Standardized mortality ratios by region of residence, Israel, 1987-1994: a tool for public health policy.

Background: Standardized mortality ratios (SMRs) are used internationally to compare health status across regions and to identify high risk areas for investigation of specific diseases, for funding determination, and for planning purposes.

Objective: To ascertain regional differences in SMRs by sub-District in Israel for 1987-1994.

Method: The indirect method of standardization of mortality rates with adjustment for age, gender, and continent of birth was used to calculate SMRs by major cause of death, by sub-District of residence for the Jewish population of Israel.

Results: SMRs for all causes of death ranged from regions with low rates (Petah Tikva, Sharon, Rehovot, Ashkelon, and Jerusalem) to those with high rates (Zefat/Golan, Hadera, Yizreel, Ramla, Haifa, Tel Aviv, and Be'er Sheva) (all p<0.0001). Zefat's SMRs are elevated for acute myocardial infarction, stroke, diabetes, and motor vehicle accidents (MVAs). Haifa's SMRs are high for all cardiovascular diseases, liver disease, MVAs, and lung cancer. Be'er Sheva residents had high SMRs for diabetes, liver disease, MVAs, some categories of cardiovascular disease, cervical cancer, and homicide. Yizreel had high SMRs for diabetes, hypertension, stroke, liver disease, and MVAs. Tel Aviv had elevated SMRs for septicemia, acute MI, perinatal causes, and colon, lung and breast cancer. Jerusalem (p<0.0001) and Kinneret residents (p<0.05) had low SMRs for everything except congenital anomalies.

Conclusions: Regional SMR differences, adjusted for age, gender, and ethnicity, may be due to socioeconomic, nutritional, environmental, occupational, or health care factors. SMRs provide a tool to identify regions for epidemiological investigation and priorities for preventive interventions. Regional health monitoring should be undertaken routinely on mortality data, as well as other national databases, as part of national health monitoring.