CHAPTER 3
MEASURING HEALTH: MORBIDITY
Because mortality data are readily available in published form they tend to
colour our view of what diseases are 'important' and we can easily underrate
those conditions which, although causing much unhappiness, are not lethal.
In 1983 a study was carried out by Holman of the reasons for which patients
consult general practitioners in Australia¹.
Figure 3.1 shows the rates at which people consult general practitioners; it is
apparent that the greatest rate of consultation occurs among the elderly,
although there is a smaller peak among infants.
18
16
14
12
10
Visits per person per year
60
Male
- Female
Figure 3.1
0 5 10 15 20 25 30 35 40
AGE
45 50 55 60
65
Consultations in general practice by age and sex in 1983
Of greater interest are the reasons people visit their general Practitioner, these
vary with the age of the patient but Figure 3.2
17
18
CHAPTER 3
shows the ten leading causes of consultation.
This pattern is markedly different from that seen from the mortality data in
Figures 2.1-2.4.
Dermatitis
III-defined
Bronchitis etc.
Ear disease
Preventive
Undiagnosed
Bones/Joints
Hypertension
Neurosis etc.
Resp. Infections
Male
Female
024
6 8 10 12
Percentage
14 16
Figure 3.2
Reasons for general practice consultation, all ages!
Another way of looking at morbidity is by questioning not why people go to the
doctor, but rather what people themselves think of their health'.
A survey in northwest Melbourne in 1978 was carried out by senior medical
students, using structured interviews
Figure 3.3 shows the prevalence of reported symptoms and the order is different
again from the relative frequency of symptoms seen by doctors.
Migraine
Menstrual problems
Ear disease
Dermatitis
Dyspepsia
Hay fever &'sinus"
Chronic Resp. Dis.
Hypertension & CHD
Musculo-skeletal
Male
Female
Figure 3.3
Symptoms' described by subjects in a Melbourne survey.
(Symptoms with a prevalence of less than 50 per 1000 do not appear on the
figure)
50 100 150
Rate per 1000
200
250
MEASURING HEALTH: MORBIDITY
19
Setting Priorities
One of the important functions of epidemiology is to provide the kind of
information described above to help governments set priorities in health care
and research.
The World Health Organization has set a world-wide goal 'Health for all by the
year 2000!'
Using epidemiological data, the Australian Government has responded with a
series of goals for this country³.
Australia's goals are to reduce the following by the year 2000
1. morbidity/mortality from circulatory diseases (in those under 70) by at least
20%;
2. morbidity/mortality from accidents by at least 30%;
3. morbidity/mortality from cancer (in those under 70) by at least 20%;
4. morbidity/mortality from infectious and respiratory disease (in those under
70) by at least 10%; to reduce inequalities in incidence among high risk groups;
5. the rate for abortions by at least 25%;
6. the incidence of sexually transmitted diseases by at least 75% (excluding
AIDS);
7. the perinatal and infant mortality rates by at least 15% and to reduce
significantly the higher rates among high risk groups;
8. the prevalence of chronic conditions and physical limitations in people over
age 65 by at least 15%;
9. the prevalence of severe mental handicap in children aged 5-15 years by at
least 10%;
10. the proportion of persons aged 15-64 who have no natural teeth.
Exercise 3.1
The goals, developed by the Australian Government, have been derived from a
mixture of mortality and morbidity data.
Consider each in terms of the likely source of the data.
Looking back at the mortality, the general practice, and the survey information
given in this chapter, do you think that the goals set out by the Australian
Government are the right ones?
With the object being, presumably, the health and happiness of the community,
can you rank the goals in order of importance?
Do you you think that the goals are achievable?
Which are those most likely to be achieved?
Exercise 3.2
Table 3.1 is taken from the annual reports of the Register-General of England
and Wales.
It shows the number of deaths from coronary heart disease in men at certain
ages in 1963 and 1976.
It is reason-
20
CHAPTER 3
able to assume that the population size and age structure did not change
significantly between these periods.
Table 3.1
Deaths from CHD, England and Wales 1963 and 1976
Age group
1963
1976
15-44
2005
1459
45-64
24 389
21 192
15-64
26 394
22 651
1. Which age group has contributed most to the observed reduction in mortality:
(a) in absolute terms?
(b) proportionally?
Under what circumstances is (a) or (b) the appropriate measure of change?
Table 3.2 is taken from the (UK) Hospital Inpatient Enquiry and gives an estimate
of the number of men admitted to hospital with CHD.
Case-fatality ratio (CFR) refers to the proportion of cases who die within a
specified time.
Table 3.2 Admissions and case-fatality ratio for CHD, England and Wales
1963
Age group
Number
CFR
Number
CFR
15-44
4 100
8%
6700
5%
45-64
30 100
19%
46 450
11%
15-64
34 200
1976
18%
53 150
10%
Case-fatality ratio
2. What conclusions can you draw by comparing Tables 3.1 and 3.2
3. In 1963 intensive coronary care facilities were rare but had become quite
common by 1976.
Are you prepared to accept this as the explanation of the changes between 1963
and 1976?
Could there be another reason and if so, which is more likely?
