indicators and determinants of health
Health status indicators
Mortality, cause specific: the source of information is the death
certificate, therefore the reliability of mortality data depends on accuracy of
the vital registration system in each country. Causes of death are coded
according to the International Classification of Diseases and Causes of Death
(ICD). Problems of temporal and geographic comparison derive from different
versions of the ICD adopted over time. Specific indicators are:
- crude death rate:
total number of deaths divided by estimated mid-year population per 1,000
- cause-specific crude
death rate: number of cause-specific deaths divided by estimated
mid-year population per 1,000
- age-specific death rate:
total number of deaths divided by mid-year population per 1,000 for specific age
groups.
- age-standardized death
rate: death rate estimated after age-standardization has been performed.
Morbidity, diseases specific: it can be assessed using different
information sources, from hospital discharge rate to attack/incidence rate of
disease (first event / first and recurrent events), from prevalence to case
fatality. Generally, it is useful to adopt crude rates and absolute numbers.
Individual indicators are defined as follows:
- hospital discharge rate
or hospitalization rate: number of hospital discharge records of a specified
main diagnosis divided by estimated population per 1,000
- attack rate: number
of events (first and recurrent) by estimated population per 1,000
- incidence rate:
number of first events divided by population at risk per 1,000. Incidence may be
estimated through the follow-up of a population enrolled in a cohort study or by
the identification of new events in a dynamic population. It can be obtained
using longitudinal studies or disease registers, when it is possible to exclude
those persons who have already experienced an event
- prevalence:
proportion of people with a specific disease in a population per 1,000 or per
100 at a particular time
- case fatality:
number of fatal cases divided by total number of events.
The importance of these indicators varies according to the disease in
question, age range and planned use:
- incidence, case
fatality and prevalence rates: they are the most important indicators
in younger age groups; incidence is particularly relevant in the case of
acute events and especially useful for etiological research objectives
- attack and
prevalence rates: they are the most important indicators in the surveillance
of old people since patients with chronic diseases have a greater impact on
public health system; these data are useful for hospital planning and primary
care.
Disability: CVD is among the leading causes of disability.
- Disability-Adjusted
Life Year - DALY: years lost due to premature mortality and years lived with
disability. It is equal to the sum of the number of years lost due to CVD in a
population (YLL) and to the number of years lived with disability of known
severity and duration for a CVD in a population (YLD)
- potential Years of Life
Lost - PYLL: it is a measure of impact of premature mortality. It’s the sum
of the years that people dying from a CVD would have lived, had they experienced
a normal life expectancy usually determined at 65 years
- activities of Daily
Living - ADL: this index measures six basic functions (moving between rooms,
using lavatory, washing and bathing, dressing and undressing, getting in and out
of bed, and feeding oneself). It has the following scores: A (person independent
in every item), B (dependent in one item), C (dependent in two items), D
(dependent in three items), E (dependent in four items), F (dependent in five
items), G (person dependent in all functions)
- instrumental Activities
of Daily Living - IADL: it measures more complex functions (using telephone,
getting to places beyond walking distance, grocery shopping, preparing meals,
doing housework or handyman work, doing laundry, taking medications, managing
money). Score ranges from 8 (able to perform all functions) to 0 (cannot perform
any function)
- EuroQol (EQ): it
is a standardized instrument for use as a measure of health outcome. Applicable
to a wide range of situations, it provides a simple descriptive profile for
health status. This index can be used in the clinical and economic evaluation of
health care as well as in population health surveys.

© Cnesps - Istituto Superiore di Sanità - 2008