statistics
11/11/2018
Contributed by National Academy of Statistical Administration, India

2. Outline of the Presentation
Introduction
Applications of Statistics in Public Health
Tools for measurement
Measurement of Mortality
Problems of Mortality data
Standardization of Rates
Measurement of Morbidity
Measurement of Fertility
Official Health Statistics
Health under the Indian constitution
Role of Central Bureau of Health Intelligence (CBHI)
Limitations of CBHI Publications
Achievements of Family Welfare Program
11/11/2018
Contributed by National Academy of Statistical Administration, India

3. Introduction
At the time of the creation of the World Health Organization (WHO), in 1948,
health was defined as
"a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity“.
But now it is defined as
Health is the general condition of a person in all aspects. It is also a level of functional and/or metabolic efficiency of an organism, often implicitly human.
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4. Applications of statistics in public health:
Population estimation and forecasting
Surveys of population characteristics, health needs and problems
Analysis of health trends
Health education
Evaluation of Health Programs
Research & Development
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5. Three tools: Rates Ratio Proportion
Tools for measurement
Three tools:
Rates
Ratio
Proportion
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6. Rate
Rates of a vital event is defined as the total number of occurrence of the event to the total number of persons exposed.
A rate consists of
(a) numerator
(b) denominator
(c) time specification
(d) multiplier
e.g.
Number of births in 2001
Birth rate= _________________________x 1000
Mid year population in 2001
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7. Three types: Crude rates Specific rates Standardized Rates
Rate (contd..)
Three types:
Crude rates
Specific rates
Standardized Rates
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8. Rate (Contd..) Crude Rates- Simplest of all the indices
and is defined as
the no. of a event (e.g. death from all causes) per k persons in the population of any given region or community during the given period.
called crude because
here denominator used is entire mid year population and we are not including specific information in numerator,
e.g. in crude birth rate we include all births whether live or still births
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9. Rate (Contd..) Specific Rates- specific causes e.g. AIDS, Cancer
These are the actual observed rates due to
specific causes e.g. AIDS, Cancer
or occurring in specific groups e.g. under five children, women from 15 to 44 years,
or during specific time periods e.g. week, month or year
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10. Rate (Contd..)
Standardized Rates- To make two populations and their rates comparable
Adjustment either by direct or indirect method for age, sex, religion etc. is made.
This way we get age or sex standardized rates.
Multivariate analysis, regression techniques can help us in standardization.
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11. Ratio express relation between two unrelated quantities.
no time frame and multiplier.
e.g. Sex ratio
i.e. number of females per 1000 males.
In 2001 it was 933: 1000.
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12. Dependency Ratio
(Population aged 0 to 14 years)+(population aged 65 years and above )
Dependency ratio = ______________________________________x Population aged 15 to 64 years
(population aged 0 to 14 years)
Child dependency ratio= _________________________x Population aged 15 to 64 years
(population aged 65 years & above)
Old age dependency ratio= ________________________________x 100
Population aged 15 to 64 years
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13. Proportion
A proportion is a ratio in which numerator is always included in the denominator.
usually expressed as percentage.
Example- (Marks obtained/ Total Marks) x 100
Proportional morality due to AIDS= (No. of deaths due to AIDS/ No. of deaths due to all causes )x 100
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14. Measurement of Mortality
Only data available in many of the developing countries
Useful for
Epidemiologic research
Health trends
Planning
Execution
Evaluation of various Health Programmes
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15. Problems of Mortality data
a) All deaths may not be reported.
b) The age of deceased and cause of death may not be recorded accurately.
c) National and international comparability poor due to lack of uniform and standardized methods of collection.
d) If a single cause of death is recorded, then information regarding associated conditions and risk factors may not be available.
e) Coding systems and diagnosing practices changes over time affecting validity/ comparability of the data.
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16. Measurement of Mortality (contd..)
Mainly following type of mortality rates are available
1. Crude death rates
2. Specific death rate
3. Standardized death rates
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17. Crude Rates Mid year population of that year)
Crude death rate= No. of deaths in year x 1000
Mid year population of that year)
Natural Increase rate= No. of births - No. of deaths x 1000
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18. Specific Death Rates
Death rates computed for a particular specified section of the population is termed as specific death rate (SDR).
SDR= {Total no. of deaths in the specified section of the population in the given period/Total population of the specified section in the same period}x k
Where k= 1000 usually. Usually S.D.R is computed specific to (i) age and (ii) sex
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19. No. of deaths within First 28 days of life in a yearX1000
Specific Rates:
Infant mortality rate=
No. of infant deaths in a year x 1000
No. of live births in that year
Neonatal mortality rate=
No. of deaths within First 28 days of life in a yearX1000
Child death rate=
Annual No. of deaths between 1st & 4th Yr. of life x 1000
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20. Standardization of Rates:
Two methods :
direct
indirect
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21. Direct Standardization
In this method given values are evaluated against some standard values.
