CRUDE

&
STANDARD
MORTALITY RATE

Aiswarya S.
11195
Div. Of Agricultural
Extension
 Mortality ???
Mortality is the study of the causes,
consequences and measurement of processes
affecting death to members of the population

• Mortality rate/ death rate: Mortality rates

measure the frequency of occurrence of
death in a defined population during a
specified interval
 a) Crude Mortality Rate???
Number of deaths in a defined population during
a specified period- usually a year-divided by the
midyear population

Crude mortality rate =( number of deaths in one

year /midyear population) * 1000
 Standardization of
Rates:
 Town A: high  Town B: affluent
unemployment rural community,
rates, poverty popular retirement
area
crude death rate –
The all-cause crude
11.1 per 1,000/year
death rate – 14.2
in 2013
per 1,000/year in
2013
This suggests that mortality is higher in Town B
although this is not what we would expect
given socioeconomic characteristics of the two
towns
 Standardization of
Rates:
45 Age distribution for two
40 populations
35

30

25 Town
population

20 A
X 1,000

15 Town
10
B
5

0
0-4 5- 15- 25- 35- 45- 55- 65- 75- 85
14 24 34 44 54 64 74 84 and
ag over
e
 Standardization of
Town A hasRates
a younger population, therefore it has a
lower death rate.
How to compare the two towns, independently
of the effects of this difference in age distribution?

We need to have a summary measure of mortality

for all age groups to avoid many tables of rates for
each age group.

Such summary measure that takes account of the

differences in age distribution of the two areas could
be derived by a technique called standardization.
 Standardization of
Rates
1. The indirect method provides standardized
mortality ratio (SMR) and indirectly standardized
rates
2. The direct method provides directly
standardized rates
3. For indirect method we need to select standard
population, e.g. country population, or one of the
‘standard populations’ (not real) created to
represent population structure: World standard
population, European standard population, etc.
 Indirect
– First, weStandardization
will calculate the SMR for Town A
1. We need to know total number of deaths
(‘observed’) in Town A in 2013
2. We need to know the population in Town A in each
age group in 2013
 Indirect
Standardization
Deaths
Population:
Country death
rate per
Deaths
Age group ‘observe ‘expected’:
Town A 1000/year
d’: Town A
(standard
Town
population)
A
0-4 12400
5-14 26900
15-24 42000
25-34 32900
35-44 31700
45-54 27200
55-64 21600
65-74 18400
75-84 11300
85+ 3200
Total 2520 227600
 Indirect
1.
Standardization
We need to know ‘observed’ deaths in Town A
2. We need to know the population in Town A in each
age group
3. We choose age-specific deaths rates for a
‘standard’ population; in this case hypothetical
country population
 Indirect
Standardization
Deaths
Populatio
Country death rate
Deaths
‘expected’:
Age group ‘observed' per 1000/year
n: Town A
Town A (standard
Town A
population)
0-4 12400 1.50
5-14 26900 0.03
15-24 42000 0.32
25-34 32900 0.64
35-44 31700 2.34
45-54 27200 4.02
55-64 21600 6.69
65-74 18400 14.32
75-84 11300 78.30
85+ 3200 180.20
Total 2520 227600
 Indirect
1.
Standardization
We need to know ‘observed’ deaths in Town A
2. We need to know the population in Town A in each
age group
3. We choose age-specific deaths rates for a
‘standard’ population
4. We calculate the numbers of deaths that would
have occurred in Town A – expected deaths, in
each age group, if the ‘standard’ population death
rates had applied.
 Indirect
• Standardization
For that, we need to multiply the country rate
(column 4) by the Town A population (column 3)
in the same age group
For example, for the 0-4 age group:
𝟏 .𝟓 𝒙 𝟏 𝟐 𝟒 𝟎 𝟎
=
𝟏 𝟎 𝟎 𝟎
• 18.6
Finally, add up all the age-specific expected
deaths to obtain
total number of expected deaths
 Indirect
Standardization
Deaths Country death rate per
Deaths
Populatio ‘expected’:
Age group ‘observed’: 1000/year
n: Town Town A
Town A (standard population)
A
0-4 12400 1.50 18.60
5-14 26900 0.03 0.81
15-24 42000 0.32 13.44
25-34 32900 0.64 21.06
35-44 31700 2.34 74.18
45-54 27200 4.02 109.34
55-64 21600 6.69 144.50
65-74 18400 14.32 263.49
75-84 11300 78.30 884.79
85+ 3200 180.20 576.64
Total 2520 227600 2106.85
 Indirect
1. We need toStandardization
know ‘observed’ deaths in Town A
2. We need to know the population in Town A in each
age group
3. We choose age-specific deaths rates for a
‘standard’ population
4. We calculate the numbers of expected deaths in
town A in
each age group.
5. We can calculate the SMR now
 Indirect
Standardization
𝑻𝒐𝒕𝒂𝒍 𝒏 𝒖 𝒎 𝒃 𝒆 𝒓 𝒐 𝒇 𝒐 𝒃 𝒔 𝒆 𝒓 𝒗 𝒆 𝒅 𝒅 𝒆 𝒂 𝒕 𝒉 𝒔
SMR = 𝑻𝒐𝒕𝒂𝒍 𝒏 𝒖 𝒎 𝒃 𝒆 𝒓 𝒐 𝒇 𝒆𝒙𝒑𝒆𝒄𝒕𝒆𝒅 𝒅 𝒆 𝒂 𝒕 𝒉 𝒔 𝒙 𝟏 𝟎 𝟎

