Case Study 4 Preparation

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University of North Carolina, Chapel Hill *

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712

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Statistics

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Feb 20, 2024

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Unit 4. Case Study – Cohort Studies SPHG712: Methods and Measures This case study will be divided up into individual case study preparation and team case study questions. Please complete all the questions in the individual case study preparation ahead of time, and skim over the questions in the team case study section so that you can work efficiently during the time with your team members. Questions to be completed with your team will be colored purple . Please provide answers written as full sentences. INDIVIDUAL CASE STUDY PREPARATION (To be completed prior to group session) & TEAM CASE STUDY QUESTIONS (To be completed with your team) Required Readings: Franks PW, Hanson RL, Knowler WC, et al. Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death. NEJM. 2010;362(6):485-93. Gregg EW. Editorial: Are Children the Future of Type 2 Diabetes Prevention? NEJM. 2010;362(6):548-50. Letters to the Editor Re: Franks PW, Hanson RL, Knowler WC et al. Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death. NEJM. 2010;362(19):1841-2. Krieger N.Chapter 12: Epidemiology – Why epidemiologists Must Reckon with Racism.In Racism: Tools for the Public Health Professional. Ed. Chandra Ford 2019 (p. 254-257). Obesity doesn’t always mean ill health; Here’s what scientists are learning . Science Mag. July 29. 2021. Emerson MA, Montoya T. Confronting Legacies of Structural Racism and Settler Colonialism to Understand COVID-19 Impacts on the Navajo Nation. AJPH. 2021;111(8):1465-69. https://doi-org.libproxy.lib.unc.edu/10.2105/AJPH.2021.306398 (Settler colonialism has been and is experienced by the Pima as well) 1
INDIVIDUAL CASE STUDY PREPARATION STARTS HERE (To be completed prior to group session) After reading the Franks et al 2010 article please answer the following questions: I1. Describe (a) the study participants (the individuals who participated in the study) using the information in Table 1; include the exposure, outcome, and 3 demographic variables in your description, (b) inclusion/exclusion criteria, and (c) how diabetes was determined in the study population. a. The study participants were 4,857 American Indian Children. The exposure was childhood risk factors, and the outcome was premature death (before 55 years old). Three of the demographic variables were BMI, glucose tolerance and blood pressure. b. The study included only the Gila River Indian Community in Arizona which is mainly Pima or Tohono O’odham Indians. The adolescents were to be between 5 and 20 years old and were at least 4/8 Pima or O’odham Indian and did not have diabetes. c. Diabetes was determined by the fasting plasma glucose concentration, higher than 7.0 mmol per liter or 126 mg per deciliter. Or if the 2-hr plasma glucose concentration was 11.1 mmol per liter or 200mg per deciliter. Data adapted from Franks et al. (*some hypothetical) Status at Baseline Endogenous Death by age 55 No Endogenous Death by age 55 Total Person-years Obese status at baseline 66* 1,329 1,394 30,316* Non-obese status at baseline 100* 3,362 3,463 85,794* Total 166 4,691 4,857 116,110 I2. Based on the table above, calculate the following and interpret in words (please show your work). Include the median number of years of follow up for your time interval a. the risk of endogenous death by age 55 in obese children and in non-obese children; Risk exposed = 66/1,394 = 0.0473 x 100 = 4.73 cases per 100 persons Risk unexposed = 100/3,463 = 0.0288 x 100 = 2.89 cases per 100 persons The risk of being obese at baseline and experiencing an endogenous death by age 55 is higher at, 4.73 cases per 100 persons, compared to the risk experiencing an endogenous death by age 55 is 2.89 cases per 100 persons. b. the rate of endogenous death by age 55 in obese children and in non-obese children; Rate exposed = 66/30,316 = 0.00217 x 1,000 = 2.17 cases per 1,000 persons 2
Rate unexposed = 100/85,794 = 0.00116 x 1,000 = 1.16 cases per 1,000 persons Rate Difference (RD) = 2.17-1.16= 1.01 The rate of being obese at baseline and experiencing an endogenous death by age 55 is 1.01 cases higher per person-year compared to those who were not obese at baseline. c. the rate ratio and 95% confidence interval for endogenous death by age 55 in obese and non-obese children. ( Click here to use OpenEpi for calculations, or you can use Stata “immediate” commands) Rate Ratio = 0.00217/0.00116 = 1.87 95% CI = 1.364, 2.545 The rate of being obese at baseline and experiencing an endogenous death by age 55 is 1.87 times those who were not obese at baseline. The 95% CI of 1.36 and 2.55 does not include the null value of 1 and therefore is not statistically significant. 3
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