IHP 330 Module Two Worksheet (1)

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Southern New Hampshire University *

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Health Science

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Jul 2, 2024

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IHP 330 Module Two Worksheet Complete this worksheet by replacing the bracketed text with the relevant information. Part 1: Measuring Disease A causal relationship between cigarette smoking and lung cancer was first suspected in the 1920s based on clinical observations. To test this apparent association, numerous epidemiologic studies were undertaken between 1930 and 1960. Two studies were conducted by Richard Doll and Austin Bradford Hill in Great Britain. The first was a case-control study begun in 1947; it compared the smoking habits of lung cancer patients with the smoking habits of other patients. The second was a cohort study begun in 1951; it recorded causes of death among British physicians in relation to smoking habits. This case study deals first with the case-control study and then with the cohort study. Data for the case-control study were obtained from hospitalized patients in London and the vicinity over a four-year period (April 1948–February 1952). Initially, 20 hospitals, and later more, were asked to notify the investigators of all patients admitted with a new diagnosis of lung cancer. These patients were then interviewed concerning smoking habits, as were controls selected from patients with other disorders (primarily nonmalignant) who were hospitalized in the same hospitals at the same time. Data for the cohort study were obtained from the population of all physicians listed in the British Medical Register who resided in England and Wales as of October 1951. Information about present and past smoking habits was obtained by using a questionnaire. Information about lung cancer came from death certificates and other mortality data recorded during the ensuing years. Over 1700 patients with lung cancer, all under age 75, were eligible for the case-control study. About 15% of these persons were not interviewed because of death, discharge, severity of illness, or inability to speak English. An additional group of patients were interviewed but later excluded when the initial lung cancer diagnosis proved to be mistaken. The final study group included 1,465 cases (1,357 males and 108 females). The following table shows the relationship between cigarette smoking and lung cancer among male cases and controls: Table 1: Relationship between cigarettes and lung cancer Patient Type Cases Controls Cigarette Smoker 1,350 1,296 Nonsmoker 7 61 Total 1,357 1,357 1. Calculate the proportion of cases that smoked. Be sure to show your calculations. 1,350 ÷ 1,357= 0.99484156  99.48% 2. Calculate the proportion of controls that smoked. Be sure to show your calculations. 1,296 ÷ 1,357= 0.9550479  95.5% This worksheet was modified using information from the original case study found on the CDC website: Centers for Disease Control and Prevention. (2003). Cigarette smoking and lung cancer. Centers for Disease Control and Prevention Epidemiology Program Office Case Studies in Applied Epidemiology , 731–703. https://www.cdc.gov/eis/downloads/xsmoke-student-731-703.pdf

3. Calculate the odds ratio with the correct equation, and interpret the calculation betweeen smoking and lung cancer. What can you infer from the odds ratio about the relationship between smoking and lung cancer? (1,350 × 61) ÷ (1,296 × 7) = 82,350 ÷ 9,072 = 9.07738095  9.08 The odds ratio is calculated at 9.08. This shows that the people who are smokers are 9 times more likely to develop cancer than those individuals who do not smoke. Table 2 shows the frequency distribution of male cases and controls by the average number of cigarettes smoked per day. Table 2: Daily Cigarette Consumption Daily Number of Cigarettes Number of Cases Number of Controls Odds Ratio 0 7 61 Referent 1–14 565 706 6.97 15–24 445 408 9.50 25+ 340 182 16.28 All smokers 1350 1296 9.08 Total 1357 1357 8.71 4. Calculate the odds ratio by category of daily cigarette consumption, comparing each category to nonsmokers. Be sure to show your calculations. Replace the bracketed text with the calculated ratios. o (61 × 565) ÷ (7 × 706) = 34,465 ÷ 4,942 = 6.97389721  6.97 o (61 × 455) ÷ (7 × 408) = 27,145 ÷ 2,856 = 9.5045518  9.50 o (61 × 340) ÷ (7 × 182) = 20,740 ÷ 1,274 = 16.2794349  16.28 o (61 × 1350) ÷ (7 × 1296) = 82,350 ÷ 9,072 = 9.07738095  9.08 o (61 × 1357) ÷ (7 × 1357) = 82,777 ÷ 9,499 =8.71428571  8.71 5. Interpret these results and describe the trends or patterns you see in the data. The results shows the odds ratio increases when more cigarettes are smokes daily. This can increase the chances of cigarette smokers being diagnosed with lung cancer. This worksheet was modified using information from the original case study found on the CDC website: Centers for Disease Control and Prevention. (2003). Cigarette smoking and lung cancer. Centers for Disease Control and Prevention Epidemiology Program Office Case Studies in Applied Epidemiology , 731–703. https://www.cdc.gov/eis/downloads/xsmoke-student-731-703.pdf

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