Town X has a Crude Death Rate of 14 per 1000 and Town Y has a Crude Death Rate of 8 per 1000. However, age-specific death rates in Town Y are higher in every age group. The most likely explanation is:

• A Town X has a younger age structure than Town Y
• B Town Y has a higher birth rate, diluting its death rate
• C Death certification is more accurate in Town Y
• D Town X has a larger proportion of elderly persons than Town Y ✓

Explanation

When every age-specific death rate favours Town Y yet its Crude Death Rate is lower, the difference must lie in age composition. Town X carries a heavier burden of elderly persons, and since mortality rises steeply with age, its crude rate is pulled upward despite better performance at every individual age. This confounding by age structure is the reason standardized death rates are computed before comparing two populations. Certification quality would affect both crude and specific rates equally and cannot produce this pattern.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.