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Epidemiology HW

At the beginning of the semester you read and analyzed in your groups a newspaper article discussing the potential role of soda consumption in the American obesity epidemic. Many of you were quite skeptical of the reported findings. Now you have a chance to examine the association for yourself (and contribute to the literature).

Scenario I: (22 points)

You are given sufficient funding to complete a case-control study of 200 individuals examining the association of obesity and soda consumption. You select 100 individuals aged 25 to 35 years that are normal weight (BMI category of 19 – 25) and 100 individuals who are obese (BMI > 30 and <40). You know that obesity does not happen over night so you decide it is important to ask your study population of 25 to 35 year olds to tell you about their soda intake while they were in their teens (10 up to 20 years of age). For your initial analysis, you divide up the self-reported soda consumption data into two groups: high (3 or more 12 oz sodas daily) and low (less than 36 oz soda per day) intake. Forty of your normal weight participants report low soda intake in their teens. Thirty of your obese participants report low soda intake. Respond to the following questions:

1. State your test-able research question. Keep in mind this is a case-control study. (2 points)

2. Set up (draw out) your 2 by 2 table of your study. Be sure to include all appropriate labels and numbers (13 pts – should be completing 13 ’cells’ or boxes)

3. Using the appropriate effect measure for this study design, how does the risk of obesity differ by soda consumption? Show your calculation and give your answer to two decimal places. (3 points)

4. Interpret your measure of association (findings). (2 points)

5. What is one primary strength of your case-control study? (1 point)

6. What is one primary weaknesses of your case-control study? (1 point)

Scenario II: (14 points)

You are given sufficient funding to develop a cohort study examining the association of obesity and soda consumption. You want to develop the best cohort study you can with the funded opportunity you’ve been provided. You realize that there are many studies that have routinely surveyed nationally-representative groups of the American population along with many large U.S. cohort studies. Most of these studies will provide access to data to investigate important questions (Examples: NHIS, NHANES, Framingham Health study, American Cancer Society cohorts, California Teachers Study, Multiethnic cohort study, Physician’s Health Study, Nurses’ Health Study, Women’s Health Initiative, etc).

Your plan is to use the information from NHANES I – the Epidemiologic Follow Up Study.

Here is some information about the NHANES I Epidemiologic Follow-Up Study (NHEFS) taken directly from the website:

The NHANES I Epidemiologic Follow-up Study (NHEFS) is a national longitudinal study that was jointly initiated by the National Center for Health Statistics and the National Institute on Aging in collaboration with other agencies of the Public Health Service. The NHEFS was designed to investigate the relationships between clinical, nutritional, and behavioral factors assessed in the first National Health and Nutrition Examination Survey NHANES I and subsequent morbidity, mortality, and hospital utilization, as well as changes in risk factors, functional limitation, and institutionalization.

The NHEFS cohort includes all persons 25-74 years of age who completed a medical examination at NHANES I in 1971-75 (n = 14,407). It is comprised of a series of follow-up studies, four of which have been conducted to date. The first wave of data collection was conducted for all members of the NHEFS cohort from 1982 through 1984. It included tracing the cohort; conducting personal interviews with subjects or their proxies; measuring pulse rate, weight, and blood pressure of surviving participants; collecting hospital and nursing home records of overnight stays; and collecting death certificates of decedents.

Continued follow-up of the NHEFS population was conducted in 1986, 1987, and 1992 using the same design and data collection procedures developed in the 1982-1984 NHEFS, with the exception that a 30-minute computer-assisted telephone interview was administered rather than a personal interview; and no physical measurements were taken. The 1986 NHEFS was conducted for members of the NHEFS cohort who were 55-74 years of age at their baseline examination and not known to be deceased at the 1982-1984 NHEFS (n = 3,980). The 1987 NHEFS was conducted for the entire non-deceased NHEFS cohort (n = 11,750). The fourth wave of data collection, the 1992 NHEFS, includes the entire non-deceased NHEFS cohort (n = 11,195). Tracing and data-collection rates in the NHEFS have been very high. Ninety-six percent of the study population has been successfully traced at some point through the 1992 follow-up. Tracing rates for each completed wave ranged from 90 to 94 percent and interview rates ranged from 91 to 96 percent of those traced.

In brief, NHEFS has demographic, dietary and physical examination data from 14,407 Nationally representative adults that were 25 to 74 years of age in 1971-1975 when each was first assessed. In 1987 and again in 1992, all of the original NHEFS participants that were not deceased were interviewed for follow up assessments. While the initial cohort was more than 14,000 adults, you have data from three timepoints (1971-75, 1987 and 1992) on 11,195 adults.

Respond to the following questions:

1. State your research question for this cohort study. (2 points) Please note: A research question must be test-able!

2. What confounders do you want to potentially include in your analyses and why? It is important to be specific and inclusive. (4 points)

3. What bias might be concerning? Why? (in other words, if you don’t account for this bias, how may it affect your results?)- select one very important potential bias only but make sure you describe it well. (i.e name, describe how the bias can happen, what may be the effect on the measure of association, why it may cause the effect) (4 points – 1 point for each part of the description)

4. What is the name of the primary measure of association you would use for your cohort study? (2 points)

5. Why would your cohort study by advantageous in comparison to the case-control study? (primary reasons) (2 points)

3. Direct standardization problem. (possible 32 points of 24; in other words - 8 possible bonus points for your overall grade)

We are in the midst of the COVID-19 pandemic. The Arizona Department of Health Services (ADHS) publishes daily updates of COVID-19 case rates, testing, and mortality information for Arizona and its 15 counties. The information for this problem is from the ADHS and census websites. Keep in mind that we are examining COVID19 cases in this problem, rather than mortality.

Table A shows the approximate COVID-19 case rates in the two Counties, as of December 1st, 2020.

1. Compute the crude case rates per 100,000 persons for each county. Show your work and give your answer as per 100,000 people with no decimal places. (2 points)

Table B provides a summary of the number of COVID19 cases by age group in Yuma and Maricopa Counties. Those under the age of 45 years is 61.0% of the population of Yuma, 45-64 years is 19.6% of Yuma County and 65 and older is 19.3%. The comparison percentages for age groups in Maricopa County is 60.4%, 24.0% and 15.5%, respectively.

1. Compute the age-group specific case rates per 100,000 persons for each county. Show your work and give your answer as per 100,000 with no decimal places. (8 points)

1. When examining age-group specific COVID19 case rates, what does a comparison between the two counties indicate? (2 points – should note two separate findings in the comparison)

1. Complete Table C, calculating the age-adjusted COVID19 case rate for each of Yuma and Maricopa County. Use the total of the two County populations as the standard. (16 points)

1. Compare and interpret the crude and age-adjusted case rates for the two Counties. (2 Points)

1. The COVID19 case rate in Arizona at this same timepoint (12/01/2020) is 4743 cases per 100,000 people. How does the case rate in Yuma and Maricopa Counties compare to the overall State case rate? What does that comparison indicate for the other 13 counties? (2 points)