Suppose a city has following parameters with CDR 10 per
Sex
Mid yr Population
Deaths in the year
Sex specific death rate
Males
30000
450
15.0
Females
70000
550
7.85
Total
100000
1000
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22. Contd….
Now lets us take a standard population with males females.
Apply sex specific death rates of above population to the standard population
Sex
Standard population
Sex Specific death rate per 1000
Expected deaths
Males
50000
15.0
750
Females
7.85
392.5
Total
100000
1143
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23. Contd…. Standardized death rate per 1000 =(750+392.5/100000) x 1000
Standardization for sex has increased death rate from 10 per 1000 to per 1000
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24. Indirect standardization
It requires:
1. Age or sex distribution of each group to be standardized
2. Total events in each group to be standardized
3. Age or sex specific rates for a standard population.
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25. Contd…… In the study population of 1,00,000 there are
60,000 Coal miners,
20,000 Farmers,
10,000 laborers
and 10,000 others.
Occupation
No. in study population
Occupation specific death rates in standard population per 1000
Actual deaths
Expected deaths in study population
Coal miners
60000 10
500
600
Farmers
20000 12
200
240
Laborers
10000 03
100 80
Other 15
150
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26. Contd…… Total expected deaths= 1070 Actual deaths = 900
Crude death rate for study population=
900/100000x1000=9 per 1000
=observed deaths/expected deaths X 100
=900/1070x100
=84.11
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27. Measurement of Morbidity
Three units-
I) Persons affected.
II) spells of illness
III) duration of illness
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28. Contd….. Utility of rates and ratios : A) help in deciding priorities.
B) help in monitoring and evaluation of various activities aimed at control and
C) Prevention of the disease
D) Research activities.
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29. Contd….. Limitations of rates and ratios : A) Illness occur in spells.
B) illness has various grades of severity.
C) illness exists over a period of time.
D) illness cannot be defined precisely.
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30. Measurement of disease frequency
Commonly used rates are-
Incidence rate: It is defined as number of new cases occurring a defined population during a specified period of time
a) Incidence rate (persons)
=(No. of persons starting an episode of illness in a defined period ) X Average no. of persons exposed to risk during that period
b) Incidence rate (spells)=
No. of spells of illness starting during the defined period x 1000
Average no. of persons exposed to risk during that period
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31. Measurement of duration of illness
Avg. duration of illness=
Sum of duration of illness of cases in a sample
No. of cases in the sample
Days of illness per spell=
Sum of days of illness of all sick persons
No. of spells of illness
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32. Measurement of fertility:
Birth rate = (No. of live births during the year/ Estimated mid year population of that year) x 1000
General fertility rate=
(No. of live births in an area during the year/ Midyear female population of age 15 to 44 (or 49) in the same area in that year) x 1000
General martial fertility rate= (No. of live births in an area during the year /Midyear female population of age 15 to 44 (or 49) and who are married, in the same area in that year)x 1000
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33. Official Health Statistics
Two broad categories:
a) Existing Health Situation
b) Response of Official Machinery to Improve the Health Situation
preventive
curative and rehabilitative
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34. Existing Health Situation include
Population information
Vital Statistics
Burden of Disease and Disability
Cause of death information
Reproductive and child health
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35. Existing Health Situation (contd..)
Environmental pollution
Availability of basic amenities like
safe drinking water,
availability of sanitation facilities,
source of lighting,
housing facility
Socio economic condition of family like
average family size,
level of poverty,
literacy level of head of household
9 International comparative information
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36. Response of Official Machinery to Improve the Health Situation include
Health and population policies
Health and medical education infrastructure
Availability and deployment of health and medical personnel
Health expenditure
Health and medical research
Checking food adulteration
Preparedness to tackle epidemics and aftermath of natural calamities
11/11/2018
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37. Health under the Indian constitution
Union List:
Port Quarantine Administration
Post graduate Medical Education
International Health
Medical Research etc.
State List:
Public Health
Sanitation and medical care
Hospitals and dispensaries
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38. Health under the Indian constitution (Contd..)
Concurrent List:
Vital Statistics (including registration of births and deaths)
Food Adulteration
Drug Control etc.
