Topic 5: Rates and Standardization Modified from the notes of A. Kuk P&G pp. 66—95.

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Presentation transcript:

Topic 5: Rates and Standardization Modified from the notes of A. Kuk P&G pp. 66—95

Demographic Data Size of population and its composition by gender, race, age etc

Vital Statistics Vita --- life Tell a story of life with numbers so that vital services can be provided --- food, lodgings, health, water, etc

Births Natural Increases Marriages Divorces Diseases Deaths Complex and massive story because we often need to deal with whole countries.

Describe health status of a population Spot trend Make projections Planning Set policy Compare groups Want to be able to:

Provisional statistics USA 12 months ending in April (millions) Live births Deaths Increase Marriages Divorces Infant deaths * 33,70032,40031,100

Death rate increasing?

“Crude” rate, single number, summary allows for standardization makes comparisons more meaningful

State of Massachusetts in 1992Number Population 6,060,943 Live births87,202 Deaths: Total53,804 Under 1 year569 Crude birth rate per 1000 persons per year Crude death rate per 1000 persons per year Infant mortality rate per 1000 live births per yr

Rate a Per 1, Live births Fertility rate b Deaths Increase Marriages Divorces Infant deaths c a=pop., b=women 15-44, c=live births

Crude rate answer all questions? StatusPop n Impair’sRate /100,000 Employed98, Unemployed7, Not in labor force 56, Total163,

Therefore it is better to be “employed” than “not in the labor force” as far as hearing is concerned Confounders?

Age distribution EmployedNot in labor force AgePop n PercentPopnPercent , , , , , , Total98, ,

Age Composition of Population Age Pop n ImpairsRate / , , , Total163,

Age Specific Impairment Rates Currently employed Age Pop n ImpairsRate / , , , Total98,

Age Specific Impairment Rates Not in labor force Age Pop n ImpairsRate / , , , Total56,

Age Specific Impairment Rates Age Employed /1000 Not in labor force / Total

Can we capture what is happening with a single number? Problem caused by different age profiles. Standardize Direct Indirect (skipped)

Direct method of getting rid of age confounder is to standardize the age distribution and apply the appropriate age specific rates. Select a standard age distribution. Logical choice is the total population

For Currently Employed Age Pop n Rate /1000 Expected Impairs , , , Total163,

For those not in labor force Age Pop n Rate /1000 Expected Impairs , , , Total163,

Crude rate Not in labor force > Employed Age adjusted Not in labor force < Employed Remember 1.This is a construct. 2.Choice of standard distribution is arbitrary.

Age-Adjusted Cancer Death Rates, Males by Site, US, Adjusted using the U.S. population in 1940 as the standard distribution

Age-Adjusted Cancer Death Rates, Females by Site, US,

When to use adjustment: Check that the age-specific rates follow more or less the same trend for all the populations to be compared. Is there a confounder? Age? Sex?

go so no