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Standardization

The document discusses the importance of age adjustment or age standardization for comparing death rates between populations with different age compositions. It outlines two methods of standardization: direct and indirect, explaining the processes involved in each. Additionally, it provides examples of calculating standardized death rates and the Standardized Mortality Ratio (SMR) to assess mortality risks in different occupational groups.
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0% found this document useful (0 votes)
7 views24 pages

Standardization

The document discusses the importance of age adjustment or age standardization for comparing death rates between populations with different age compositions. It outlines two methods of standardization: direct and indirect, explaining the processes involved in each. Additionally, it provides examples of calculating standardized death rates and the Standardized Mortality Ratio (SMR) to assess mortality risks in different occupational groups.
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Standardization

Dr Praveer Kumar
Associate Professor
• If we want to compare the death rates of two
populations with different age-composition,
the crude death rate is not the right yardstick.

• This is because, rates are only comparable if


the populations upon which they are based
are comparable.
• It is difficult to use a series of age specific
death rates for comparison.
• The answer is "age adjustment" or "age
standardization", which removes the
confounding effect of different age structures
and yields a single standardized or adjusted
rate, by which the mortality experience can be
compared directly.
• Standardization is carried out by one of two
methods -
1. Direct standardization.
2. Indirect standardization
• Both the methods begin by choosing a
"standard population", not the age-structures
of the populations.
DIRECT STANDARDIZATION

• A standard population is defined as one for


which the numbers in each age and sex group
are known.
• The standard population may also be
"created" by combining 2 populations; this is
shown in the second example.
1. The next step is to apply to the standard population,
the age-specific rates of the population whose crude
death rate is to be adjusted or standardized.
2. As a result, for each age group, an "expected"
number of deaths (or events) in the standard
population is obtained;
3. These are added together for all the age groups,
to give the total expected deaths.
4. The final operation is to divide the "expected" total
number of deaths by the total of the standard
population, which yields the standardized or age-
adjusted rate.
Example 1

Q. Calculate Standardized death rate of city X.


Ans - (a) The computation of age-specific death
rates per 1000 population for city X

(b) Application of these rates to a standard population


to obtain the "expected deaths" and the standardized
or age-adjusted death rate
• Standardizing for age distribution has reduced
the crude death rate from 8.3 to 6.56 .
Q1. Compare the death rate of
Community A & Community B
Community A Community B

Age (year) Population Deaths Population Deaths

0 3,000 25 7,000 100

1–4 5,000 13 30,000 35

5 – 14 9,000 16 45,000 35

15-19 16,000 112 27,000 85

20-24 10,000 155 18,000 160

25 -34 17,000 180 15000 200

35 - 44 23,000 2,600 25,000 1,350

45 - 54 30,000 2921 32,000 1,765


55 - 64 32,000 3000 40,000 3400
Q1. Compare the death rate of
Community A & Community B
Community A Community B

Age (year) Population Deaths Population Deaths

0 2,000 5 3,000 10

1–4 5,000 3 7,000 5

5 – 14 8,000 6 7,000 3

15-19 16,000 12 17,000 35

20-24 15,000 55 18,000 60

25 -34 20000 100 20000 100

35 - 44 23,000 260 25,000 150

45 - 54 30,000 221 32,000 165


55 - 64 32,000 300 40,000 340
Example 2

Q. In a study of lung cancer and smoking,


42 per cent of cases and 18 per cent of controls
were heavy smokers. Is it true difference due to
smoking habit?
CASES CONTROLS
Number Heavy % Number Heavy %
Smoker Smoker

500 210 42 500 90 18


• Age adjustments were carried out –
(a) First, by combining the number of subjects in both
the age groups (500+500=1,000) to create a standard
population
(b) Applying the observed age-specific proportions of
heavy smokers (i.e., 50% and 10% in both cases and
controls) to the same standard population.
The results (or "expected" values) show that the age
adjusted proportions of heavy smokers are identical
(30%) for cases and controls.
The previously observed difference is explained
entirely by the difference in age composition.
INDIRECT AGE STANDARDIZATION

1. Standardized Mortality Ratio (SMR)


The simplest and most useful form of indirect
standardization is the Standardized Mortality
Ratio (SMR).
• Standard mortality rate is a ratio (usually expressed
as a percentage) of the total number of deaths that
occur in the study group to the number of deaths
that would have been expected to occur if that
study group had experienced the death rates of a
standard population (or other reference
population).
• If the ratio had value greater than 100, then
the occupation would appear to carry a
greater mortality risk than that of the whole
population. If the ratio had value less than
100, then the occupation risks of mortality
would seem to be proportionately less than
that for the whole population.
• Mortality experience of coal workers was 129 per
cent, which meant that their mortality was 29
percent more than that experienced by the national
population.
Values over 100 percent represent an unfavorable
mortality experience and those below 100 per cent
relatively favorable mortality experience.
Q. Calculate Standardized Mortality Ratio for asbestos
workers and draw inference ?
AGE NATIONAL COAL WORKERS OBSERVED EXPECTED
POPULATION POPULATION DEATHS DEATHS
DEATH RATES
PER THOUSAND

25 – 34 3.0 500 --------------

35 – 44 5.0 600 --------------

45 – 54 8.0 800 -------------

55 - 64 25.0 900 --------------

Observed 334
Deaths
Q. Calculate Standardized Mortality Ratio for cigarette
Industry workers and draw inference ?
AGE NATIONAL COAL WORKERS OBSERVED EXPECTED
POPULATION POPULATION DEATHS DEATHS
DEATH RATES
PER THOUSAND

25 – 34 3.0 200 --------------

35 – 44 5.0 300 --------------

45 – 54 8.0 900 -------------

55 - 64 25.0 1500 --------------

Observed 670
Deaths
Thank You

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