Name:

NUTR 510

FALL 2018

PROBLEM SET

DUE DATE: 9/14/18, 11:59pm

Please work independently to complete this assignment. Please submit via the digital dropbox on
Compass and provide a hard copy. Please show all of your work to receive full credit.

1. The total fertility rate (TFR) and life expectancy are both "period" measures, in that each
measure summarizes age-specific rates at a given point (or short interval) of time.
However, the TFR is simply the sum of the age-specific fertility rates for each year of age
between 15 and 44 or 49, whereas life expectancy requires a life table to calculate. What
key difference between fertility and mortality leads to the use of a different approach to
summarize the age-specific rates? (8)

The key difference is that fertility considers only in female population while mortality
considers both male and female population.

2. In a study of risk factors for angina (chronic chest pain or discomfort), subjects were
asked the question, “Do you smoke cigarettes?” Answers were used to classify each
respondent as a smoker or non-smoker. Furthermore subjects were classified as positive
for angina if they had, at some time in the past, been told by a doctor that they had
angina.
When the resultant data was analyzed, no association was found between cigarette
smoking status and angina status. (25)
a. Has the study measured incidence or prevalence of angina?
Prevalance
b. Suggest possible reasons why the study here failed to find an association between
cigarette smoking and angina.
They must have asked if they got angina after they started smoking and they failed to
ask if they stopped smoking due to angina also they failed to take into consideration
of passive smoking
c. How might you redesign this study to consider the characteristics of the population
you would like to recruit, the critical period for the development of angina, as well as
how to measure your exposure (smoking status).
Did you ever have angina? Were/are you smoking when you had angina either actively or
passively?
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3. A group of researchers met to plan a study of causes of poor eating habits among graduate
students. After the meeting, the group left their building, and walked outside into a raging
snowstorm. Their planning notes were ripped from their hands, and tossed to the street. Although
the notes were recovered, they were hopelessly mangled and out of order. Suppose that you were
the team member who offered to re-construct the notes. Describe in a logical order the steps that
the team should undertake to develop, test, and evaluate a hypothesis on the causes of poor eating
among graduate students. Be sure to also discuss how you plan to focus your hypothesis in terms
of: A. will you study all graduate students? Will you study graduate students in certain
disciplines? Will you restrict your population to a single university? Public or private
universities? B. How will you define “poor” eating habits? C. How will you measure eating
habits? (20)
Ideally, I would study all graduate students if possible. But as that is not possible I would
randomly select few students from all the disciplines. I would make sure the study
includes all groups of graduate students like students living in dorms and students living
off campus. I would also try to get information from both public and private universities a
few of each.
I would define poor eating habits as people who are not meeting their daily requirement
of nutrients, not just calories but also a wholesome diet. I would try to get information
about their diet (what it includes, if it is a wholesome diet or not?)
I would make a simple questionnaire asking how any meals do they have in a day, what
they have in each meal? How wholesome and how many extra calories they are taking in
everyday (or in a week).

4. Suppose that you began a one-year study of tuberculosis (TB) in a subsidized housing
community in the Lower East Side of New York City on January 1st, 2016. You enrolled
500 residents in your study and checked on their TB status on a monthly basis. At the
start of your study on January 1st, you screened all 500 residents. Upon screening, you
found that 20 of the healthy residents were immigrants who were vaccinated for TB and
so were not at risk. Another 30 residents already had existing cases of TB on January 1st.
On February 1st, five residents developed TB. On April 1st, five more residents
developed TB. On June 1st, 10 healthy residents moved away from New York City were
lost to follow-up. On July 1st, 10 of the residents who had existing TB on January 1st
died from their disease. The study ended on December 31, 2016. Assume that once a
person gets TB, they have it for the duration of the study, and assume that all remaining
residents stayed healthy and were not lost to follow-up. (consider drawing a schematic)
(26)

Jan 1 500 (20 vaccinated, 30 already have TB) – 450 at risk ,30 TB/500
Feb 1 5more have TB - 445 at risk, 35 TB/500
Apr 1 5 more have TB - 440 at risk, 40 TB/500
June 1st 10 healthy moved away - 430 at risk, 40 TB/490
July 1st 10 people with TB died - 430 at risk, 30/480
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a.Is the subsidized housing community in the Lower East Side of New York City a
dynamic or fixed population? Briefly explain the rationale for your answer.
It would generally be a fixed population because there are generally only a fixed number
or people who can stay in that community and most of them are from low income
population. But if we consider a tiny portion of population dying every year and new
people coming in every year it is a little dynamic. But for the study period od one year it
is mostly a fixed population.

b. What was the prevalence of TB in the screened community on January 1st?

