Clinicians and epidemiologists view crude death rates differently

BMJ 1999;318:395 ( 6 February )

Letters

Clinicians and epidemiologists view crude death rates differently

The first 150 words of the full text of this article appear below.

EDITOR $---$ We agree with Tunstall-Pedoe that crude death rates are misleading in comparisons.¹ However, clinicians and epidemiologistshave different attitudes towards these healthindicators.

Mortality from ischaemic heart disease has been low in Japan.² None the less, its recent trends were interpreted differentlyby clinicians and epidemiologists. On the basis of their experience,clinicians believed that mortality from ischaemic heart diseasewas on the rise. Trends in crude rates were compatible with theirbelief. Epidemiologists argued that to see the secular trend requiredage adjustment, which reduced the resultant rates. There was nosimple answer about the validity of the two interpretations.³Which wastrue?

If age adjusted mortality is higher in one population than in another, discovering the cause is a concern of public health.However, age adjusted mortality differs from the crude mortalitythat directly reflects the real number of deaths because it isa hypothetical value. . . . [Full text of this article]