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Related Experiment Videos

Why do we continue to use standardized mortality ratios for small area comparisons?

S A Julious1, J Nicholl, S George

  • 1SmithKline Beecham Pharmaceuticals, Harlow.

Journal of Public Health Medicine
|April 24, 2001
PubMed
Summary

Standardized mortality ratios (SMRs) are commonly used but inappropriate for comparing mortality across geographical areas due to differing denominators. A comparative mortality figure offers a more reliable alternative for public health analysis.

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Area of Science:

  • Public Health
  • Epidemiology
  • Biostatistics

Background:

  • Geographical mortality comparisons are essential for public health.
  • Indirect standardization, yielding standardized mortality ratios (SMRs), is the prevalent method.
  • Concerns exist regarding the interpretability and data requirements of direct standardization.

Purpose of the Study:

  • To evaluate the appropriateness of indirect standardization for comparing mortality across geographical areas.
  • To introduce and validate an alternative index, the comparative mortality figure.
  • To demonstrate the bias inherent in SMR calculations.

Main Methods:

  • Comparative analysis of indirect standardization (SMR) and direct standardization methods.
  • Calculation of a comparative mortality figure from directly standardized rates.

Related Experiment Videos

  • Empirical testing using mortality data from Sheffield electoral wards (1980-1987).

    • Main Results:

    • Standardized mortality ratios (SMRs) are inappropriate for comparing different geographical areas due to varying denominators.
    • The bias in SMR construction outweighs the advantage of a smaller standard error.
    • A comparative mortality figure can be reliably calculated from directly standardized rates in most scenarios.

    Conclusions:

    • Indirect standardization (SMR) is generally inappropriate for comparing mortality across geographical areas.
    • Direct standardization, with a comparative mortality figure, offers a more accurate approach.
    • SMRs should be reserved for situations with severely limited subgroup data.