BIO 485 Epidemiology Exam 2 2009 Answer Key

Name:__________________________

1. Two groups of students are studied to determine their exposure to Giardia. One group has been
diagnosed with Giardia and the other has not. The two groups are compared to try to determine
exposure differences. This is an example of: (4 points)
A. A case-control study
B. A cross-sectional study
C. A cohort study
D. A randomized trial
E. An ecologic study
2. An erroneous inference that may occur because an association observed between variables on an
aggregate level does not necessarily reflect the association at an individual level is known as an: (4
points)
A. Odds ratio
B. Ecologic correlation
C. Ecologic fallacy
D. Attributable risk
E. None of the above
3. The lowest dose at which a particular response occurs is known as the: (4 points)
A. Threshold
B. Mode
C. Latency
D. Epidemic curve
E. None of the above
4. For which of the following criteria do epidemiologists need to observe the cause before the effect? (4
Points)
A. Biological gradient
B. Coherence
C. Temporality
D. Replication
E. Consistency
5. Epidemiologic studies of the roles of a suspected factor in the etiology of a disease may be
observational or experimental. The essential difference between experimental and observational
studies is that in experimental investigations: (4 points)
A. The study and control groups are equal in size.
B. The study is prospective.
C. The study and control groups are always compatible.
D. The investigator determines who shall be exposed to the suspected factor and who shall not.
E. Controls are used.

BIO 485 Epidemiology Exam 2 2009 Answer Key

Name:__________________________

Use the following information to answer Questions 6-8

A hypothetical case-control study of 200 people with stomach cancer (SC) and 400 Controls yielded the
following data, with regard to coffee consumption status:
SC +

SC -

Coffee +

112

226

Coffee -

88

174

6. Would you calculate the Odds Ratio or Relative Risk of development of stomach cancer in coffee
drinkers, and why? (4 points)
You would calculate OR, since it would not be possible to calculate the RR since we do not know
the source population at risk (denominator of the formula).
7. Calculate it: (4 points)
OR = (a x d)/(b x c) = (112 x 174)/(226 x 88) = 19488/19888 = 0.98
8. What is the interpretation of that value? (4 points)
There is no significant difference in the development of stomach cancer between coffee drinkers
and those that do not drink coffee.
Use the following information to answer Questions 9-13

An investigator conducts a retrospective cohort study to explore the relationship between perimenopausal
exogenous estrogen use and the risk of breast cancer (BC). A total of 5000 exposed and 5000 unexposed
women are enrolled and followed for 15 years for the development of breast cancer. A total of 100
estrogen users and 400 nonusers developed breast cancer.
9. Construct a 2x2 table from this information. (4 points)
BC +

BC -

Estrogen +

100

4,900

5,000

Estrogen -

400

4,600

5,000

500

9,500

10,000

10. The risk of breast cancer among estrogen users is: (4 points)
Re = a/(a + b) = 100/5,000 = 0.02 or 2 per 100 persons
11. The risk of breast cancer among nonusers of estrogen is: (4 points)
Ru = c/(c +d) = 400/5,000 = 0.08 or 8 per 100 persons
12. The relative risk for breast cancer is: (4 points)
RR = Re/Ru = 0.02/0.08 = 0.25

BIO 485 Epidemiology Exam 2 2009 Answer Key

Name:__________________________

13. What is the interpretation of this value? (4 points)

Estrogen users had one quarter the risk of breast cancer as non-users. That is to say there was a
protective effect of estrogen on the development of breast cancer.
Use the following information to answer Questions 14-19

A hypothetical study of the effect of diet on the risk of obesity in UNCW students aged 20-21 was
conducted. Body Mass Index (BMI) of 2000 study subjects identified 152 subjects as obese, 42 of whom
listed their pizza consumption level as "high." Of the students that were not obese, 420 listed their pizza
consumption level as "high." Interviews were conducted at the same time as the examinations to
determine the exposure level of study participants.
14. This is an example of: (4 points)
A. A case-control study
B. A cross-sectional study
C. A cohort study
D. A randomized trial
E. An ecologic study
15. Construct a 2x2 table of these data. (4 points)
Obese
Not Obese
High Pizza
42
420
462
Low Pizza
110
1,428
1,538
152
1,848
2,000
16. What is the prevalence of obesity in the high pizza consumption group? (4 points)
Pe = a/(a+b) = 42/462 = 0.09
17. What is the prevalence of obesity in the low pizza consumption group? (4 points)
Pu = c/(c+d) = 110/1,538 = 0.07
18. What is the prevalence ratio of obesity due to high pizza consumption? (4 points)
PR = Pe/Pu = 0.09 / 0.07 = 1.29
19. What is the prevalence odds ratio of pizza consumption and obesity? (4 points)
POR = ad/bc = (42 x 1,428) / (420 x 110) = 59976/46200 = 1.29
Use the following information to answer Questions 20-25

The following data are from a hypothetical cohort study comparing the incidence of Coronary Heart
Disease (CHD) with smoking:
CHD +

CHD -

Smoke +

184

816

Smoke -

187

1,813

BIO 485 Epidemiology Exam 2 2009 Answer Key

Name:__________________________

20. What is the incidence of CHD per 1,000 persons per year among those who smoke? (4 points)
Re = a/(a + b) = 184/1000 = 0.184 or 184/1000
21. What is the incidence of CHD per 1,000 persons per year among those who do not smoke? (4 points)
Ru = c/(c + d) = 187/2000 = 0.094 or 94/1000
22. What is the Relative Risk of smoking? (4 points)
RR = Re/Ru = 0.184/0.094 = 1.96
23. Interpret this value. (4 points)
Individuals who smoke were almost twice as likely (1.96 times) to have CHD
24. Calculate the attributable risk of smoking. (4 points)
AR = (Re-Ru)/Re = (0.184 0.094)/0.184 = 0.49 or 49%
25. Explain its significance? (4 points)
The attributable risk is the proportion of the disease in the exposed individuals that can be attributed
to the exposure (in this case 49%). It represents the amount of risk that can be reduced by eliminating
the exposure.
Bonus Question. Fill in the blanks. A cohort study selects those with a(n) __exposure__ _, and measures
____disease______, whereas a case-control study begins with a(n) ___disease_____ and measures
____exposure_____. (4 Points Extra Credit)