𝟐𝟓
SMR = 𝟐𝟐𝟏 𝟎𝟎 𝟔 . 𝟖 𝟓
𝒙 𝟏 𝟎 𝟎 = 𝟏𝟏𝟗. 𝟔
~ 𝟏𝟐𝟎

An SMR 120 means that, independently of the

influence of the age distribution in Town A, the overall
mortality in Town A is 20 per cent higher than country
average (our ‘standard’ population).
 Indirect
Standardization
– Interpretation of SMR
Independently of the influence of the age distribution,
an SMR
1. of 100% means no difference between the
overall mortality in the population of interest
and in the standard population.
2. >100% means that the overall mortality in the
population of interest is higher than in the standard
population.
3. < 100% means that the overall mortality in the
population of interest is lower than in the
standard population.
 Indirect Standardization
Now, we will calculate the SMR for Town B
Deaths
Deaths Country death rate
Populatio ‘expecte
Age group ‘observe per 1000/year
n: Town d’: Town
d’: (standard population)
B B
Town
B
0-4 5200 1.50 7.80
5-14 15100 0.03 0.45
15-24 11300 0.32 3.62
25-34 11100 0.64 7.10
35-44 16600 2.34 38.84
45-54 15400 4.02 61.91
55-64 14900 6.69 99.68
65-74 12700 14.32 181.86
75-84 8800 78.30 689.04
85+ 3100 180.20 558.62
Total 1626 114200 1648.93
 Indirect
Standardization
– We will calculate the SMR for
Town B
𝑻𝒐𝒕𝒂𝒍 𝒏 𝒖 𝒎 𝒃 𝒆 𝒓 𝒐 𝒇 𝒐 𝒃 𝒔 𝒆 𝒓 𝒗 𝒆 𝒅 𝒅 𝒆 𝒂 𝒕 𝒉 𝒔
SMR = 𝑻𝒐𝒕𝒂𝒍 𝒏 𝒖 𝒎 𝒃 𝒆 𝒓 𝒐 𝒇 𝒆𝒙𝒑𝒆𝒄𝒕𝒆𝒅 𝒅 𝒆 𝒂 𝒕 𝒉 𝒔 𝒙 𝟏 𝟎 𝟎

SMR=1626/1648.93 X 100 =98.6 ~99

An SMR 99 means that, independently of the influence

of the age distribution in Town B, the overall mortality
in Town B does not differ significantly (very close to
100) from that for the ‘standard’ population.
 Indirect
Standardization
– Comparison of SMRs
We cannot compare SMRs between two populations,
e.g. Town A and Town B - only to the standard
population – because the age-specific rate have
been applied to two different populations

What we can state, is that mortality in Town A is 20

per cent higher than the country average. For Town
B, mortality does not differ significantly from the
country level (very close to 100).
 Direct
Standardization
Direct standardization allows direct comparison
between two populations
 Direct
Standardization
– We will use population of Town A as the standard
and standardize population of Town B against it
– We will first look at crude death rate for people aged 65
and over
Town A (standard) Town B
Age Age
No. of Deaths No. of Deaths
specific specific
population observed populatio observe
rate/1000 rate/1000
n d
per year per year
65-74 18400 65-74 12700 45
75-84 11300 75-84 880 93
85+ 320 85+ 310 220
30020 297 9.89 13890 358 25.77
 Direct
Standardization
– Now, we will calculate age-specific rates for Town
B

Town A (standard) Town B

Age Age
No. of Deaths No. of Deaths
specific specific
population observed populatio observe
rate/1000 rate/1000
n d
per year per year
65-74 18400 65-74 12700 45 3.54
75-84 11300 75-84 880 93 105.68
85+ 320 85+ 310 220 709.68
30020 297 9.89 13890 358 25.77
 Direct
Standardization
– Standardize the Town B rate to the Town A:
1. Apply age-specific rates of Town B to the age-specific
groups of Town A to calculate the expected numbers
in each group

Age-specific rate for Town A (standard) Expected deaths for

Town B population Town B

65-74 3.54 18400 65.20

75-84 105.68 11300 1194.20
85+ 709.68 320 227.10
30020
 Direct
– StandardizeStandardization
the Town B rate to the Town A:
2. Add up the expected deaths to obtain the total
3. Divide the total expected cases by the total Town A (standard
) population to obtain the age-standardized death rate (x
1,000)

Age-adjusted rate Town A Expected deaths

for Town B (standard) for Town B
population
65-74 3.54 18400 65.20
75-84 105.68 11300 1194.20
85+ 709.68 320 227.10
49.52 30020 1486.50
 Direct
Standardization
– Interpretation
• Before standardization:
– Crude death rate in Town A for people aged 65 and
over was 9.89 per 1000 per year
– Crude death rate in Town B for people aged 65 and
over was 25.87 per 1000 per year (2.5 times
higher than in Town A)
• After standardization of the population of Town B crude
death rate to the population of Town A:
– Age-adjusted death rate in Town B for people
aged 65 and over was 49.52 per 1000 per year (5 times
higher than in Town A)
 SUMMAR
Y
Standardization is applicable for factors
other than age (socio-economic status, race,
area of residence)
Any rates can be standardized, e.g. incidence
Standardization is required to adjust rates for
influence of factors, e.g. age, which could
have impact on the comparison of those
rates
 SUMMAR
Y indirect and
 There are two methods:
direct standardization
 Indirect standardization applies age-specific
rates from the standard population to the
numbers of people in each age group in the
index population
 Direct standardization applies age-specific
rates from the index population to the
numbers of people in each age group of a
standard population
 SUMMAR
Y (calculation of SMR)
 Indirect standardization
does not require age-specific rates in the
index population
 Indirect standardization does not allow
direct comparison between SMRs
 Indirect standardization is more precise