Case Study 4 Preparation
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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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