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The SMR is an indirect method based on the age structure of the target population. It is a ratio of the observed (O) to the expected (E) number of deaths, where E is the number of individuals of the target population multiplied by the ageand sex-specific mortality rates of the standard population. In his commentary, Shibata wrote that ‘‘The authors should have compared the mortality directly between the target population and a common standard population,...’’. We are unclear what is meant by this statement. If we were to compare age-period specific mortality rates for each age group (seven classes) and calendar year (five periods), we would need to analyze 35fold (seven age-classes times five periods) more data than that analyzed in the reported study. The result of such a mega-analysis would be to diffuse the focus of our study, with the reader ultimately having great difficulty understanding the results. A comparison using SMR may not have been the best approach, but we could not have achieved the aim of our study if we did not use summary rates. Shibata said that ‘‘the effects of the age distribution in the target population on the power of the hypothesis test are considerably large’’. The test of significance was performed appropriately in our paper. Therefore, his comment is unrelated to the validity of the analysis in our study. If, as pointed out by Shibata, ‘‘a relatively large portion of LSS subjects have been living in areas other than Hiroshima or Okayama prefecture,’’ the results may have been the same—even if other prefectures were used as the standard population. Therefore, we also believe that if information were to be provided on the percentage of the LSS group living in areas other than Hiroshima and Okayama prefectures, this would be valuable data for discussion and future research.

environmental health and preventive medicine

Answer to the comment by Yoshisada Shibata on “Hiroshima survivors exposed to very low doses of A-bomb primary radiation showed a high risk for cancers”