30 cases / 500 people
c. What was the prevalence of TB on June 30th?
40/490
d. What was the cumulative incidence of TB over the year?

e. Suppose that you wanted to calculate the incidence rate of TB in the study population.
Calculate the amount of person-time that would go in the denominator of this
incidence rate. Be sure to show your work.
10 people 5 months
10 people 6 months
480 people 1 year
Total of 489.16 person years

5. Results from an epidemiological study were recently published in an article titled

“Green Tea Consumption and Mortality among Japanese Elderly People: The Prospective
Shizouka Elderly Cohort.” The following information comes from the published article:

BACKGROUND:
Green tea has been extensively studied for its potential preventive role, especially for
cardiovascular disease and cancer. Data from animal studies support this role, but the
results of prior epidemiological studies have been inconsistent, and so the effects of green
tea remain unclear in humans.
PURPOSE:
To investigate the association between green tea consumption and mortality from all
causes, cancer, and cardiovascular disease among elderly people.
METHODS:
A total of 22,200 elderly residents (aged 65-84 years) were randomly chosen from all 74
municipalities in the Shizuoka prefecture in Japan. The Shizuoka prefecture has a
population of 3.8 million people among 1.3 million households. A total of 14,001 of the
randomly selected residents agreed to participate in the study and returned the study
questionnaire, in December 1999. The questionnaire included an item on current green
tea consumption. Participants were followed for up to 6 years from submission of their
questionnaire to December 2005 to determine who died and their causes of death. These
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data were analyzed to determine levels of green tea consumption among participants
(which ranged from less than 1 cup/day to more than 7 cups/day) and the relationship
between green tea consumption and mortality from all causes, cancer, and cardiovascular
disease. (80)

a. Use the information given above to describe one hypothesis being tested in this study.

Remember to include all of the key components of a good hypothesis.

Consumption of more than or equal to 7 cups of green tea decreases the incidence of
cardio vascular diseases and cancer

b. State the “index” group and the “comparison/reference” group for the hypothesis described
in part a.

Index group would be the population who drink greater than or equal to 7 cups and the
comparison group is people who drink less than 7 cups of tea

c. Are the residents of the Shizuoka prefecture considered members of a fixed or dynamic
population? Justify your choice in one to two sentences.

d. Are the residents who returned the study questionnaire considered members of a fixed or
dynamic population? Justify your choice in one to two sentences.

e. The following table describes some characteristics of the participants at enrollment.

Green Tea Consumption at Enrollment

Characteristics at Enrollment <1 cup/day 1-3 cups/day 4-6 cups/day >=7 cups/day

N=321 N=2,981 N=5,970 N=2,979

N % N % N % N %

Sex

Male 209 65.1 1,621 54.37 2,859 47.96 1,542 51.81

Female 112 34.9 1,360 45.62 3,111 52.19 1,437 48.28

Physical Activity Level

No exercise 201 62.6 1,557 52.2 2,810 47.0 1,299 43.6

Some exercise each day 120 37.4 1,424 47.8 3,160 53.0 1680 56.4

a. Fill in the percentages that describe the proportion of male and female participants according to
green tea consumption in the shaded boxes above.
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b. Describe in words and numbers the relationship between physical activity and green tea
consumption among study participants at baseline.

People who had more green tea had more physical activity or people who had more green tea
were more physically active.

3. The following results for cardiovascular disease (CVD) mortality were obtained in this study:

Green Tea Consumption at Enrollment

<1 cup/day 1-3 cups/day 4-6 cups/day >=7 cups/day

Cardiovascular disease (CVD)

mortality over

six-year follow-up period

Number of deaths 25 139 190 51

Number of subjects 321 2,981 5,970 2,979

Number of person-years 1,465 14,932 31,556 16,049

a. Using the data given in the above table, calculate proportion of subjects who drank >=7
cups/day and the proportion of subjects who drank <1 cup/day.

Less than 1 cup a day = 321/ 12,232 = 2.62 % of people

= 1464/64,002= 2.28 % of person years

More than 7 cups a day= 2979/12,232= 24.35% of people

=16,049/64,002 =25.07% of person years

b. Calculate (1) the cumulative incidence of death from CVD among subjects who drank >=7
cups/day and (2) the cumulative incidence of death among subjects who drank <1 cup/day.
Show all of your work.

1)25/321=7.78% over 6 years

2)51/2,979= 1.71% over 6 years

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c. Use your answers in part b above to calculate the cumulative incidence ratio (risk ratio)
comparing subjects who drank >= 7 cups/day to those who drank <1 cup/day. Show all of
your work.

cumulative incidence ratio = 7.78/1.71=4.54

d. State in words your interpretation of the above cumulative incidence ratio.

