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Exercise of causal inference

Liyan Guo
Department of Epidemiology
Question1. In a large case-control study of pancreatic
cancer,17% of the patients were found to be diabetic at the
time of diagnosis, compared to 4% of a well-matched
control group (matched by age, sex, ethnic group, and
several other characteristics) that was examined for
diabetes at the same time as the cases were diagnosed. It
was concluded that the diabetes played a causal role in
the pancreatic cancer. This conclusion:
• A. Is correct
• B. May be incorrect because there is on control or
comparison group
• C. May be incorrect because of failure to establish the time
sequence between onset of the diabetes and diagnosis of
pancreatic cancer
• D. May be incorrect because of less complete
ascertainment of diabetes in the pancreatic cancer cases
• E. May be incorrect because of more complete
ascertainment of pancreatic cancer in non-diabetic
persons
Question2. All of the following are important criteria when
making causal inferences except:
• A. Consistency with existing knowledge
• B. Dose-response relationship
• C. Consistency of association in several studies
• D. Strength of association
• E. Predictive value
Question3. Several studies have found that approximately
85% of cases of lung cancer are due to cigarette smoking.
This measure is an example of:
• A. An incidence rate
• B. An attributable risk
• C. A relative risk
• D. A prevalence risk
• E. A proportionate mortality ratio
• Questions 4 and 5 refer to the following
information:
• The results of a 10-year cohort study of
smoking and coronary heart disease (CHD)
are shown below:
Outcome After 10 YRS

At Beginning of CHD CHD Did Not


Study Developed Developed
2,000 Healthy 65 1,935
smokers
4,000 Healthy 20 3,980
nonsmokers
• 4. The incidence of CHD in smokers that
can be attributed to smoking is:
• 5. The proportion of the total incidence of
CHD in smokers that is attributable to
smoking is:
• The incidence of a disease that is attributable to the exposure
in the exposed group can be calculated as follows:
Incidence in exposed group - Incidence in nonexposed group
(How much of the risk of the disease is due to exposure?)

• The attributable risk as proportion of the total incidence in the


exposed group that is attributable to exposure can be
calculated as follows:
(Incidence in exposed group - Incidence in nonexposed group)
Incidence in exposed group

(What proportion of the risk of the disease in exposed persons


is due to exposure?)
• Questions 6 and 7 refer to the following
information:
• In a cohort study of smoking and lung cancer,
the incidence of lung cancer among smokers
was found to be 9/1000 and the incidence
among nonsmokers was 1/1000. From another
source we know that 45% of the total population
were
smokers.
• 6. The incidence of lung cancer attributable to
smoking in the total population is:
• 7. The proportion of the risk in the total
population that is attributable to smoking is:
Formula for Attributable Risk for the Total Population-
Population Attributable Risk (PAR)

• Incidence in total population-Incidence in nonexposed group


• OR
• (Incidence in smokers) (%Smokers in population)
+(Incidence in nonsmokers) (%Nonsmokers in population)
• Formula for the attributable risk for the total
population

p (r − 1)
PAR% =
p (r − 1) + 1
Where p is the proportion of the population with the
characteristic or exposure and r is the relative risk (or
odds ratio).
OR
(Incidence in total population - Incidence in nonexposed
group)
Incidence in total population