IHP 330 Module Two Worksheet (1) (Repaired)

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Southern New Hampshire University *

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IHP 330

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Health Science

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May 17, 2024

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IHP 330 Module Two Worksheet 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 Cases Controls Cigarette Smoker 1,350 1,296 Nonsmoker 7 61 Total 1,357 1,357 1. Accurately calculate the proportion of cases that smoked. Be sure to show your calculations. Cigarette Smokers – 1350 / Nonsmoker – 7 / Total – 1357 Calculation – 1350 ÷ 1357 × 100 = 99.48% Answer: 99.48% Proportion of the cases that smoked. 2. Accurately calculate the proportion of controls that smoked. Be sure to show your calculations. Cigarette Smokers Controlled – 1296 / Nonsmoker Controlled – 61 / Total – 1357 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

Calculation – 1296 ÷ 1357 × 100 = 95.50% Answer: 99.5 % Proportion of controls that smoked. 3. Accurately calculate the odds ratio, with the correct equation. What do you infer from the odds ratio about the relationship between smoking and lung cancer? (1350 × 61 = 82,350) (1296 × 7 = 9,077) (82,350 ÷ 9,072 =9.077) Answer: Individuals who smoke are 9 times more likely to develop 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

Table 2 shows the frequency distribution of male cases and controls by 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 7.0 15–24 445 408 9.5 25+ 340 182 16.3 All smokers 1350 1296 9.1 Total 1357 1357 4. Accurately calculate the odds ratios by category of daily cigarette consumption, comparing each category to nonsmokers. Be sure to show your calculations. “1-14” (565 × 61 = 34,465) (7 × 706 = 4,942) (34,465 ÷ 4,942 = 6.97) rounding up 7.0 “15-24” (445 × 61 = 27,145) (7 × 408 = 2,856) (27,145 ÷ 2,856 = 9.5) “25+” (340 × 61 = 20,740) (7 × 182 = 1,274) (20,740 ÷ 1,274 = 16.27) rounding up 16.3 “All smokers” (1,350 × 61 = 82,350) (7 × 1,296 = 9,072) (82,350 ÷ 9,072 = 9.07) rounding up 9.1 5. Interpret these results, and describe the trends or patterns you see in the data. Individuals who smokes more cigarettes daily, is at a higher risk to develop lung cancer. As the odds or daily number of cigarettes smokers increased, the number of cigarettes also increases. 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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