Lecture 2: Direct Standardization of Measures of Disease Occurrence Lecture 2: Direct Standardization of Measures of Disease Occurrence Dankmar B¨ ohning Southampton Statistical Sciences Research Institute University of Southampton, UK Advanced Statistical Methods in Epidemiology February 4-6, 2013 1 / 23
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Lecture 2: Direct Standardization of Measures of Disease Occurrence
Lecture 2: Direct Standardization ofMeasures of Disease Occurrence
Dankmar Bohning
Southampton Statistical Sciences Research InstituteUniversity of Southampton, UK
Advanced Statistical Methods in EpidemiologyFebruary 4-6, 2013
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Lecture 2: Direct Standardization of Measures of Disease Occurrence
Outline
Purpose
The purpose of this material is to provide an introduction to theproblems of medical surveillance and associated standardizationproblems:
I comparing disease (risk factor) occurrence
I standardization methodology
I examples
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Lecture 2: Direct Standardization of Measures of Disease Occurrence
Outline
Medical Surveillance
Example on problems with comparison of rates
The Directly Standardized Rate
How to execute in STATA?
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Lecture 2: Direct Standardization of Measures of Disease Occurrence
Medical Surveillance
Definitiondetection of the occurrence of health-related events or exposures ina target population
Goalto identify changes in the distributions of diseases in order toprevent or control these diseases within a population
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Lecture 2: Direct Standardization of Measures of Disease Occurrence
Medical Surveillance
potential specific goals
I identification of pattern of disease occurrence
I detection of disease outbreaks
I development of clues about possible risk factors (ecologicalstudy)
I finding of cases for further investigation
I anticipation of health service needs
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Lecture 2: Direct Standardization of Measures of Disease Occurrence
Medical Surveillance
traditionally
medical surveillance activities were developed to monitor thespread of infectious disease through a population
today
target are all diseases and health related conditions and exposuressuch as traffic accident morbidity and mortality, smoking, sexualhabits, etc
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Lecture 2: Direct Standardization of Measures of Disease Occurrence
Medical Surveillance
Data Sources
Surveillance of deaths
I mortality statistics
Surveillance of morbidity
I important function of registries such as cancer registries,traffic accident registries, etc.
I legislation on certain transmittable diseases
Surveillance of risk factors
I micro-census
I survey
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Lecture 2: Direct Standardization of Measures of Disease Occurrence
Example on problems with comparison of rates
to detect change
morbidity or mortality needs frequently be compared
I in time (weekly, monthly, yearly, ...)
I in space (county, states, city-areas, ...)
such a comparison - if done without care - can be quite problematic
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Lecture 2: Direct Standardization of Measures of Disease Occurrence
Example on problems with comparison of rates
Comparing Mortality from Lung Cancer in Berlin(West) 1960 and 1989age-group deaths 1989 under risk deaths 1960 under risk
Lecture 2: Direct Standardization of Measures of Disease Occurrence
How to execute in STATA?
how to execute in STATA?
execution of standardizationa very practical way to accomplish this is to choose in the first filethe population name as the name of the reference standard, in thisexample world
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Lecture 2: Direct Standardization of Measures of Disease Occurrence