EPID 5400 – Epidemiology

Fall 2017

EXERCISE 3: Measures of Disease Occurrence: Mortality

NAME: Robert Watterson

INSTRUCTIONS:

Answer the following three questions. Make sure to show your calculations. When
completed, please submit Exercise 3 to the Dropbox folder located on D2L. The deadline
for receipt of the completed assignment is Tuesday, October 3, by 11:30 PM.

1. State the main difference between an age-specific rate and an age-adjusted rate.

Age-specific mortality rate is a mortality rate limited to a particular group. The

numerator is the number of deaths in that age group and the denominator is the
number of persons in that age group in the population. Age-adjusted mortality rates
can be used to compare the rates in one area with the rates in another area, or to
compare rates over time. Mortality rates increase with age so a higher mortality rate
among one population than among another might reflect the fact that the first
population is older than the second.

2. Consider the following stroke mortality data from two hypothetical countries, including
a developing and a developed country.

Age group (years) Size of the population in Death rate from stroke
age group

Hypothetical developing 1,000,000

country – All ages

0-20 300,000 2/100,000 person-years

21-50 400,000 20/100,000 person-years

51 and above 300,000 40/100,000 person-years

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Hypothetical developed 1,000,000
country - All ages

0-20 200,000 2/100,000 person-years

21-50 300,000 20/100,000 person-years

51 and above 500,000 40/100,000 person-years

a) Using this table, calculate the overall crude death rates from stroke in the
hypothetical developing and developed countries.

CDR= total death/number of population* constant

CDR for developing country
CDR=(0-20) = (2/300000)* 100,000= 0.67
CDR=(21-50 = (20/400000)* 100000= 5
CDR (51 and above) = (40/300000)*100000 = 13.33
Overall CDR= summation (number of deaths * population/total population )*100000
=(2*300000 + 20*400000 + 40*300000/1,000,000)*100000
=0.000206*100000
=20.6 per 100000

CDR= total death/number of population* constant

CDR for developed country
CDR=(0-20) = (2/200000)* 100,000= 1
CDR=(21-50 = (20/300000)* 100000= 6.67
CDR (51 and above) = (40/500000)*100000 = 8
Overall CDR= summation (number of deaths * population/total population )*100000
=(2*200000 + 20*300000 + 40*500000/1,000,000)*100000
=0.000264*100000
=26.4 per 100000
b) Based on these data, do you think that it is better to compare the stroke death
rates in the two countries using the overall crude rate or the age-standardized rate
for each country? Explain (no calculations needed).

Crude death rate is the mortality rate from all causes of death for a population but
it is not specific for age groups from one area to another. The age-standardized
rate helps us see that moving to a developed country does not mean we will be in an

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 area with less deaths from strokes. It also helps to eliminate distortion caused by
different underlying age distributions in different populations, statistical
techniques are used to adjust or standardize the rates among the populations to be
compared. The techniques take a weighted average of the age-specific mortality
rates, and eliminate the effect of different age distributions among the different
populations. Comparing the stroke death rates in the two countries using the age-
standardized rate is overall better.

Question 3 is based on the following information:

Population A Population B
Age Group (yr) Size No of deaths Size No of deaths
All ages 600,000 650 800,000 1,250
20-39 300,000 20 350,000 55
40-59 200,000 295 250,000 565
60 and over 100,000 335 200,000 630

3. Calculate the age-adjusted death rate for each population and compare the age-
adjusted death rates – (hint: add the two populations to create a standard population).

Population A: Age-Adjusted Death Rate= (650/600,000) X 100000 = 108.33 per 100,0000

20-39- 20/300000= 6.66

40-59- 295/200000= 147.5

60 and over- 335/100000= 335

Population B: Age-Adjusted Death Rate = (1,250/800,000) x 100000 = 156.25 per 100,000

20-39- 55/350000= 15.71

40-59- 565/250000= 226

60 and over- 630/200000= 315

Standard Population= # of total population from A & B

Hospita Hospita Pooled Wt. Rate A Rate B Age Age

lA l Populatio of adjuste Adjusted
n age dA B
B group

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 20-39 20-39 650 .3431 .3431*6.66 . 2.29 10.33
(20) (55) (A) 6579*15.71

40-59 40-59 1250 . . .6579*226 50.61 148.69

6579 3431*147.5
(295) (565)
(B)

60 and 60 and .3431*335 .6579* 315 114.94 207.24

over over

(335) (630)

650 1250 1900 167.84 365.9

=650 + 1250= 1,900 Total Population from A & B

Weight of A=34.31%

Weight of B= 65.79%

Hospital B has a higher CMR and an older population than hospital A