지역 간 건강수준 비교를 위한 표준화율 적용의 적절성 평가: 2008년 지역사회건강조사를 바탕으로
Assessment of Applicability of Standardized Rates for Health State omparison Among Areas: 2008 Community Health Survey
1
조회
0
다운로드
18
인용
0
참고문헌
키워드
초록
Objectives: This study shows the issues that should be considered when applying standardized rates using Community Health Survey(CHS) data. Methods: We analyzed 2008 CHS data. In order to obtain the reliability of standardized rates, we calculated z-score and rank correlation coefficients between direct standardized rate and indirect standardized rate for 31 major indices. Especially, we assessed the change of correlations according to population composition (age and sex), and characteristics of the index. We used Mantel-Haenszel chi-square to quantify the difference of population composition. Results: Among 31 major indices, 29 indices’ z-score and rank correlation coefficients were over 0.9. However, regions with larger differences in population composition showed lower reliability. Low reliability was also observed for the indices specific to subgroups with small denominator such as ‘permanent lesion from stroke’, and the index with large regional variations in age-related differences such as ‘obtaining health examinations’. Conclusions: Standardized rates may have low reliability, if comparison is made between areas with extremely large differences in population composition, or for indicies with large regional variations in age-related differences. Therefore, the special features of standardized rates should be considered when health state are compared among areas.
Abstract
Objectives: This study shows the issues that should be considered when applying standardized rates using Community Health Survey(CHS) data. Methods: We analyzed 2008 CHS data. In order to obtain the reliability of standardized rates, we calculated z-score and rank correlation coefficients between direct standardized rate and indirect standardized rate for 31 major indices. Especially, we assessed the change of correlations according to population composition (age and sex), and characteristics of the index. We used Mantel-Haenszel chi-square to quantify the difference of population composition. Results: Among 31 major indices, 29 indices’ z-score and rank correlation coefficients were over 0.9. However, regions with larger differences in population composition showed lower reliability. Low reliability was also observed for the indices specific to subgroups with small denominator such as ‘permanent lesion from stroke’, and the index with large regional variations in age-related differences such as ‘obtaining health examinations’. Conclusions: Standardized rates may have low reliability, if comparison is made between areas with extremely large differences in population composition, or for indicies with large regional variations in age-related differences. Therefore, the special features of standardized rates should be considered when health state are compared among areas.
참고문헌 (24)
- Lee KS, "Health promotion strategies under regional health planning", Korean J Health Policy Adm, 7(1), pp.1~31 (1997)
- 정백근, "우리나라에서의 지역의 물질적 결핍수준과 15-64세 인구 표준화사망비의 관계", 예방의학회지, 39(1), pp.46~52 (2006), 대한예방의학회
- Lee SI, "The possibility of regional health insurance data in blueprinting the local community health plan", Korean J Prev Med, 30(4), pp.870~883 (1997)
- Carson CA, "Agestandardization in epidemiological data", Int J Epidemiol, 23(3), pp.643~644 (1994)
- Fleiss JL, "Statistical Methods for Rates and Proportions, 3rd ed", pp.627~647 (2003), John Wiley & Sons Inc
- Inskip H, "Methods for ageadjustment of rates", Stat Med, 2(4), pp.455~466 (1983)
- Julious SA, "Why do we continue to use standardized mortality ratios for small area comparisons?", J Public Health Med, 23(1), pp.40~46 (2001)
- Kitagawa EM, "Standardized comparisons in popoulation research", Demography, 1(1), pp.296~315 (1964)
- Breslow NE, "Indirect standardization and multiplicative models for rates, with reference to the age adjustment of cancer incidence and relative frequency data", J Chronic Dis, 28(5), pp.289~303 (1975)
- Gail M, "The analysis of heterogeneity for indirect standardized mortality ratios", J R Stat Soc Ser A, 141(2), pp.224~234 (1978)
- John WT, "The Collected Works of John W. Tukey: Graphics, 5th ed", pp.109~122 (1988), Bell Telephone Laboratories Inc
- Cressie NA, "Statistics for Spatial Data", pp.803~872 (1991), John Wiley & Sons Inc
- Curtin LR, "A short history of standardization for vital events", Vital Health Stat, 4(29), pp.11~16 (1992)
- Anderson R, "Age standardization of death rates: Implementation of the year 2000 standard", Natl Vital Stat Rep, 47(3), pp.1~20 (1998)
- Korea Center for Disease Control and Prevention, "Operating System of Community Health Survey: Center for Chronic Disease" (2008), Korea Center for Disease Control and Prevention
- Curtin, LR, "Direct standardization (age-adjusted death rates)", Healthy People 2000 Stat Notes, (6), pp.1~10 (1995)
- Pickle LW, "Effects of the choice of ageadjustment method on maps of death rates", Stat Med, 14(5), pp.615~627 (1995)
- Spiegelman M, "Empirical testing of standards for the age adjustment of death rates by the direct method", Hum Biol, 38(3), pp.280~292 (1966)
- Walter SD, "Mapping mortality and morbidity patterns: An international comparison", Int J Epidemiol, 20(3), pp.678~689 (1991)
- 김지현, "표준사망비를 활용한 우리나라 소지역별 건강불평등 비교", 예방의학회지, 41(5), pp.300~306 (2008), 대한예방의학회
- Yule GU, "On some points relating to vital statistics, more especially statistics of occupational mortality", J R Stat Soc, 97(1), pp.1~84 (1934)
- Kilpatrick SJ, "Mortality comparisons in socio-economic groups", J R Stat Soc, Ser C (Appl Stat), 12(2), pp.65~86 (1963)
- Rezaeian M, "Do hot spots of deprivation predict the rates of suicide within London boroughs?", Health Place, 13(4), pp.886~893 (2007)
- 강영호, "센서스인구 대 주민등록인구 : 지역별 사망률 연구에서 어느 인구를 분모로 사용하여야 하나?", 예방의학회지, 38(2), pp.147~153 (2005), 대한예방의학회