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To the Editor.—
Drs Pomrehn, Wallace, and Burmeister (1982;248:1073) report that farmers in Iowa are approximately 10% less likely to die of ischemic heart disease than non-farmers. They also note lower mortality rates from cancer, cerebrovascular disease, and all causes taken together. The similarity of the standardized mortality ratios for these dissimilar diseases raises the question of whether a bias inherent in their methods might be a cause of systematic error.These authors categorized decedents as farmers or others on the basis of the occupation given on the death certificates, a judgment made at the time of death by the physician or other health worker who filled out the form. The population at risk is computed from census data, in which the assignment of individuals to the categories of farmers or others occurs in the context of filling out a census form and is done by the person himself, a
Gordon RS. Mortality Rates in Farmers and Nonfarmers. JAMA. 1983;249(16):2179. doi:10.1001/jama.1983.03330400031018
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