Westerling R
Department of Social Medicine, Uppsala University, Sweden.
Scand J Soc Med. 1993 Sep;21(3):176-87. doi: 10.1177/140349489302100307.
When comparing health administrative areas in Sweden the variation in death rates for 13 suggested indicators of avoidable mortality was analysed for the time periods 1974-79 and 1980-85. For most indicators the variation was significant. The level of systematic (nonrandom) variance differed between the sexes for certain conditions. According to the theory of mass-significance it would be appropriate to use a sharpened significance test of high SMRs. For certain health policy indicators it was possible to detect areas accounting for nearly all the deviation above the national standard using a sharpened test (p < 0.001). For most medical care indicators, however, the high death rates had a lower level of significance. When sensitivity is given priority an ordinary test (p < 0.05) should be preferred. This means, however, dealing with potential false positive warning signals. Epidemiological surveillance of indicators of avoidable mortality should be the starting point for in-depth studies.
在比较瑞典的卫生行政区时，分析了1974 - 79年和1980 - 85年期间13项建议的可避免死亡率指标的死亡率差异。对于大多数指标，差异具有显著性。在某些情况下，系统性（非随机）方差水平在性别之间有所不同。根据大量显著性理论，使用高标准化死亡比（SMR）的强化显著性检验是合适的。对于某些卫生政策指标，使用强化检验（p < 0.001）可以检测出几乎所有高于国家标准偏差的地区。然而，对于大多数医疗保健指标，高死亡率的显著性水平较低。当优先考虑敏感性时，应首选普通检验（p < 0.05）。然而，这意味着要处理潜在的假阳性警告信号。可避免死亡率指标的流行病学监测应作为深入研究的起点。
