Tsai S P, Wen C P
Int J Epidemiol. 1986 Mar;15(1):8-21. doi: 10.1093/ije/15.1.8.
This paper is a review and clarification of methodological issues related to the standardized mortality ratio (SMR), widely used in occupational epidemiology. Although the SMR seems to be a simple statistic, it can be misused and misinterpreted. The paper discusses SMRs in relation to age-specific mortality ratios, relative risk, life expectancy, and statistics derived from direct standardization. Inter-SMR comparisons and the effect of the choice of the comparison population on the SMR are also discussed. Mathematical and empirical review of SMR use has led to the development of a correction procedure which permits direct comparisons of two SMRs by adjusting for the age distributions of the two populations. The paper also proposes a method for testing the trend of age-specific mortality ratios (MRs). If MRs are homogeneous, this method can also be used to compare two SMRs. If MRs are not homogeneous, the relative risk between two sets of age-specific MRs can be tested for significance, but no summary index, including the SMR, can accurately describe the mortality experience over the entire age range. It is suggested that the summary statistics of a cohort mortality experience should include relative risk, attributable risk, and life expectancy. These statistics are complementary and can be derived or approximated from the data that generated the SMR. A valid risk assessment should weigh the evidence from all three summary statistics.
本文是对职业流行病学中广泛使用的标准化死亡比（SMR）相关方法学问题的综述与澄清。尽管SMR看似是一个简单的统计量，但它可能会被误用和误解。本文讨论了SMR与年龄别死亡率、相对风险、预期寿命以及直接标准化得出的统计量之间的关系。还讨论了SMR之间的比较以及比较人群的选择对SMR的影响。对SMR使用的数学和实证研究促成了一种校正程序的开发，该程序通过调整两个人群的年龄分布来允许直接比较两个SMR。本文还提出了一种检验年龄别死亡率（MR）趋势的方法。如果MR是同质的，该方法也可用于比较两个SMR。如果MR不是同质的，可以检验两组年龄别MR之间的相对风险是否具有显著性，但包括SMR在内的任何汇总指标都无法准确描述整个年龄范围内的死亡经历。建议队列死亡经历的汇总统计量应包括相对风险、归因风险和预期寿命。这些统计量是互补的，可以从生成SMR的数据中推导或近似得出。有效的风险评估应权衡来自所有这三个汇总统计量的证据。
