EPID 6430 Advanced Epidemiology

EPID 6430 Advanced Epidemiology

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EPID 6430 Advanced Epidemiology

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EPID 6430 Advanced Epidemiology

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Course Code: EPID6430
University: The University Of Newcastle

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Country: Australia

Questions:

Question 1  
A few surgeons seek your advice (as the local epidemiologist) concerning a study they would like to conduct to determine the effect of tonsillectomy on subsequent mortality. What might you recommend? 
Question 2 
What method(s) of sampling would you use to determine the following? Give brief reasons for your choice.a) Prevalence of asthma in 4-year-old residents in Canberra? 
b) Prevalence of diabetes mellitus in Australia. 
c)  Measles vaccine coverage in a district of Papua New Guinea.  

Answer:
Recommendations made
Epidemiological studies are aimed at revealing any unbiased relationships between different exposures which can include alcohol, stress, biological factors, mortality or morbidity. Identifying this causal relationship is crucial in any study. Establishing the exposure and outcome is a critical aspect 1. Thus, in this case, there is a determination of causality and effect between tonsillectomy and mortality which is the eventual outcome. Thus in order to undertake a successful study, a case-control study shall be undertaken. In this case, individuals with disease positive are compared against disease negative. Case-control reviews past action at exposure period which both groups have encountered and association created based on outcomes . 
Sampling methods to be used and their reasons

Prevalence of asthma in 4-year-old residents in Canberra? (2 marks)

Purposive sampling

This method of sampling allows for subjective or selective of the subjects to participate in the study. A researcher may choose a representative sample to suit their needs based on their specific characteristics. In this study, only residents who have lived for 4 years in Canberra are selected to participate in the study while those who don’t meet these criteria are not selected to participate in the study3. 

Prevalence of diabetes mellitus in Australia. 

Simple random sampling

In this assessment study, the respondents will be chosen through chance and all the population of Australia has an equal chance. This method is crucial as it gives error sampling to be calculated and reduces selection biases. Thus all the population has an equal chance of selection to assess diabetes prevalence. 

Measles vaccine coverage in a district of Papua New Guinea.  

Clustered sampling

This technique allows for identification and selection of population subgroups compared to undertaking individual selection. The population under this consideration are the clusters which in this case Papua district being defined for the coverage assessment to be undertaken .
Statistics table

 

Alcohol consumption group

Number of

None

Occasional

Light

Moderate

Heavy

Subjects

466

1845

2544

2042

832

Deaths

41

142

143

116

62

Calculate the risk and the relative risk  

Alcohol consumption

Subjects

Deaths

None

466

41

Occasional

1845

142

Light

2544

143

Moderate

2042

116

Heavy

832

62

Relative risk for occasional drinkers to die
RR = a(a+b)/c(c+d)
=466(507)/1845(1987)
= 0.919/0.928
= 0.99
 
= the risk of dying for occasional drinkers is less likely to occur.
Relative risk for light drinkers to die
RR = a(a+b)/c(c+d)
=466(507)/2544(2687)
= 0.919/0.946
= 0.97 
= the risk of dying for light drinkers is less likely to occur.
Relative risk for moderate drinkers to die
RR = a(a+b)/c(c+d)
=466(507)/2042(2158)
= 0.919/0.946
= 0.971 
= the risk of dying for occasional drinkers is less likely to occur.
Relative risk for heavy drinkers to die
RR = a(a+b)/c(c+d)
=466(507)/832(894)
= 0.919/0.93
= 0.98 
= the risk of dying for heavy drinkers is less likely to occur.

Conclusions and reasoning behind the rationale given.  

