Test Bank for Gordis Epidemiology 6th by Celentano

Test Bank for Gordis Epidemiology 6th by Celentano

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Chapter 06: The Natural History of Disease: Ways of Expressing Prognosis
Celentano: Gordis Epidemiology, 6th Edition

Test Bank

MULTIPLE CHOICE

1. What is the effective number exposed to risk of dying in the 13- to 24-month interval? Use the
following table to answer the question.
Survival of Patients With Metastatic Cancer Z Following Diagnosis
Interval Alive at Died Withdre Effective Proporti Proportion Cumulative
since beginning during w during number on who who did not proportion
beginning of interva interval exposed died die during who
treatment interval l to risk of during interval survived
(months) dying interval from
enrollment
to end of
interval

x Ix dx Wx I’x qx px Px

1–12 200 10 40

13–24 150 20 30

25–36 100 30 20

37–48 50 40 10

a. 40
b. 90
c. 120
d. 135
e. 160

ANS: D

The effective number of exposed to risk of dying is defined as the “number of alive at beginning
of interval” less “half of number withdrew during interval.” The effective number of exposed to
risk of dying is 130. See the following table.
x Ix dx Wx I’x qx px Px

13–24 150 20 30 140

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Test Bank 6-2

2. What is the probability of dying in those who did not die during the 25- to 36-month interval?
Use the following table to answer the question.
Survival of Patients With Metastatic Cancer Z Following Diagnosis
Interval Alive at Died Withdre Effective Proporti Proportion Cumulative
since beginning during w during number on who who did not proportion
beginning of interva interval exposed died die during who
treatment interval l to risk of during interval survived
(months) dying interval from
enrollment
to end of
interval

x Ix dx Wx I’x qx px Px

1–12 200 10 40

13–24 150 20 30

25–36 100 30 20

37–48 50 40 10

a. 0.30
b. 0.33
c. 0.38
d. 0.67
e. 0.70

ANS: D

The probability who did not die during interval of dying is defined as “1 minus proportion who
died during interval.” The proportion who died during interval equals the “number of deaths
during interval” divided by the “effective number exposed to risk of dying.” The effective
number of exposed to risk of dying is defined as the “number of alive at beginning of interval”
less “half of number withdrew during interval.” See the following table.
x Ix dx Wx I’x qx px Px

25–36 100 30 20 90 0.33 0.67 N/A

= The probability who did not die during interval of dying
= 1 − dx/(Ix − ½  Wx)
= 1 − 30/(100 − ½  20)
= 0.67

3. What is the cumulative probability of surviving to the end of the 4-year follow-up period? Use
the following table to answer the question.
Survival of Patients With Metastatic Cancer Z Following Diagnosis

Copyright © 2020 by Elsevier, Inc. All rights reserved.

Test Bank 6-3

Interval Alive at Died Withdre Effective Proporti Proportion Cumulative

since beginning during w during number on who who did not proportion
beginning of interva interval exposed died die during who
treatment interval l to risk of during interval survived
(months) dying interval from
enrollment
to end of
interval

x Ix dx Wx I’x qx px Px

1–12 200 10 40

13–24 150 20 30

25–36 100 30 20

37–48 50 40 10

a. 0.06
b. 0.11
c. 0.54
d. 0.67
e. 0.89

ANS: A

The cumulative probability of surviving (Px) is a multiplication of the probability of surviving

each interval. For detailed calculation, see the following table.
x Ix dx Wx I’x qx px Px

1–12 200 10 40 180 0.06 0.94 0.94

13–24 150 20 30 135 0.15 0.85 0.80

25–36 100 30 20 90 0.33 0.67 0.54

37–48 50 40 10 45 0.89 0.11 0.06

4. What is the most important assumption in this type of analysis? Use the following table to
answer the question.
Survival of Patients With Metastatic Cancer Z Following Diagnosis
Interval Alive at Died Withdre Effective Proporti Proportion Cumulative
since beginning during w during number on who who did not proportion
beginning of interva interval exposed died die during who
treatment interval l to risk of during interval survived

Copyright © 2020 by Elsevier, Inc. All rights reserved.

