Chapter 4

Mortality and Other

Measures of Disease Impact
Comparing mortality in different populations
• Compare 2 or more populations or one population in different time
periods
• Populations may differ with regard to many characteristics
• Age – single most important predictor of mortality
 Adjusted or Standardized rates
• Rates are only comparable only if the population are comparable
• It is difficult to use series of age-specific death rates
• Age adjustment or Age standardization
• Remove confounding effect of different age structures
• Adjustment can be made for age, sex, race, parity etc..
• 2 methods
1. Direct standardization
2. Indirect standardization
 Direct standardization
• Select a standard population
• One for which the numbers in each age and sex are known
• May also be created by combining 2 populations
• Calculation of age specific death rates for study population
• Application of these rates to standard population to obtain expected
deaths
• Standardized or Age adjusted death rate
Total no. of expected deaths x 1000
Standard population
• For direct method of standardization

Actual age specific rates in subgroups of the observed population

Number individuals in each subgroup

Indirect age standardization
 Standardized Mortality Ratio (SMR)
• Ratio of 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
• SMR= Observed deaths x 100
Expected deaths
• More stable rates of larger population is applied to a smaller study
group
• Gives a measure of excess risk of mortality due to the occupation
• Value >100 – occupation carry a greater mortality risk than the whole
population
• <100- less risk
• SMR permits adjustment for age where age specific rates are not
available
• Need to know
• Number of persons in each age group in the study population
• Age specific rates of the standard population