McMichael A J
J Occup Med. 1976 Mar;18(3):165-8. doi: 10.1097/00043764-197603000-00009.
The age-standardized mortality ratio (SMR) is a relative index of mortality, expressing the mortality experience of the study population relative to that of a comparison ("standard") population. With the general population as the "standard", the SMR for an occupational population will underestimate the mortality experience of that latter population (since it comprises individuals necessarily healthy enough to be employable --and whose mortality risk is therefore initially lower than the general population average). However, this "healthy worker effect" does not equally to all groups within the study population. Therefore, if one attempts to adjust for this effect, the summary nature of the SMR must be recognized, and allowance must be made for variation in the healthy worker effect between different age groups, different races, different work-status groups, different causes of death, and different elapsed-time periods of observation.
年龄标准化死亡率（SMR）是一种相对死亡率指标，它表示研究人群相对于对照（“标准”）人群的死亡经历。以普通人群作为“标准”，职业人群的SMR会低估后者的死亡经历（因为职业人群必然由健康到足以就业的个体组成，因此其死亡风险最初低于普通人群的平均水平）。然而，这种“健康工人效应”在研究人群的所有组中并不相同。因此，如果试图对此效应进行调整，就必须认识到SMR的汇总性质，并且必须考虑到不同年龄组、不同种族、不同工作状态组、不同死因以及不同观察时间段之间健康工人效应的差异。
