Case fatality rate
In epidemiology, a case fatality risk (CFR) — or case fatality rate, case fatality ratio or just fatality rate — is the proportion of deaths within a designated population of "cases" (people with a medical condition), over the course of the disease. A CFR is conventionally expressed as a percentage and represents a measure of risk. CFRs are most often used for diseases with discrete, limited time courses, such as outbreaks of acute infections.
For example: Assume 9 deaths among 100 people in a community all diagnosed with the same disease. This means that among the 100 people formally diagnosed with the disease, 9 died and 91 recovered. The CFR, therefore, would be 9%. If some of the cases have not yet resolved (either died or recovered) at the time of analysis, this could lead to bias in estimating the CFR.
A mortality rate — often confused with a CFR — is a measure of the number of deaths (in general, or due to a specific cause) in a population, scaled to the size of that population, per unit of time. (For example, a rate of 50 deaths per 10,000 population in a year resulting from diabetes. The mortality rate, therefore, would be 50:10,000 or 5:1,000.)
Technically, CFRs are actually risks (or "incidence proportions") and take values between 0 and 1. They are not rates, incidence rates, or ratios (none of which are limited to the range 0-1). If one wants to be very precise, the term "case fatality rate" is incorrect, because the time from disease onset to death is not taken into account. Nevertheless, the term case fatality rate (and the abbreviation "CFR") is often used in the scientific literature.
A half dozen examples will suggest the range of possible CFRs for diseases in the real world:
- The CFR for the Spanish (1918) flu was >2.5%, about 0.1% for the Asian (1956-58) and Hong Kong (1968-69) flus, and <0.1% for other influenza pandemics.
- Legionnaires' Disease has a CFR of about 15%.
- The CFR for yellow fever, even with good treatment, ranges from 20 to 50%.
- Bubonic plague, left untreated, will have a CFR of as much as 60%.
- Zaïre Ebola Virus is among the deadliest viruses with a CFR of roughly 90%.
- Rabies virus, if infecting an unvaccinated individual who does not seek treatment, is also extremely deadly, with a CFR of virtually 100%.
- Taubenberger, Jeffery K.; David M. Morens† (January 2006). "1918 influenza: the mother of all pandemics". Emerging Infectious Diseases (Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention) 12 (1). ISSN 1080-6059. Retrieved 2009-04-17.
- Li, F C K; B C K Choi, T Sly, A W P Pak (June 2008). "Finding the real case-fatality rate of H5N1 avian influenza". Journal of Epidemiology and Community Health 62 (6): 555–559. doi:10.1136/jech.2007.064030. ISSN 0143-005X. PMID 18477756. Retrieved 2009-04-29.
- King, John W (April 2, 2008). "Ebola Virus". eMedicine. WebMd. Retrieved 2008-10-06.
- Definitions of case fatality for coronary events in the WHO MONICA Project
- Swine flu: what do CFR, virulence and mortality rate mean?