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Rates
Incidence Density
Incidence Rate Difference and Ratio
Confidence Intervals
Standardized Rates and Their Comparison
1
A Definition
2
Rates
♦ A well-known example of rate is velocity, i.e., change of
distance per unit of time (given, e.g., in km/h).
• In practice, it does (should?) have an upper-bound
3
Incidence/Mortality Rate
♦ Kleinbaum, Kupper and Morgenstern, Epidemiologic
Research: Principles and Quantitative Methods (1982),
p.100:
4
Incidence Rate
♦ Other terms:
• an “instantaneous risk” (or probability);
• a “hazard” (especially for mortality rates);
• a “person-time incidence rate”;
• a “force of morbidity”.
5
Rates and Risks
♦ Assume that the incidence rate is constant over time (=λ),
and the same for all individuals.
7
Incidence Density
♦ A hypothetical cohort of 12 subjects.
♦ Followed for the period of 5.5 years.
♦ 7 withdrawals among non-cases
• three (7,8,12) lost to follow-up;
• two (3,4) due to death;
• two (5,10) due to study termination.
♦ PT = 2.5+3.5+…+1.5 = 26.
♦ ID=5/26=0.192 per (person-) year
or
1.92 per 10 (person-)years.
8
Population-Time Without Individual Data
9
Population-Time Without Individual
Data: Example
10
Incidence Density: Remarks
11
Incidence Density: Remarks
♦ If applied to the whole cohort/population, sometimes called
crude rate.
13
Estimating Incidence Densities: Example
♦ Postmenopausal Hormone and Coronary Heart Disease Cohort Study:
• Stampfer et al., NEJM (1985).
• Involving female nurses:
Hormone use
Yes No Total
CHD 30 60 90
Person-years 54308.7 51477.5 105786.2
15
Comparing Two Incidence Densities:
Example
♦ Postmenopausal Hormone and Coronary Heart Disease Cohort Study:
• Stampfer et al., NEJM (1985).
• Involving female nurses:
Hormone use
Yes No Total
CHD 30 60 90
Person-years 54308.7 51477.5 105786.2
I0 I1
SE( IRD) = + ♦ Standard error of ln IRR can be
( PT0 ) ( PT1 ) 2
2
estimated by:
♦95% CI for:
IRD: -0.00061 ± 1.96∙0.00018 = (-0.00096, -0.00025)
ln IRR: ln(0.474) ± 1.96∙0.22 = (-1.178, -0.315)
IRR: (e-1.178, e-0.315) = (0.308, 0.729)
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Comparing Two Incidence Densities:
“Test-Based” Method
♦ 95% “test-based” CI for IRD can Exposed Unexposed Total
be computed as Cases I1 I0 I
IRD ± 1.96 ∙ SE(IRD), Pop.-time PT1 PT0 PT
where SE(IRD)= IRD / χ and
PT1 ♦ Similarly, SE(ln IRR)= (ln IRR) / χ
I1 − I ⋅
PT
χ= ♦ 95% “test-based” CI for ln IRR is
I ⋅ PT0 ⋅ PT1
ln IRR ± 1.96 ∙ (ln IRR) / χ
PT 2
♦ Can be written as
♦ Can be re-expressed as
( 1 ± 1.96 / χ ) ∙ ln IRR
(1 ± 1.96 / χ) ∙ IRD
• 99% CI: (1 ± 2.58 / χ) ∙ IRD
♦ 95% CI for IRR is thus
exp{ ( 1 ± 1.96 / χ ) ∙ ln IRR}
19
Comparing Two Incidence Densities:
Example
PT1
I1 − I ⋅ Exposed Unexposed Total
PT
χ= Cases I1 I0 I
I ⋅ PT0 ⋅ PT1
Pop.-time PT1 PT0 PT
PT 2
54308.7 Hormone use
30 − 90 ⋅ Yes No Total
105786.2
χ= = 3.41 CHD 30 60 90
90 ⋅ 54308.7 ⋅ 51477.5
Person 54308.7 51477.5 105786.2
105786.2 2 -years
♦ Indirect method
• Age-specific rates from the standard population are applied to the
age-distribution of the study population.
(rates standard → age study)
23
Direct Standardization
Age Study Population Standard Population
Group (e.g., USA 1990)
Observed Person-years Rate Observed Population Rate
<40 I1 PT1 I1/ PT1 B1 N1 B1/N1
40-64 I2 PT 2 I 2/ PT 2 B2 N2 B2/N2
65+ I3 PT 3 I 3/ PT 3 B3 N3 B3/N3
Total It PT t I t/ PT t Bt Nt Bt/Nt
26
Indirect Standardization
Age Study Population Standard Population Expected
Group (e.g., USA 1990)
Obs Person- Rate Obs Population Rate
years
<40 I1 PT1 I1 / PT1 B1 N1 B1 /N1 E1= PT 1* (B1 /N1)
40-64 I2 PT2 I2 / PT 2 B2 N2 B2 /N2 E2= PT 2* (B2 /N2)
65+ I3 PT3 I3 / PT 3 B3 N3 B3 /N3 E3= PT3* (B3 /N3)
Total It E1+ E2+ E3=∑Ej
♦ DSR for Colorado: 10.45 (per 1000 life births; crude: 9.8).
♦ DSR for Louisiana: 9.35 (per 1000 life births; crude: 11.8).
30
Standardization of Rates: Example
♦ Indirect standardization: apply race-specific rates of a standard
population (US, 1987) to the race-distribution of the states.
♦ SMR for Colorado: 527/488.3 = 1.08 (8% higher than the US).
• ISR = SMR x 10.1 = 10.9 (race-adjusted infant mortality-rate).
♦ SMR for Louisiana: 872/908.8 = 0.96 (4% lower than the US).
• ISR = SMR x 10.1 = 9.7 (race-adjusted infant mortality-rate).
31
Standardization of Rates: Example
♦ Is it reasonable to use the
adjusted rates?
•The plot of race-specific rates
shows similar trend
(black>white>other).
•The distribution of race in the US
is similar to the two states
(white>black>other).
•Results for both standardization
methods are similar.
32
Comparison of Directly Standardized
Rates
♦ If we have two standardized rates, we may want to compare them.
DSR1 − DSR2
Z=
SE( DSR1 − DSR2 )
34
Comparison of Directly Standardized
Rates: Example
♦ DSR1 (Colorado): 0.01045 (10.45 per 1000 life births).
SE( DSR1 − DSR2 ) = ( 0.168 ⋅ 0.0024) 2 + ( 0.786 ⋅ 0.0006) 2 + ( 0.046 ⋅ 0.0017 ) 2 = 0.0006
35
Comparison of Directly Standardized
Rates: Example
SE( DSR1 − DSR2 ) = ( 0.168 ⋅ 0.0024) 2 + ( 0.786 ⋅ 0.0006) 2 + ( 0.046 ⋅ 0.0017 ) 2 = 0.0006
♦ On the other hand, it is valid to ask whether SIR (or SMR) is different
from 1.
38