Test Bank 6-4

(months) dying interval from

enrollment
to end of
interval

x Ix dx Wx I’x qx px Px

1–12 200 10 40

13–24 150 20 30

25–36 100 30 20

37–48 50 40 10

a. There has been no secular (temporal) change in the effectiveness of treatment or in

survivorship over calendar time.
b. The effect of treatment has improved during the period of the study.
c. The survival experience of people who are lost to follow-up is better than the experience of
those who are followed up.
d. The survival experience of people who are lost to follow-up is worse than the experience of
those who are followed up.
e. An equal number of men and women enrolled each year.

ANS: A

There are two important assumptions made in using life-time table. The first one is that there has
been no improvement on treatment effect. The second one is that the survival experience of
people who are lost to follow-up is same as the experience of those who are followed up. “The
effect of treatment has improved during the period of the study” is not correct. The treatment
effect should be the same during the period of the study. “The survival experience of people who
are lost to follow-up is better than the experience of those who are followed up” and “The
survival experience of people who are lost to follow-up is worse than the experience of those
who are followed up” are not correct. The survival experience of people who are lost to follow-
up should be the same as the experience of those who are followed up. “An equal number of men
and women enrolled each year” is not correct. An equal number of men and women enrolled in
the study does not have any meaning in life-time table.

5. The following table describes the survival of patients treated from disease X from 2015 to
2017 followed for 3 years (assuming no loss to follow-up). What was the probability of surviving
the third year?
Number alive at the end of year
Year of treatment Number of patients treated 1 year 2 year 3 year
2015 100 67 42 30
2016 50 31 18
2017 75 52

Copyright © 2020 by Elsevier, Inc. All rights reserved.

Test Bank 6-5

Totals 225 150 60 30

a. 0.29
b. 0.33
c. 0.61
d. 0.67
e. 0.71

ANS: E

Please see calculations for each year:

P1 = Probability of surviving the first year = 150/225 = 0.67, or 67%
P2 = Probability of surviving the second year = 60/(150−52) = 0.61, or 61%
P3 = Probability of surviving the third year = 30/(60−18) = 0.71, or 71%

6. The following table describes the survival of patients treated from disease X from 2015 to
2017 followed for 3 years (assuming no loss to follow-up). If a person is treated and using all the
information from the table, what is the probability of surviving 3 years after treatment?
Number alive at the end of year
Year of treatment Number of patients treated 1 year 2 year 3 year
2015 100 67 42 30
2016 50 31 18
2017 75 52
Totals 225 150 60 30

a. 0.29
b. 0.33
c. 0.61
d. 0.67
e. 0.71

ANS: A

Please see calculations for each year:

P1 = Probability of surviving the first year =150/225 = 0.67, or 67%
P2 = Probability of surviving the second year = 60/(150−52) = 0.61, or 61%
P3 = Probability of surviving the third year = 30/(60−18) = 0.71, or 71%
Now the probability of surviving 3 years is the product of the probability of surviving each year.
Therefore 0.67  0.61  0.71 = 0.29, or 29%.

7. Which of the following illustrates a violation to one of the assumptions made when using the
Kaplan-Meier method?

a. Some patients who dropped out of the study have a similar probability of survival as those
who remained in it.
b. Patients present the outcome at different time intervals.

Copyright © 2020 by Elsevier, Inc. All rights reserved.

Test Bank for Gordis Epidemiology 6th by Celentano

Test Bank 6-6

c. An event of interest different from death is studied.

d. There is a significant improvement in the treatment of the condition being studied in the
middle of the duration of the study.
e. The median survival time is longer than the duration of the study.

ANS: D

A significant improvement in the treatment of the condition being studied is known as a secular
(temporal) trend. One of the assumptions to use the Kaplan-Meier method is that no secular
trends happen in the duration of the study.

Copyright © 2020 by Elsevier, Inc. All rights reserved.

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