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An alternative to the proportionate mortality ratio

O S Miettinen, J D Wang

    American Journal of Epidemiology
    |July 1, 1981
    PubMed
    Summary

    The mortality odds ratio (MOR) offers a superior alternative to the proportionate mortality ratio (PMR) for comparing exposed and nonexposed groups. MOR provides a more accurate measure of mortality risk, free from the arbitrary limitations of PMR.

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    Area of Science:

    • Epidemiology
    • Biostatistics
    • Public Health Research

    Background:

    • The proportionate mortality ratio (PMR) is commonly used to compare mortality between exposed and nonexposed populations.
    • However, PMR has limitations and arbitrary elements that can affect its accuracy and interpretation.
    • Existing methods for comparing mortality risks may not fully account for the complexities of cause-specific mortality data.

    Purpose of the Study:

    • To introduce and evaluate the mortality odds ratio (MOR) as a superior alternative to the PMR.
    • To demonstrate that MOR can be computed under the same conditions that justify PMR use.
    • To highlight the advantages of MOR in providing a more robust and interpretable measure of mortality risk.

    Main Methods:

    • The study proposes the calculation of the mortality odds ratio (MOR) using existing data suitable for PMR analysis.
    • MOR is defined as the ratio of mortality odds between a cause of interest and other causes.
    • The paper contrasts the interpretation and properties of MOR with those of PMR.

    Main Results:

    • The mortality odds ratio (MOR) is shown to be equivalent to the exposure odds ratio under specific assumptions.
    • MOR can be interpreted as an observed-to-expected ratio or standardized mortality ratio, assuming auxiliary causes are unrelated to exposure.
    • MOR is independent of the arbitrary selection of auxiliary causes, unlike PMR.

    Conclusions:

    • The mortality odds ratio (MOR) is a more statistically sound and interpretable measure than the proportionate mortality ratio (PMR).
    • MOR overcomes the arbitrary nature of PMR by not depending on the size of the auxiliary cause domain.
    • Viewing PMR studies as case-referent studies, as suggested by the MOR framework, has implications for selecting reference series.

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