Case Study 2 Preparation
docx
keyboard_arrow_up
School
University of North Carolina, Chapel Hill *
*We aren’t endorsed by this school
Course
712
Subject
Medicine
Date
Feb 20, 2024
Type
docx
Pages
4
Uploaded by ColonelMonkey4004
INDIVIDUAL CASE STUDY PREPARATION
(To be completed prior to class session/live meeting)
Objectives
1.
Distinguish between incident and prevalent cases in case definitions
2.
Identify leading causes of death in the US and globally
3.
Calculate
and interpret
measures of disease occurrence (prevalence, risks, rates) 4.
Describe
how participants contribute person-time in cohort studies
5.
Critically reflect on the use of the variable race to describe disease patterns in the population
In the set of questions
, we’ll focus on applications of measures of occurrence to topics hypertension, opioid overdoses, and racism. Measures of occurrence can be used to describe disease and/or “exposure” patterns. Many diseases are the result of a complex web of environmental, social, structural, cultural, economic “exposures.” As public health practitioners,
measures of occurrence also impact how we understand a public health issue and identify opportunities of intervention.
In this week’s case study, individual case study questions are interspersed with team case study
questions. Answer the questions in black
for your individual case study preparation, and those in green with your teammates. Case Definitions
In this course we discussed the critical importance of a clear case definition. For national and state statistics on disease morbidity and mortality in the US, as well as around the world, the International Classification of Disease 10 (ICD-10-CM) codes are often used. The CDC regularly posts updates on the ICD classifications here.
Given the previous case study topic of high blood pressure among cooks using traditional cook stoves, let’s start with the example of high blood pressure (i.e. hypertension). We will use the
I10
ICD-10-CM code for a case definition of “primary” hypertension. Hypertension is defined by the American College of Cardiology (ACC) as follows: Hypertension (stage 1) is defined by blood pressure cut points of >=130mm Hg (systolic) or >80mm Hg (diastolic). Stage 2 hypertension is defined as >=140mm Hg or >90mm Hg. Until fall of 2017, hypertension was defined as >=140mm Hg (systolic) or >90mmHg (diastolic). See the ACC Definition* and brief overview of 2017 change
and the American Heart Association Definition
.
I1.
Please answer the questions below.
a.
Define an incident case of hypertension in the context of a 5-year time period.
An individual, participating in a 5-year case study on the risk of hypertension, was diagnosed with hypertension at year 4 of the study. This individual is now an incidence case of hypertension as the individual was diagnosed during the 5-year time period in which the study was being conducted. b.
Several of your organization’s funders have asked you to describe the issue of hypertension and traditional cookstove use within the context of the ranking of cardiovascular disease mortality in the US and globally. Use Table 1 above from the CDC data sheet,
the WISQARS
site, and the Institute for Health Metrics and Evaluation Data Visualization tool (below). Course lecture slides include data from 1990 and 2010. The Global Burden of Disease website has updated data, including those for 2019. To review 2019 data, follow this link
.
Once at the “GBD Compare | Viz Hub”, click on the various “Settings” options along the left-hand side of the screen to ensure they match those in the screen shot below. To view tables similar to those provided in the lecture slides, make sure to click on the “arrow diagram” option (indicated with green below). Compare the five leading causes of death in the US and globally. How similar are the leading causes of death in the US and globally in 2019?
Globally - 2019: 1. cardiovascular disease 2. Neoplasms 3. Chronic Respiratory 4. Respiratory infections & TB 5. Diabetes & CKD
U.S. – 2019: 1. cardiovascular disease 2. Neoplasms 3. Chronic Respiratory 4. Neurological Disorders 5. Diabetes & CKD
The leading cause of death Globally and in the US were almost the same except for #4 where globally it was Respiratory infections & TB and in the US it was Neurological disorders. In both scenarios the other option was ranked #7, too.
I2.
Consider Figure 1
. on person-time in Ranapurwala et al 2018
. How many person-years does person 7 contribute to the study? Explain
Person 7 contributes 7 person-years because they began the study later and were incarcerated two times and person-years were not counted during incarceration. I3.
Use Stata to answer the following questions. First, import the Excel data file (“Week 1-3 Cook stove Data and Codebook”) into Stata. See the tutorial for reading Excel files into Stata for step-by-step instructions. Select the “Data” spreadsheet for analysis. Second, include the Stata output you use to answer the questions as an appendix (using screen
shots, cut and paste, or your preferred method). Calculate and interpret the incidence “rate” of high blood pressure in the total cohort.
The IR or incident rate command = ir=outcome exposure person-time = ir HI_BP TRAD_COOK PERSONDAYS. IR of the total cohort = incident case/total person-time = 92/435135 person-days = 0.000203 x 10,000 person-days = 2.03/10,000 person-days.
The incident rate of high blood pressure in the total cohort is 2.03 cases per every 10,000 person-days. Measures of Occurrence & Race and Racism as Variables In your work as a public health professional, you will encounter the variable race used as a descriptor variable. During this semester we will examine and discuss how the variable is used and how data patterns are described, interpreted, and communicated.
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
Please read p. 250 and Box 12-1 in Chapter 12: Epidemiology-Why Epidemiologists Must Reckon
with Racism by Nancy Krieger, In “Racism: Science and Tools for the Public Health Professional
” ed. Chandra Ford. For the next set of questions, please refer to Figure 1, Panels, A, B, and C
in Kramer MR, Black NC, Matthews SA, James SA. The legacy of slavery and contemporary declines in heart disease mortality in the U.S. South
. SSM Popul Health. 2017 Dec;3:609-617. I4.
Use Figure 1, Panels B&C
, to describe the pattern in percent decline in mortality among the two groups in a sentence or two. The percent decline in mortality is higher in areas of the deep south with higher rates of white Americans compared to Black Americans meaning Black Americans have a higher rate
of mortality in respect to heart disease.