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39. Organizational setup MINISTRY OF HEALTH & FAMILY WELFARE
Department of Health and Family Welfare
Department of AYUSH
Department of Health Research
Department of AIDS Control
Central Bureau of Health Intelligence (CBHI)
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40. Health Care Delivery System – Government
Sub Centre (5000 population)
Primary Health Centre (6 Sub Centers)
Central Health Centre (for 4 PHC’s)
Hospital: Municipal, District Level, Teaching Hospital, Non Teaching Hospital etc.
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41. Information flow to central authorities
Sub Center
Primary Health Center
Primary Health Center
District Health Office
State
Center
Community Health Center
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42. Statistical set up at the centre and States/ UTs
CBHI,
National AIDS Control Organization
States:
SBHI or
State demographer or
State AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy ) officer.
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43. Central Bureau of Health Intelligence (CBHI)
CBHI collects information on
Education:
Allopathic Medical/ Dental Education from MCI/ DCI recognized Medical and Dental Colleges through annual proforma
Paramedical education from Dental Health Services/ DME of states/ UTs to annual proforma
Physiotherapy
Occupational Therapy
Prosthetics & Orthotics
Speech & Hearing Therapy
Medical Laboratory Technology
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44. Manpowers Registered number of
allopathic doctors
dental surgeons
general nurses
Pharmacists
from the respective all India councils such as medical council, dental council and pharmacy council annually.
Registered number of AYUSH practitioners from Department of AYUSH annually
Number of allopathic doctors/dental surgeons working in Govt. establishments in States/ UTs from the DHS of States/ UTs through annual proforma.
Number of paramedical personnel from States/UT’s
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45. CBHI (Contd..) Treatment infrastructure :
Allopathic treatment infrastructure in Govt. Sector on annual basis from DHS of States/ UTs.
Rural health facilities information from infrastructure division of department of family welfare annually
Information on treatment infrastructure from Department of Ayush
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46. CBHI (Contd..) Annually Public Health Information :
Reported cases and deaths due to Cholera (weekly), communicable (monthly) and non communicable diseases (monthly) through prescribed formats
Information on Malaria, Filaria, Kala Azar, Dengue from National Vector Borne Disease Control Programme – annually
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47. CBHI (Contd..) Causes of death information From RGI annually
All information is published in an annual publication titled “Health Information of India”
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48. Health Information of India
Population & Vital statistics,
Per capita Income,
Percent of population below poverty line,
Medical & Dental Education,
Registered Personnel Information,
Number of Govt. Allpathic Hospitals,
No. of ISM&H facility (both Educational & treatment),
Production of certain Essential drugs,
Public Health Statistics for Cholera & major communicable disease,
Causes of Death Statistics,
International Comparative Statistics etc.
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49. Limitations of CBHI Publications:
Data below States/UT level are not available in central health statistical publications.
Private sector health data are not included. There is no Statutory provision to collect Health Data from Private Health establishment.
Age & Gender specific data are not done. Action is being taken to capture morbidity data, gender wise for the publication
Morbidity surveys are not done regularly and hence, there is a dearth of data on prevalence/incidence rates of disease.
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50. Limitations of CBHI Publications (Contd..)
There is no systematic generation of health data and scientific methods of recording at grass root levels.
There are no data on cost of Health Care, availability of specialty treatments in the various Hospitals.
Hospital inpatient & Out patient Medical Records are not computerized.
There is no data on registered Para Medical Professional.
The registered Health Personnel data are not corrected for death etc.
There is no District Health Facilities Directory in many of the States/UTs.
11/11/2018
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51. Achievements of Family Welfare Program
S.No
Parameters
1951
1981
1991
Current Levels
Highest(2008)
Lowest
(2008) 1
Crude Birth Rate
(per population)
40.8
33.9
29.5
22.8 (2008)
U.P. (29.1)
Bihar (28.9)
Kerala (14.6)
Tripura (15.4) 2
Crude Death Rate
(per 1000 population
25.1
12.5
9.8
7.4
(2008)
Orissa (9.0)
M.P.(8.6)
Chandigarh
(4.4)
Nagaland (4.6) 3
Total Fertility Rate
6.0
4.5
3.6
2.6
(2008)
Bihar (3.9)
UP (3.8)
Kerala 1.7
Tamil Nadu (1.7) 4
Infant Mortality Rate (per 1000 live births)
146 ( )
110 80 53
(2008)
M.P. (70)
Orissa (69)
Kerala (12)
Tamil Nadu (31) 5
Child Mortality Rate (0-4 yrs.) per 1000 Children
57.3 (1972)
41.2
26.5
16.0 (2007)
M.P.(26.5)
U.P.(22.3)
Kerala (2.8)
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52. If you have health, you probably will be happy, and if you have health and happiness, you have all the wealth you need, even if it is not all you want.  ~
Elbert Hubbard
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