# Situation: The public health nurse of a Rural Health Unit (RHU) prepares the annual health statistics report of a municipality with a midyear population of 62,000. The nurse compares two barangays of the municipality: Barangay P — crude death rate 6.1 per 1,000; 22% of residents aged 60 years and older; death rate per 1,000: under 60 years 1.9, 60 years and older 21.0 Barangay Q — crude death rate 3.9 per 1,000; 7% of residents aged 60 years and older; death rate per 1,000: under 60 years 2.1, 60 years and older 27.5 Which conclusion do these data BEST support?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627089  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse of a Rural Health Unit (RHU) prepares the annual health statistics report of a municipality with a midyear population of 62,000.

The nurse compares two barangays of the municipality:
Barangay P — crude death rate 6.1 per 1,000; 22% of residents aged 60 years and older; death rate per 1,000: under 60 years 1.9, 60 years and older 21.0
Barangay Q — crude death rate 3.9 per 1,000; 7% of residents aged 60 years and older; death rate per 1,000: under 60 years 2.1, 60 years and older 27.5
Which conclusion do these data BEST support?

## 보기

1. Barangay P has poorer health status and needs a larger share of resources
2. The higher crude rate of Barangay P comes from its older population **✔ 정답**
3. Barangay Q likely underreports deaths, since its crude rate is lower
4. Age-specific rates cannot be compared between barangays of unequal size

**정답: 2**

## 해설

Crude death rates depend on age structure. Barangay P has three times the proportion of older residents, yet its death rates are lower than Barangay Q's in both age groups (1.9 vs 2.1 and 21.0 vs 27.5 per 1,000). Its higher crude rate (0.78 × 1.9 + 0.22 × 21.0 = 6.1) therefore reflects its older population, so comparisons should use age-specific or age-standardized rates.

## 심화 해설

Crude rates are shaped by age structure
A crude death rate divides all deaths by the whole population. Because the risk of death rises steeply with age, a population with many older residents will have a higher crude rate even if each age group is as healthy as, or healthier than, the same age group elsewhere. In this item Barangay P has 22% of residents aged 60 and older, compared with 7% in Barangay Q. P's crude rate is higher (6.1 vs 3.9 per 1,000), yet its age-specific death rates are lower in both age groups: 1.9 vs 2.1 under 60, and 21.0 vs 27.5 at 60 and older. P's higher crude rate comes from its older population, not from poorer health in each age group.

Checking the arithmetic
A crude rate is the weighted average of the age-specific rates, weighted by the share of the population in each age group. For P: 0.78 × 1.9 + 0.22 × 21.0 ≈ 1.5 + 4.6 = 6.1 per 1,000. For Q: 0.93 × 2.1 + 0.07 × 27.5 ≈ 2.0 + 1.9 = 3.9 per 1,000. Both crude rates are exactly what the age-specific rates and age structures predict. This weighted-average view explains why the barangay with lower rates in every age group can still show the higher crude rate.

| Measure | Barangay P | Barangay Q |
| --- | --- | --- |
| Residents 60 and older | 22% | 7% |
| Death rate under 60 (per 1,000) | 1.9 | 2.1 |
| Death rate 60 and older (per 1,000) | 21.0 | 27.5 |
| Crude death rate (per 1,000) | 6.1 | 3.9 |

Why the other conclusions fail
Saying P has poorer health and needs more resources judges by the crude rate alone and ignores the age structure; within each age group, P actually fares better. Suspecting that Q underreports deaths has no basis, since Q's crude rate matches its age-specific rates and young population. Claiming that age-specific rates cannot be compared between barangays of unequal size misunderstands rates: each is already expressed per 1,000 people in its group, which removes the effect of population size. Watch out! This pattern, in which one group looks worse overall but better within every subgroup, is a classic exam trap called confounding by age.

Exam takeaway
When populations differ in age structure, compare age-specific or age-standardized rates rather than crude rates. Age standardization applies each barangay's age-specific rates to one standard population, producing summary figures that can be compared fairly. In the annual report, the nurse should present age-specific rates alongside crude rates and avoid allocating resources on crude rates alone. Barangay P's large older population still matters for planning, since it will generate many deaths and needs for elderly care, but that is a question of program size, not of poorer health.

## 임상 시나리오

Crude Versus Age-Specific RatesConfounding by age structure
Crude death rates depend on age structure. Barangay P has 22% older residents against 7% in Q.

P's age-specific rates are lower than Q's in both age groups (1.9 vs 2.1; 21.0 vs 27.5 per 1,000), so its higher crude rate (6.1) reflects its older population.

Compare barangays with age-specific or age-standardized rates.

CautionDo not allocate resources or judge health status from crude rates alone when age structures differ.

## 핵심 개념

- **Crude death rate** — Total deaths in a year per 1,000 midyear population, without adjustment for age.
- **Age-specific death rate** — Deaths in an age group per 1,000 people in that same age group.
- **Age standardization** — A method that adjusts rates to a common age structure so populations can be compared fairly.
- **Confounding** — Distortion of a comparison by a third factor, such as age, linked to both the groups and the outcome.

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