Seminar 3 Questions

EPIDEMIOLOGY AND BIOSTATISTICS 1 (HSH205)

SEMINAR 3: ANALYTICAL STUDIES (1)

Read
• Carneiro et al (2011) Chapter 7: Cross-sectional studies.
• Carneiro et al (2011) Chapter 6: Ecological studies
• Oleckno (2002) available on CloudDeakin

1. Complete Activity 7.1 on page 95 of Carneiro et al.

2. To assess the association between the use of chewing tobacco and mortality from oral cancers,
an epidemiological study involving 32 countries was carried out in 2005. The following
scatterplot shows the mortality rates from oral cancer and average intake of chewing tobacco.

Oral cancer mortality per

100,000 population

Average intake of chewing tobacco per capita per annum

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The main methods of the study were as follows:

o Estimates of the average intake of chewing tobacco for the 32 countries for 2004
were derived from Customs data on the amount of chewing tobacco imported in
that year in each country
o Mortality rates from oral cancers for 2005 were obtained from data published
routinely by the cancer registries in each country
o The association between level of chewing tobacco intake and oral cancer mortality
was assessed.

Using this information, answer the following questions:

a. What type of study is this? Give reasons for your answer.
b. Do the data suggest that there is an association between chewing tobacco use and
oral cancer? Why or why not?
c. Can you establish a causal link between use of chewing tobacco and oral cancer on
the basis of this study? Give reasons for your answer.

3. A prevalence survey conducted from 1st January to 31st December 2005, in Cunningham, a city
of 1 million people, identified 850 people with raised blood pressure that required
investigation. The incidence rate of this type of high blood pressure in this population had
been previously estimated at 5 per 100,000 persons each year.
a. How many and what percentage of the 850 people requiring further investigation
had developed high blood pressure within the past year?
b. What was the prevalence of high blood pressure in Cunningham in 2005?

4. In a second city of 2 million people, Woodville, the local health promotion authority had been
conducting a campaign to encourage everyone 45 years and older to have their blood pressure
checked annually, so that those identified with hypertension could receive treatment to lower
their blood pressure. A prevalence survey was conducted in Woodville at the same time as the
one in Cunningham. The survey identified 1,000 people with high blood pressure that required
further investigation.
a. What was the prevalence of high blood pressure in Woodville in 2005?
b. Is the prevalence of high blood pressure higher in Woodville or Cunningham?
c. What measure would you use to compare the rates in the two cities? Calculate it
and briefly interpret your result.

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d. Do you think the health promotion campaign in Woodville was successful?

Provide reasons for your answer.

5. Are the measures described in each of the following incidence (cumulative incidence or
incidence rate) or prevalence (point prevalence or period prevalence)? Identify the particular
measure described and provide a brief explanation for your choice.
a. At the time of sentencing, tests conducted in Victorian prisons on 300 prisoners
with sentences of at least two years revealed that 71 had a major psychological
disorder. Follow-up testing 18 months later showed that 165 were categorised as
having a major psychological disorder. The person-time of follow-up between tests
was 464 person-years.
b. In a community with a population of 83,168 people, 657 developed high blood
pressure during a 1-year period.
c. In 2009, a survey of 11,734 13 to 17 year old female secondary school students
found that 37% had smoked marijuana.
d. In a survey of the reproductive histories of Australian women conducted in 2001,
24% were found to have had at least one abortion.
e. 1,658 healthy women were followed for 15 years and 67 developed type II
diabetes.
6. Two investigators were interested in testing the hypothesis that high educational attainment is
associated with more frequent unintentional injuries in the home. To test their hypothesis the
investigators selected a random sample of 5,000 men and women, 21 years of age and older,
living in owner-occupied, single family dwellings in Seattle, Washington, during February
2002. Data were also collected on potential confounders, such as age, sex, income level and
health status. The results of this cross-sectional study were as follows:
• 10% of the sample had high educational attainment (defined as a college degree or
higher) and unintentional injuries in the home in the previous 12 months
• 10% of the sample had high educational attainment but no unintentional injuries in
the home in the previous 12 months
• 20% of the sample had low educational attainment (defined as having no college
degree) and unintentional injuries in the home in the previous 12 months
• 60% of the sample had low educational attainment but no unintentional injuries in
the home in the previous 12 months

Based on this information, calculate and interpret the prevalence rate ratio.