Standardization

(Adjusted measure)

Oleh
Lintang Dian Saraswati, SKM, M.Epid
 Scenario
1. CDR for Florida is 2.7 times of those for
Alaska. Does that means condition in Florida is
worse than Alaska?
2. The incidence of deafness in corporation X is
higher than those in corporation Y. Is the noise
level in X higher than Y?
3. CFR for CHD in hospital M is higher than those
in hospital N. Does that means that the case
management is better in N than M?
 Standardization
• Definition: A set of techniques to remove as far
as possible the effect of differences in age or
some other confounding variables when
comparing two or more population. The common
method uses averaging of rate specific of the
confounding variable
• Methods:
1. Direct standardization
2. Indirect standardization
 Direct standardization
• The specific rates in a study population
are averaged, using as weight the
distribution of a specified reference
(standard) population
• The directly standardized rate represents
what the crude rate would have been in
the study population if that population has
the same distribution as the standard
population
 Requirement
• Number of individuals in each stratum of
the study population
• Total number of event
• A reference (standard) population divided
into the same number of stratum in the
study population
• Specific rate for each stratum in the
reference population
Terminology
Direct adjustment
Reference population
Reference population
Formula for direct age adjustment

• Ni = number of people in stratum i of the

reference population
• ri = rate of disease in the stratum i of the
study population
Example
Age-specific
Example (cont.)
Example
 Indirect adjustment
• The specific rates in the reference
population are averaged, using as weight
the distribution of the study population.
• Used to compare study population for
which are either statistically unstable or
unknown
• Need an SMR to produce the indirectly
standardized rate
Formula