INDIRECT AGE ADJUSTMENT

LA ROSA, GABRIELLE ANNE

MED- 2A

INDIRECT AGE ADJUSTMENT

used when numbers of deaths for each age-specific stratum
are not available

used to study mortality in an occupationally exposed

population
Do people who work in a certain industry, such as mining or

construction, have a higher mortality than people of the same age in

the general population?
Is an additional risk associated with that occupation?

EXAMPLE OF INDIRECT AGE ADJUSTMENT

In a population of 534,533 white male miners, 436 died from
tuberculosis (TBC) in 1950.
How many deaths would we expect in these white miners if they had

the same mortality experience as white men in the same age group in
the general population?

INDIRECT AGE ADJUSTMENT

1. Choose a reference or standard population.
2. Calculate the observed number of deaths in the population (s) of
interest.

3. Multiply the number of people in each age group of the population(s) of

interest by the age-specific mortality rate in the comparable age group
of the reference population.

4. Add the total number of expected deaths for the population of interest.
5. Divide the total number of observed deaths of the population(s) of
interest by the expected deaths (SMR).

INTERPRETATION OF STANDARDIZED
MORTALITY RATIO (SMR)
SMR=100 or 1
observed number of deaths is the same as the expected number of deaths

SMR>100
observed number of deaths exceeds the expected number

SMR<100
observed number of deaths is less than the expected number

SMR = 2.41 or 241% White miners are 2.41 times more likely to die than
the U.S general population because of TBC

THE COHORT EFFECT

COHORT EFFECT
COHORT

A group of people who share the same experience

Cohort effect(sometimes referred to as generation

effects)
is generally conceptualized as variation in the risk of a health

outcome according to the year of birth, often coinciding with shifts in

the population exposure to risk factors over time
a period effect that is differentially experienced through age-specific
exposure or susceptibility to that event or cause

COHORT EFFECT
When examining changes in mortality over time, one should
always ask whether any apparent changes that are observed
could be the result of a cohort effect.

EXAMPLES OF COHORT
High rate of leukemia and radiation effects in people who
were exposed to the atomic bombs in Hiroshima and
Nagasaki in 1945 those afflicted are now older, manifesting
higher rates of radiation-related disease than persons born
later or earlier

Thalidomide babies in Europe in the early 1960s- there

should have been a relatively high rate of thalidomideaffected adults among those aged 20 in 1980 compared with
others younger or older

INTERPRETING OBSERVED
CHANGES IN MORTALITY

CHANGES IN MORTALITY
Increase
Decrease
Artifactual

result from errors of human origin

Real

Changes in mortality over time that reflect a true change in the

incidence of disease

ARTIFACTUAL CHANGES
Before 1949, all death certificates that mentioned diabetes as
either the immediate cause of death, underlying cause of
death, or other significant condition contributing to death were
coded as death due to diabetes.

After 1949, this practice changed so that only death

certificates listing diabetes as the underlying cause of death
were coded as death due to diabetes. This caused an artifactual
decline in diabetes.

ARTIFACTUAL CHANGES
AIDS surveillance case definitions were changed in 1987 and
1993
1987- include additional illnesses and diagnostic criteria
1993- include HIV-infected people with CD4+ lymphocyte counts of

less than 200 cells/microliter but who do not necessarily have an AIDS
indicator disease

This resulted in artifactual large influxes with apparent spikes

in reporting rates.

REAL CHANGES
May result when the genetic composition of a population
changes or when the environmental milieu changes

May also result when age distribution of a population shifts or

when the case fatality rate for a given disease changes

THANK