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# lecture 7 - Lecture 7 Lecture Goals o o Identify...

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1 Lecture 7 Indirect Standardization Lecture Goals o Identify information needed for indirect standardization o Discuss limitations of indirect standardization o Calculate and interpret the SMR Standardization o Creation of a summary measures of morbidity and mortality information o Used as a means to compare health outcomes of populations o Two types of standardization: o Direct o Indirect Direct Standardization What information is needed? o Stratum-specific rates for the study population(s) o Stratum-specific structure of standard population Result: Adjusted rate Indirect Standardization o Use when stratum-specific rates of the study population are not known o Use specific rates from a standard population to obtain the “expected” number of deaths in the study population In other words… o Use a standard rate instead of a standard population structure to adjust the study population. The source of the standard is usually US Vital Statistics data. Indirect Standardization What information is needed? o Structure of the study population o Total # outcomes in the study population o Stratum-specific rates for the standard population Result: Standard Mortality Ratio (SMR)

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SMR Standardized morbidity (mortality) ratio SMR = Observed *100 Expected Expressed as a percentage Interpretation of an SMR SMR of 100% means that there is no difference between the number of outcomes in the study population and what you would expect to see if the study population was like the standard population Interpretation of an SMR o SMR > 100% means that the study population has a higher rate of death/illness than the comparable standard population Interpretation of an SMR SMR < 100% means that the number of outcomes in the study population is less than what you would expect to see in the standard population o In other words, the study population is generally healthier than the standard population Healthy Worker Effect o People who work tend to be healthier than people who don’t work o We expect SMR < 100% in working populations Interpreting an SMR o Example: SMR = 200% o The study population has a mortality rate 2x that which you would expect in the general population
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lecture 7 - Lecture 7 Lecture Goals o o Identify...

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