BALRAJ

2K4-Batch
INTRODUCTION

Each year, death information is analysed and resulting

tabulations made available
by each Government

This mortality data provide the starting point for many

epidemiological studies
INTERNATIONAL DEATH CERTIFICATE
Approx.
CAUSE OF DEATH interval b/n
I onset and
death
Disease or condition directly (a)Bronchopneumonia
leading to death. due to ……………
Antecedent causes ……

Morbid conditions, if any, giving rise (b)Strangulated Hernia

to above cause, stating the due to
underlying condition last. ……………
……
II
Other significant conditions
contributing to death, but not Diabetes
related to the disease or
condition causing it. ……………
……
DEATH CERTIFICATE USED IN INDIA
 LIMITATIONS OF MORTALITY DATA

1.INCOMPLETE REPORTING OF DEATHS

2.LACK OF ACCURACY

3.LACK OF UNIFORMITY

4.CHOOSING SINGLE
CAUSE OF DEATH

5.CHANGING

6.DISEASE WITH LOW FATALITY RATE

 USES OF MORTALITY DATA
1. FOR EXPLAINING TRENDS
IN OVERALL MORTALITY
LIKE ROAD TRAFFIC ACCIDENTS

2. FOR INDICATING
PRIORITIES FOR
HEALTH ACTION

3. FOR ALLOCATION
OF HEALTH RESOURCES

4. DESIGNIG INTERVENTION PROGRAMMES

 MORTALITY RATES
1. CRUDE DEATH RATE

2. SPECIFIC DEATH RATE

3. CASE FATALITY RATE

4. PROPORTIONAL MORTALITY RATE

5. SURVIVAL RATE

6. ADJUSTED (OR) STANDARDIZED RATES

 CRUDE DEATH RATE
CDR IS SIMPLEST MEASURE OF
MORTALITY

• CDR = NO OF DEATHS IN YEAR X 100

MID YEAR
POPULATION
CDR SUMMARIZES THE EFFECT
OF TWO FACTORS

1.POPULATION COMPOSITION

2.AGE SPECIFIC DEATH RATES

AGE SPECIC DEATH RATES PER
1000 POPULATIONS
Population Crude Death Age-specific death rates/1000 population
Rate 0-1 1-4 5-7 8-44 45-64 65+

A 15.2 13.5 0.6 0.4 1.5 10.7 59.7

B 9.9 22.6 1.0 0.5 3.6 18.8 61.1

ABOVE TABLE SHOWS CDR OF 2 POPULATIONS:A & B

CDR OF A - 15.2 PER 1000

CDR OF B - 9.9 PER 1000

1. POPULATION B APPEARS HEALTHIER THAN POPULATION A.

2. POPULATION B HAS HIGHER AGE SPECIFIC RATES.

3. HIGHER CDR IN A IS DUE TO ITS OLDER POPULATION.

4. THIS IS THE PREVAILING

SITUATION IN MOST DEVELOPING
COUNTRIES WITH:

a) LOW CDR
b) HIGH AGE SPECIFIC DEATH RATES
 DISADVANTAGE OF CDR

LACK OF COMPARABILITY FOR

COMMUNITIES WITH POPULATION THAT
DIFFER BY AGE,SEX & RACE
 2.SPECIFIC DEATH RATE
SPECIFIC DEATH RATE MAY BE

1. CAUSE (OR) DISEASE SPECIFIC

EX:- TB , ACCIDENT

2. RELATED TO SPECIFIC GROUPS

EX: AGE SPECIFIC or
SEX SPECIFIC
 2.SPECIFIC DEATH RATE
SDR TB = NO OF DEATHS FROM TB IN YEAR X 1000

MID YEAR POPULATION

SDR MALE = NO OF MALE DEATHS IN YEAR X 1000

MID YEAR POPULATION

WEAKLY DEATH RATE = DEATH IN THE WEEK X 54 X 1000

MID YEAR POPULATIN
 3.CASE FACILITY RATE(RATIO)
CFR = TOTAL NO.OF DEATHS DUE TO DISEASE X 1000
NO OF CASES DUE TO SAME DISEASE

EX: CFR DUE TO CHOLERA IN AP = 500 X 1000 = 100

5000
1.CFR REPRESENTS THE KILLING
POWER OF DISEASE

2.IT IS THE RATIO OF

DEATHS TO CASES
 CASE FATALITY RATE
• 3.CFR USED IN ACUTE INFECTOUS
DISEASES.

• EX: FOOD POISONING , CHOLERA,

• ITS USEFULNESS FOR CHRONIC

DISEASES IS LIMITED BECAUSE
PERIOD FROM ONSET TO DEATH IS
LONG & VARIABLE..
4.PROPORTIONAL MORTALITY
RATE
1.PMR EXPRESSES THE NO. OF DEATHS
DUE TO A PARTICULAR CAUSE PER
100 TOTAL DEATHS.
PROPORTIONAL MORTALITY
FROM SPECIFIC DISEASE
PMR = NO OF DEATHS FROM SPECIFIC DISEASE IN YEAR X 100

TOTAL DEATHS FROM ALL CAUSES IN THAT YEAR

EX : PMR DUE TO TRAIN ACCIDENTS IN A.P = 500 X 100 = 1

50,000
 PROPORTIONAL MORTALITY
UNDER AGE 5
PMR = NO OF DEATHS UNDER 5 YEARS OF AGE IN YEAR X 100
TOTAL NO OF DEATHS DURING THE SAME PERIOD

EX: 1000 X 100 =2

50000
PROPORTIONAL MORTALITY RATE
FOR AGED 50 YRS & ABOVE

PMR = NO OF DEATHS AGED 50 YEARS X100

TOTAL DEATHS OF ALL AGES IN YEAR
EX : 1500 X 100 = 3
50000
NOTE : PMR IS COMPUTED USEALLY FOR A
COMMUNICABLE DISEASES & FOR
SPECIFIC DISEASE OF MAJOR PUBLIC
HEALTH IMPORTANCE EX:CANCER,CAD
 5.SURVIVAL RATE
1.IT IS THE PROPORTION OF SURVIVAL
IN A GROUP OF PATIENTS, STUDIED &
FOLLOWED OVER A PERIOD.

