Tugas : Tutorial Biostatistik Lab 11

A Survival Analysis

Viktor Hendrik S.
15/388250/PKU/18611

MINAT SISTEM INFORMASI MANAJEMEN KESEHATAN (SIMKES)

PROGRAM STUDI ILMU KESEHATAN MASYARAKAT
FAKULTAS KEDOKTERAN
UNIVERSITAS GADJAH MADA
2015
 HOMEWORK 11

A. Please read the Case–Control Study of Human Papillomavirus and Oropharyngeal

Cancer G. D’Souza and Others - 10 May, 2007 in the New England Journal of medicine.
The investigators were looking for associations between HPV and oropharyngealcancer.
Use the table 3 to answer questions 1-5.

1. In Table 3:
(a) There is no association between having Positive Oral HPV-16 infection and
oropharyngeal cancer because the confidence interval does not cross 1.0.
(b) There is a 33.3-fold increase in oropharyngeal cancer in patients seropositive for
E6 or E7 but it is not statistically significant.
(c) There is a 32.2-fold adjusted increase in the odds of oropharyngeal cancer for
those with Seropositive HPV-16 L1 serologic status and it is statistically significant.
(d) The data cannot be interpreted because the numbers are too sparse.
 (e) According to these data, patient who were seropositive for HPV-16 L1 were less
likely to develop oropharyngeal cancer.
2. Calculate the unadjusted risk ratio for the risk of oropharyngeal cancer in patientswho
were positive for oral HPV-16 infection.
(a) 17.6
(b) 11.4
(c) 3.06
(d) 8.0
(e) Cannot calculate from the information given

3. What statistical method was used to calculate the “adjusted odds ratios” given in the
table?
(a) Linear regression
(b) Cox regression
(c) Poisson regression
(d) Logistic regression
(e) Multiple 2x2 tables

4. The unadjusted odds ratio for HPV-16 L1 seropositivity is 17.6 but the adjusted odds
ratio is 32.2. How do you explain this difference?
(a) This is most likely an error—as adjustment for confounding should always reduce
the magnitude of the odds ratio.
(b) The change is irrelevant since both odds ratios are statistically significant anyway.
(c) The unadjusted odds ratio was an underestimate—which could happen if some
of the confounders were inversely related to exposure or disease.
(d) Since both odds ratios are statistically significant, this indicates that there is little
confounding going on.
(e) The unadjusted odds ratio was artificially inflated due to confounding.
 5. Which of the following represents the correct statistic for comparing oral HPV
infection prevalence in cases versus controls?

Answer: C
B. The following figure displays the Hazards Ratios derived from five different
Coxregression models. Use the table 4 from the article in the NEJM available in the
webas follow:http://content.nejm.org/cgi/reprint/356/11/1099.pdf

Please answer questions 1-4 belows.

1. Which of the following is the result of an unadjusted (univariate) analysis?
(a) Female sex.
(b) 1.039 (1.012-1.066)
(c) 1.023 (0.997-1.049)
(d) None of the above. Since this is a Cox-Regression, it is always an adjusted
(multivariate) analysis.
 2. Weekend admission is a statistically significant predictor of death in all the
following except?
(a) Model 1 (column 1)
(b) Model 2 (column 2)
(c) Model 3 (column 3)
(d) Model 4 (column 4)
(e) Model 5 (column 5)

3. According to the statistical modeling performed by the authors, which of then

following variable groups may be explaining the increased risk of death amongpatients
admitted on the weekends for treatment of M.I.?
(a) Age of patient and female sex.
(b) Mechanical and arrhythmic complications.
(c) Longer length of stay when patients are admitted on the weekend.
(d) No invasive cardiac procedure within 30 days of admission.

4. Which of the following pair reflects the 1) PRIMARY INDEPENDENT VARIABLE

of interest AND the 2) DEPENDENT VARIABLE in this table of Cox
RegressionModels.
(a) Primary Indep: Weekend Admission. Depend Variable: Cardiac Intervention
Procedures (including catheterization, PCI, and CABG).
(b) Primary Indep: Cardiac Intervention Procedures (including catheterization, PCI,
and CABG). Depend Variable: Time to Death.
(c) Primary Indep: Weekend Admission. Depend Variable: Time to Death.
(d) Primary Indep: Age. Depend Variable: Time to Death.

C. The following figure displays the Kaplan-Meier curves from a randomized trial
comparing botulism toxin A with botulism toxin B for the treatment of cervical dystonia
(n=122). Patients were followed until their pain returned or until they were censored.

1. Which of the following can be concluded directly from the figure?

 Figure 1: The Kaplan-Meier curves from a randomized trial comparing botulism
toxin A
with botulism toxin B for the treatment of cervical dystonia

(a) Botulism toxin A is a better drug for treating cervical dystonia than toxin B.
(b) Botulism toxin B is a better drug for treating cervical dystonia than toxin A.
(c) The median time to return of pain was longer in the botulism toxin A group
than the B group.
(d) The median time to return of pain was longer in the botulism toxin B group
than the A group.
(e) There is a statistically significant difference between the treatments

2. The authors also ran a univariate Cox regression to get the hazard ratio comparing
treatment A to treatment B for the outcome return of pain. The hazard ratio from this
model will be:
(a) =1.0
(b) > 1.0
(c) < 1.0
(d) _ 1.0
(e) _ 1.0
3. The median time to return of pain in the botulism toxin A group was approximately:
(a) 0 weeks
(b) 5 weeks
(c) 12 weeks
(d) 14 weeks
 (e) 25 weeks

4. The estimate of survival from pain for the botulism toxin A group at 19 weeks is
about:
(a) 100%
(b) 80%
(c) 70%
(d) 50%
(e) 30%