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QUESTION 1
1. The following table describes hypothetical age-specific rates of heart disease in India and the United States in 2009. Also included are hypothetical age distributions for the two countries and the entire world population.

Age Group
(in years) % of Population in Age Group Heart Disease Rate per 100,000 person-years
INDIA U.S.A. WORLD INDIA U.S.A.
< 30 60% 30% 50% 50 75
30-55 30% 40% 30% 80 150
> 55 10% 30% 20% 120 400

• Calculate the crude rate of heart disease for each of the two countries. Suppose that you want to compare the rate of heart disease in India to that in the United States. You know that age is an important risk factor for heart disease. Examine the age distribution of each country’s population.
• Should you use the two crude rates to compare the two countries? Why or why not?
• Calculate an age-adjusted rate for heart disease in each country. Use the age distribution of the entire world as your standard.
• Based on these answers, would you say that the age differences between India and the United States account for the entire difference in crude heart disease rates between the two countries? Why or why not?

QUESTION 2
1. Phthalates are present in many diverse products, including insect repellents, body lotions, perfumes, and food packaging. Because animal experiments suggest that phthalates may have an adverse effect on the male reproductive system, a group of infertility specialists decided to conduct a case-control study on phthalate exposure and sperm abnormalities in adult men.100 cases with sperm abnormalities and 100 controls were identified and enrolled from among patients at their infertility clinic. 30 cases and 10 controls had high urinary phthalate levels; the remainder had normal urinary phthalate levels.
• Set up and fill in the two by two table using these data
• Use these data to calculate the odds ratio describing the relationship between phthalate levels and sperm abnormalities
• State in words your interpretation of this odds ratio

QUESTION 3
1. Recently, Australian researchers conducted a study of the relationship between optimism and colon cancer survival. Their hypothesis was that colon cancer patients who had a positive outlook on life would have a lower five-year cumulative incidence of mortality. The study included 100 recently diagnosed colon cancer patients who underwent psychological testing and were found to have a optimistic outlook on life and 100 recently diagnosed colon cancer patients who underwent the same psychological tests and were found to have a pessimistic outlook on life. By the end of five years of follow-up, 50 of the 100 patients with the optimistic outlook and 75 of the 100 patients with the pessimistic outlook had died from colon cancer.
• Set up and fill in the two by two table using these data.
• What is the prevalence of colon cancer in the study population?
• Compare the cumulative incidence of mortality in the optimistic group to the cumulative incidence of mortality in the pessimistic group using a ratio measure of association.
• State in words your interpretation of the result you found in part c.

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• Calculate the crude rate of heart disease for each of the two countries. Suppose that you want to compare the rate of heart disease in India to that in the United States. You know that age is an important risk factor for heart disease. Examine the age distribution of each country’s population.
The age distribution is not the same in two countries. The % of people over 55 is much higher in USA compared to India, while % of people younger than 30 is higher in India.
We can not calculate crude rate for the whole country because we need total number of person with heart disease and total population of the country. We can calculate age-adjusted rate for the country.
India
age specific rate x percent of standard population=50x0.6 + 80x0.3 + 120x0.1=30+24+12=66
USA
age specific rate x percent of standard population=75x0.3 + 150x0.4 + 400x0.3= 22.5+60+120=202.5

• Should you use the two crude rates to compare the two countries? Why or why not?
We should not use crude rate to compare two countries because of very different age structure.
• Calculate an age-adjusted rate for heart disease in each country. Use the age distribution of the entire world as your standard....

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