Topic: Direct & Indirect Rate adjustment

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Scenario 1
Vital Statistics for Florida and California, 1991
Florida

California

Age
(years)
0-4
5-24
25-44

Deathsc
2,177
2,113
8,400

915,000
3,285,000
4,036,000

5,500
5,736
19,178

45-64
65-74
75+

21,108
30,977
71,483

2,609,000
1,395,000
1,038,000

37,313
45,306
102,078

2,651,000
8,824,000
10,539,00
0
5,179,000
1,874,000
1,314,000

Total

136,258

13,278,000

215,111

30,381,000

Population

Deathsc

Population

Age
Group
0-4
5-24
25-44

Standard
Million Age
Distribution
for the Year
1991,
United
States
Standard
Million
76,158
286,501
325,971

45-64
65-74
75+

185,402
72,494
53,474

Total

Case
specific
rates/10000
0

Expected deaths

Flori
da
238
64
208

Calif
ornia
207
65
182

Florida Californi
a
181
158
183
186
678
589

809
2220
6887

720
2418
7768

1500
1609
3683

1335
1753
1969

1,000,000

7834

5990

Adjusted DR

784.4

599

CDR/105

1026

708

The above table reports the vital statistics for the states of Florida & California in 1991.
1. Calculate the crude death rate for the state of California in 1991. Compare this
rate to that of Florida
2. Calculate age-specific death rates.
3. Using the standard as the external reference population, directly adjust
California's death rate.
Answers
The crude death rates (CDR) for the state of California
=

Total deaths in 1991/the total population in 1991

215,111/ 30,381,000 * 100,000

about 708 deaths per 100000 persons in California

And In Florida
Using the same formula to get the CDR

136258/13278000*100000

About 1056 deaths per 100000 persons

The crude death rate for Florida is higher than that of California

2. Age specific death rates for both states is calculated and filled in the table
3. Adjusted Californias death rate. 5990/106*105

=599Scenario 2
Vital Statistics for Florida and Arkansas, 1991
Florida

Age

Deathsc

Arkansas

Populationb

Deathsa

Populationb

2,177
915,000
2,113
3,285,000
8,400
4,036,000
21,108
2,609,000
30,977
1,395,000
71,483
1,038,000
136,258 13,278,000d
1026

449
562
1,459
4,072
5,466
13,037

170,000
697,000
694,000
458,000
196,000
157,000
2,372,000
1056

(years)

0-4
5-24
25-44
45-64
65-74
75+
Total
CDR/
105

25,045

Standard Million Age

Distribution for the
Year 1991, United
States

Specific rates /
100000

Expected deaths

Age Standard
Grou
Million
p
0-4
76,158
5-24
286,501
25-44
325,971
45-64
185,402
65-74
72,494
75+
53,474
Total 1,000,000
Adjusted DR/105

Florid
a

Arkans
as

Florid
a

Arkan
sas

238
64
208
809
2220
6887

264
81
210
889
2789
8304

181
183
678
1500
1609
3683
7834
783.4

201
232
684
1648
2022
4440
9227
922.7

The above table reports the vital statistics for the states of Florida & Arkansas in 1991.
1. Calculate the crude death rate for the state of Arkansas. Compare this rate to
that of Florida.
2. Using the standard million as the external reference population, directly adjust
Arkansas's death rate.
3. Compare Arkansas's adjusted death rate to that of Florida.
Solutions
1 Crude death rates for Arkansas.
=136,258/13,278,000 *105
=1026 deaths per 100000
Crude death rates for Florida
=25045/2,372,000 *105
=1056 deaths per 100000
The crude death rate for Florida is greater than that for Arkansas with about 30 deaths
per 100000 persons

2 Adjusted death rates

Arkansas
9227/1000000*100000
=922.7
Florida
7834/1000000*10000
=783.4
From the adjusted death rate, had the two states had the same population they
could Florida would have experienced the a lower death rate as compared to
Arkansas with about 140 deaths per 100000 persons.

Scenario 3
Insert table of vital statistics for Kenya here. Need to get data.
Egypt
Age
(years
)
0-4

Deaths

Kenya
b

US
b

Population
Adjusted rate

Expected
Deaths

7,909,000

18112

6282163

5-24

24,560,000

15227

17149482

25-44
45-64
65-74
75+
Total
CDR

13,764,000
6,921,000
1,485,000
524,000
55,163,000

24775
54607
38877
42161
193759

7625995
3070384
926152
372486
36138746

416000

Population

Expected
deaths

Death
rate

14386
10633
13727
24225
24247
29970
117435

.00229
.00062
.00180
.00789
.02618
.08046

The above table reports the vital statistics for Egypt.

1. Calculate Egypt's crude death rate. How does this compare to the 1991 U.S.
crude death rate of 860 per 100,000?
The crude death rate for Egypt is

= 416000/55163000*100000
= 754 per deaths 100000 persons
2. Adjust Egypts death rate using the indirect method, using the U.S. data as the
external reference population. Interpret your results.
SMR for Egypt

=
=
=

Observed deaths / expected deaths

416000/193759
2.15

The observed deaths in Egypt was 2.15 times higher than the expected using the USA
age specific standard rates
3. Calculate Kenyas crude death rate. How does Egypts rate compare with Kenya?
Death rate for Kenya: 9.72 deaths/1,000 population
I.e. about 972 deaths per 100000 persons
Source http://www.indexmundi.com/kenya/death_rate.html
This compared with the Egypts rate at 754 per deaths 100000 persons
Hence using the CDR the Kenyans are dieing at a higher rate as compares to Egypt.
Thats about 218 more deaths per 100000 persons as compres to Egypt
References
http://www.indexmundi.com/kenya/death_rate.html
http://www.kenya-information-guide.com/kenya-population.html
www.cbs.co.ke Central Bureau of Statistics
Epidemiology, Leon Gordis, W.B Saunders Company, 2000
Epidemiology kept Simple, B. Burt Gerstman, Wiley-Liss Publications, 1998