Age and sex adjustments are critical when comparing death rates

Islam, Nazrul and Jdanov, Dmitri A (2023) Age and sex adjustments are critical when comparing death rates. BMJ, 381, 845, [p845]. (doi:10.1136/bmj.p845).

Record type: Editorial

Abstract

Unadjusted rates can be seriously misleadingThe covid-19 pandemic took an unprecedented toll on human lives, but the burden was shared unequally among countries and among different population groups within countries, including between sexes.Accurate, timely, and meaningful comparisons of death rates are important for evaluating the comparative effectiveness of pandemic control policies. National estimates of crude deaths—total number deaths across all age groups divided by the total population—were initially reported to help monitor national pandemic trajectories in real time, but these crude rates were subsequently used for international comparisons. Crude comparisons between and within countries were—and are—misleading, as they fail to account for important differences in the underlying age structures of the populations being compared.1234Age is the most important predictor of mortality; it is also associated with multimorbidity, which itself influences mortality.5 Moreover, mortality rates across age groups vary considerably between sexes, adding a further layer of complexity to comparisons.6To illustrate these issues, we examined how mortality estimates from England …

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