Zocchetti C, Consonni D
Istituti Clinici di Perfezionamento, Clinica del Lavoro Luigi Devoto, Milano.
Med Lav. 1994 Jul-Aug;85(4):327-43.
The rate is an epidemiologic measure which has a widespread use in describing the occurrence of diseases. In this paper, with a didactic approach, the definition of the mortality (morbidity) rate is introduced following two ways of reasoning: firstly, in the context of survival analysis, as an instantaneous conditional probability of failure (either disease or death) (instantaneous risk) and, secondly, as a traditional measure of rapidity of change in time. We then proceed to highlight the differences, in terms of definition, interpretation, and application, between the concepts of rate and risk. As a next step the statistical properties of the rate are explored and it is explained why the variability of the measure is simply associated with the numerator (events) and not with the denominator (person-times) of the rate. In this context the Poisson distribution is commonly considered the probability distribution which better describes the statistical variability of the observed events, and examples of such a distribution are presented. When the number of deaths is sufficiently elevated the Poisson distribution can be adequately approximated by the Gauss distribution, which is simpler and in common use in occupational medicine, and formulas are presented to compute mean and variance of the rate in this situation. When the number of deaths is small a suggestion is made of making a log transformation of the rate (or of the deaths) before using the Gauss distribution: formulas are proposed for this situation, too. As a practical application of the statistical properties presented and as a concluding example, a confidence interval for the rate is computed. Numerical and graphical comparisons of the results deriving from the use of different formulas are described.
率是一种流行病学测量指标,在描述疾病的发生情况方面有着广泛的应用。在本文中,我们采用一种教学方法,通过两种推理方式引入死亡率(发病率)的定义:首先,在生存分析的背景下,将其作为失败(疾病或死亡)的瞬时条件概率(瞬时风险);其次,将其作为随时间变化速度的传统测量指标。然后,我们着重强调了率和风险在定义、解释及应用方面的差异。接下来,我们探讨了率的统计特性,并解释了为什么该测量指标的变异性仅与分子(事件)相关,而与率的分母(人时)无关。在此背景下,泊松分布通常被认为是能更好地描述观察到的事件统计变异性的概率分布,并给出了此类分布的示例。当死亡人数足够多时,泊松分布可以由高斯分布充分近似,高斯分布更简单且在职业医学中常用,文中给出了在这种情况下计算率的均值和方差的公式。当死亡人数较少时,建议在使用高斯分布之前对率(或死亡数)进行对数变换:文中也给出了针对这种情况的公式。作为所呈现的统计特性的实际应用以及一个总结性示例,我们计算了率的置信区间。描述了使用不同公式得出的结果的数值和图形比较。