People who drink less than 1 cup a day are at 4.54 times more risk than people who drink
more than 7 cups of green tea a day

e. Use your answers in part b above to calculate the cumulative incidence difference (risk
difference) comparing subjects who drank >= 7 cups/day to those who drank <1 cup/day.
Show all of your work.

Risk Difference = 7.78-1.71 = 6.07

f. State in words your interpretation of the above cumulative incidence difference.

There is a 6.07 % more chance of people dying of CVD in people drinking less than 1 cup of
coffee when compared to people drinking more than 7 cups a day

g. As stated in the study summary on page two, the maximum number of years of follow-up for
each subject was 6 years. The average number of years of follow-up among subjects
consuming < 1 cup/day was 4.6 years. State two possible reasons why the average follow-up
was less than the maximum follow-up.

One of the main reasons is there are more cases of deaths in people drinking less than 1 cup
of tea. So, this results in loss of person years of people died which is the reason for low avg.

One other reason might be people migrating away who can’t be followed up.
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6. How does each of the following conditions influence the prevalence of a disease in a
population and why? For each scenario, assume that no other changes occur. Your choices
are: increases prevalence, decreases prevalence, or has no effect on prevalence. (9)

a. A treatment is developed that prolongs the life of people suffering from the disease

b. A new measure is developed that prevents new cases of disease from occurring

c. There is immigration of a large number of healthy people into the population.

7. If an exposure has no association with a certain outcome, then what value would you
obtain for each of the measures of association listed below? Fill in all the blanks. (4)

A.Rate ratio ________________

B. Rate difference _____________

8. Quote from a news report: “Based on interviews and blood samples of over 8,000
persons, 11% of persons classified as heavy drinkers of alcohol were involved in home
accidents over a three-month period.” Can we conclude that there is an association
between drinking and home accidents from these data? Why or Why not? Please justify
your answer.(8)

9. Suppose that your company has just developed a new screening test for a disease and you are in
charge of testing its validity and feasibility. You decide to evaluate the test on 1000 individuals and
compare the results of the new test to the gold standard. You know the prevalence of disease in your
population is 30%. The screening test gave a positive result for 292 individuals. 285 of these individuals
actually had the disease on the basis of the gold standard determination. (30)
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a. Fill in all cells of the two by two table.

Gold Standard Determination

of Disease
Total
Test Results of Screening
Yes No

Positive

Negative

Total

b. Calculate the sensitivity of the new screening test.

c. Interpret the results of sensitivity calculation in one sentence.

d. Calculate the specificity of the new screening test.

e. Interpret the results of specificity calculation in one sentence.

f. Calculate the predictive value of a positive test.

g. Interpret the results of the predictive value positive calculation in one sentence.

h. What would happen to the predictive value positive if this test were administered in a
population with a disease prevalence of 1% instead of 30%? (Note that the sensitivity and
specificity of the test remain the same.) Would it remain the same? Increase? Decrease?
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10. The following questions refer to the article by Daviglus et al., “Dietary beta-carotene,
vitamin C, and risk of prostate cancer: results from the Western Electric Study”
Epidemiology 1996;7:472-477. (25)
a) The authors describe the study as a “prospective, population-based investigation.”
What is the population in this study? How is the sample chosen from the population?
What are some advantages to the sample selection?
b) Comment on the length and quality of follow-up in this study.
c) Published autopsy data indicate that the prevalence of prostate cancer at time of death
is approximately 40% in US men. How does this compare to the estimated incidence
in the Western Electric Cohort? If there are differences, what could explain them?
Does this have any impact on the study findings?
d) What are some limitations of this study?
e) Is this the best possible study design to look at this particular research question? If
yes, say why. If no, suggest alternatives.

Bonus/Extra Credit (10 points). Please show all of your work to get full points

For the following hypothesized data on viral upper respiratory infections (URI), calculate the
epidemiologic measures listed below. Assume that:
a) Each infection lasts 10 days and confers no immunity
b) Infections begin at 12:01 AM of the date shown
c) There are no deaths from URI or other causes and no loss to follow-up
d) Remember the number of days in each month
e) A person is not at risk for a new URI until he/she has recovered from an existing episode
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i) Point prevalence of URI on September 1: 1case/8people

ii)Point prevalence of URI on November 30:_2cases/8 people

iii) Person-days at risk (total) for the period September 1

through November 30, inclusive:689(928-2-10-10-5-10-2)

iv) Incidence density for period of September 1 through November

30, inclusive:__5/728*100= 0.6 per 100 person days of
observation