Standardisasi

Standardisasi
 Kapan Standardisasi?
 Membandingkan rate penyakit pada populasi yg
mempunyai distribusi karakteristik populasi yg
berbeda dan karakteristik tersebut berhubungan
dengan penyakit
 2 cara membandingkan:
 Menggunakan category-specific rate
 Menggunakan adjusted rate
 Standardisasi
 Methods:
 Direct
 Category-specific rates dari populasi sendiri
 Distribusi populasi dari populasi standard

 Indirect
 Distribusi populasi dari populasi sendiri
 Category-specific rates dari populasi standard
 Direct vs Indirect
 Direct:
 Category-specific rates di populasi yang dibandingkan diketahui
 Jumlah populasi dan jumlah orang berdasarkan karakteristik
cukup besar untuk dapat menghitung category-specific rates
yang stabil

 Indirect
 Category-specific rates di populasi yang dibandingkan tidak
diketahui
 Jumlah orang berdasarkan karakteristik pada suatu populasi
sangat kecil sehingga menyebabkan tidak stabilnya category-
specific rates
Prosedur Perhitungan: Direct
 Dapatkan category-specific rates populasi
yang dibandingkan
 Tentukan standard populasi
 Hitung jumlah “expexted deaths/cases”
 Hitung rate yang distandardisasi:
Total “expected deaths/cases”
Total populasi standard
Prosedur Perhitungan: Indirect
 Tentukan category-specific rates populasi
standard
 Dapatkan distribusi populasi yang dibandingkan
 Hitung jumlah “expexted deaths/cases”
 Hitung SMR :
Jumlah kematian yang diobservasi
Jumlah “expected deaths”
 Hitung rate yang distandardisasi:
SMR x Crude Death Rate populasi standard
 Community A Community B

Crude Crude
Death Death
Age Pop Deaths rate Pop Deaths rate
(per (per
1000) 1000)

Under1 1,000 15 15.0 5,000 100 20.0

1-14 3,000 3 1.0 20,000 35 1.0

15-34 6,000 6 1.0 35,000 35 1.0

35-54 13,000 52 4.0 17,000 85 5.0

55-64 7,000 105 15.0 8,000 160 20.0

Over 64 20,000 1,600 80.0 15,000 1,350 90.0

All Ages 50,000 1,781 35.6 100,000 1,740 17.4

 Death Expected Death Expected
Standard
Age(year) rate pop death at rate pop death at
Populatio
A A’s rates B B’s rate

Under 1 6 000 15 90 20 120

1-14 23 000 1 23 0,5 11,5

15-34 41 000 1 41 1 41

35-54 30 000 4 120 5 150

55-64 15 000 15 225 20 300

Over 64 35 000 80 2800 90 3150

Total 150 000 35,6 3299 17,4 3 772,5

Adjusted
death
22,0 25,0
rate per
1000
Age Population A Standard Expected
(year) death rate death in A
using standard
rate
Under 1 1 000 20,0
1 – 14 3 000 0,5
15 – 34 6 000 1,0
35 – 54 13 000 5,0
55 – 64 7 000 20,0
Over 64 20 000 90,0
Total 50 000 17,4
Age Population A Standard Expected
(year) death rate death in A
using standard
rate
Under 1 1 000 20,0 20
1 – 14 3 000 0,5 1,5
15 – 34 6 000 1,0 6
35 – 54 13 000 5,0 65
55 – 64 7 000 20,0 140
Over 64 20 000 90,0 1 800
Total 50 000 17,4 2 032,5
SMR A = O/E = 1781 / 2032,5 = 0.876
Adjusted Death rates per 1000 = 0.876 x 17.4 = 15.24
Advantages and Disadvantages of Crude, Specific
and Adjusted Rates
Advantages Disadvantages
Crude rates Actual summary rates Differences in crude
Readily calculable for rates difficult to
international interpret
comparison
Specific rates Homogeneous Cumbersome to
subgroups. Detailed compare many
rates useful for subgroups of two or
epidemiologic more population
purposes
Adjusted rates Differences in Fictional rates
composition of groups Absolute magnitude
removed dependent on
Unbiased comparison standard population
chosen