2.IT IS THE METHOD OF DESCRIBING

PROGNOSIS OF THE DISEASE.
 5.SURVIVAL RATE

SR= TOTAL NO OF PTS ALIVE AFTER 5YRS X 100

TOTAL NO OF PTS TREATED

NOTE:SR RECEIVED SPECIAL

ATTENTION IN CANCER STUDIES.
 6.ADJUST(OR)STANDARDIZED
RATES:-

• STANDARDIZATION IS CARRIED OUT

BY ONE OF 2 METHODS

• 1. DIRECT STANDARDIZATION

• 2.INDIRECT STANDARDIZATION
 1. DIRECT STANDARDIZATION

• STANDARD POPULATION IS DEFINED

AS ONE FOR WHICH THE NUMBERS IN
EACH AGE & SEX GROUPS ARE
KNOWN

NATIONAL POPULATION IS USUALLY

TAKEN AS STANDARD POPULATION
 1. DIRECT STANDARDIZATION

• IST STEP : STANDARD POPULATION

IS SELECTED

• IT MEANS AGE COMPOSITION IS

KNOWN
 1. DIRECT STANDARDIZATION

• 2ND STEP: AGE SPECIFIC RATE IS APPLIED

ON STANDARD POPULATION WHOSE CDR
IS TO BE ADJUSTED (OR)STANDARDIZED

• --- AS A RESULT FOR EACH GROUP AN

EXPECTED NO OF DEATH IN THE
STANDARD POPULATION IS OBTANIED
THESE ARE ADDED FOR ALL AGE GROUP
TO GIVE TOTAL EXPECTED DEATHS
 1. DIRECT STANDARDIZATION

• 3RD STEP: DIVIDE THE EXPECTED

TOTAL NO OF DEATH BY TOTAL OF
STANDARD POPULATION , THIS YEILD
STANDARDIZED ADJUST RATE..
 1.Age-specific death rates for a city x
Age Mid-Year population Deaths in the Age-specific
per 1000 year death rates
0 4,000 60 15.0
1-4 4,500 20 4.4
5-14 4,000 12 3.0
15-19 5,000 15 3.0
20-24 4,000 16 4.0
25-34 8,000 25 3.1
35-44 9,000 48 5.3
45-54 8,000 100 12.5
55-64 7,000 150 21.4
53,500 446
 2.Standardized death rate for a city x
Age Standard Age-specific Expected
population Death rates deaths
per 1000
0 2,400 15.0 36
1-4 9,600 4.4 42.24
5-14 19,000 3.0 57
15-19 9,000 3.0 27
20-24 8,000 4.0 32
25-34 14,000 3.1 43.4
35-44 12,000 5.3 63.6
45-54 11,000 12.5 137.5
55-64 8,000 21.4 171.2
93,000 609.94
1. DIRECT STANDARDIZATION

FROM TABLE 1 & 2

CDR PER 1000 = 446 x 1000 = 8.3

53500
SDR PER 1000 = 609.94 X1000 = 6.56
93,000

STANDARIZING FOR AGE DISTRIBUTION

HAS REDUCED CDR FROM 8.3 TO 6.56:
2.INDIRECT STANDARDIZATION
1.STANDARIZED MORTALITY RATIO(SMR)

• THE SIMPLEST &MOST USEFUL

FORM OF INDIRECT
STANDARDIZATION IS SMR

• IN ENGLAND –SMR IS THE BASIS FOR

ALLOCATION OF GOVT. MONEY TO
HEALTH REGIONS
1.STANDARIZED MORTALITY RATIO
(SMR)

• SMR= OBSERVED DEATHS X 100

EXPECTED DEATHS

- IT GIVES A MEASURE OF EXCESS

RISK OF MORTALITY DUE TO THE
OCCUPATION
1.STANDARIZED MORTALITY RATIO
(SMR)

• IF RATIO >100,THE OCCUPATION

WOULD APPER TO CARRY GREATER
MORTALITY RISK THAN THAT OF
WHOLE POPULATION.

• IF <100,LESSER MORTALITY RISK

THAN THAT OF WHOLE POPULATION.
 SMR for coal workers
Age National population Coal workers Observed Expected
Death rates per population deaths Deaths
1000

25-34 3.0 300 * 0.9

35-44 5.0 400 * 2.0

45-54 8.0 200 * 1.6

55-64 25.0 100 * 2.5

1,000 9 7.0

SMR = 9 X 100 = 129

7
TABLE SHOWS THAT MORTALITY
WAS 29% MORE THAN THAT
EXPERIENCED BY NATOINAL
POPULATION.
 OTHER STANDARDIZATION
TECHNIQUES

• 1. ABSOLUTE AGE ADJUSTED RATE

• 2. LIFE TABLE

• 3. REGRESSION TECHNIQUES

• 4.MULTIVARIATE ANALYSIS
• THANK YOU