When comparing health administrative areas in Sweden the variation in death rates for 13 suggested indicators of avoidable mortality was analysed for the time periods 1974–79 and 1980–85. For most indicators the variation was significant. The level of systematic (nonrandom) variance differed between the sexes for certain conditions.
According to the theory of mass-significance it would be appropriate to use a sharpened significance test of high SMRs. For certain health policy indicators it was possible to detect areas accounting for nearly all the deviation above the national standard using a sharpened test (p < 0.001). For most medical care indicators, however, the high death rates had a lower level of significance. When sensitivity is given priority an ordinary test (p < 0.05) should be preferred. This means, however, dealing with potential false positive warning signals. Epidemiological surveillance of indicators of avoidable mortality should be the starting point for in-depth studies.
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