The conclusion s on the above is misleading in that intervening factors were not controlled during the study. This can be seen with the rate of none drinkers having more deaths observed hence meaning that deaths being witnessed are merely caused by other factors rather than the drinking of alcohol.
For an effective study, prospective study will be undertaken and followed among the drinkers of alcohol. Data collection tools to be used include follow up questionnaires, surveys, follow-up assessment. The variables of importance in this study will be the disease status of the respondents, a number of alcohol drinking per volume consumed, frequency of intake and type of alcohol consumed.
Statistics table
The death rate by cause of death and by cigarette habit at last survey:

Cause of death

Annual death rate per 100,000 men

Non-smokers

Current smokers (cigarettes/day)

All smokers

1-14

15-24

>25

Lung Cancer
 

10

78

127

251

140

Ischaemic Heart Disease

413

608

652

792

669

Part A

Type of study presented (1 mark)

The prospective study which detailed assessments during baseline and severally after baseline year and up to end of the study in 1971 

The advantage of this study in ascertaining causal cause (1 mark)

Prospective study help in determining risk factors for the smokers due to being observed longitudinally while results collected at regular intervals, hence recall error is reduced. 

Advantages of using the register.  
The advantage of using professional workers is that needed or the right information will be sought in the study. Hence getting accurate data. 

31% of men did not complete the questionnaire due to.  

This can lead to biases due to the loss of follow up. 

Part B
The Risk Ratios and Attributable Risk between non-smokers and different smoking exposures, for the outcomes of lung cancer and ischaemic heart disease

Smoking habit
(cigarettes/day)

Risk Ratios

Lung Cancer

Ischaemic heart disease

1-14

7.8

1.5

15-24

12.7

1.6

>25

25.1

1.9

All smokers

14.0

1.6

 

Smoking habit
(cigarettes/day)

Attributable Risk

Lung Cancer

Ischaemic heart disease

1-14

68

195

15-24

117

239

>25

241

379

All smokers

130

256

 
Disease strongly associated with lung cancer. 
Ischemic heart attack

The etiological fraction of cases among the exposed population which the disease has played a crucial role
There are an excess fraction of cases which have occurred during the same period among the exposed population causing a high death rate per day compared to lung cancer5.

Calculation of proportion of all deaths from lung cancer and ischaemic heart disease attributable to smoking in the population (2 marks)

 

Lung cancer

Ischemic heart attack

Smokers

140

669

Non-smokers

10

413

Relative risks
RR = a/(a+b)/c/(c+d)
= 140(809)/10/(423)
= 0.17/0.02
= 8.5
Pe  =It is calculated as A F p = P e ( R R − 1 ) 1 + P e ( R R − 1 ) {displaystyle AF_{p}={frac {P_{e}(RR-1)}{1+P_{e}(RR-1)}}}
= Pe(RR-1)/1+Pe(RR-1)
= 1232(8.5-1)/(1+1232(8.5-1)
= 164.26/9241
= 0.017

Choice of male gender of the medical profession due to (2 marks)
This study employed purposive sampling where the subjects were chosen purposively which suited the needs of the study. The investigators wanted to avoid low response rates (6). 

References 

Advantages & Disadvantages of Cohort Studies(Internet). Accessed at https://sphweb.bumc.bu.edu/otlt/MPHModules/EP/EP713_CohortStudies/EP713_CohortStudies5.html. Viewed on 13/09/2018
Cohort Studies(Internet). Accessed at https://sphweb.bumc.bu.edu/otlt/MPH-Modules/EP/EP713_CohortStudies/EP713_CohortStudies_print.html. viewed on 13/09/2018
Ben-Shlomo Y, Brookes S, Hickman M. Lecture notes Epidemiology, evidence-based medicine, and public health. John Wiley & Sons; 2013 Jan 30.
Robertson LS. Injury epidemiology. Lulu. com; 2015 Sep 12.
Attributable Riskand Population Attributable Risk (PAR) Measures, (Internet). Accessed at https://www.med.uottawa.ca/sim/data/PAR_e.htm. viewed on 13/09/2018
Hennekens CH, Buring JE. Analysis of epidemiologic studies: evaluating the role of confounding. Epidemiology in medicine. 1987:287-323.

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