A Pocket Guide to Epidemiology
David G. Kleinbaum Kevin M. Sullivan Nancy D. Barker
A Pocket Guide to Epidemiology
David G. Kleinbaum Department of Epidemiology Rollins School of Public Health Emory University 1518 Clifton Road, NE Atlanta, GA 30322 USA email@example.com Nancy D. Barker 2465 Traywick Chase Alpharetta, GA 30004 USA firstname.lastname@example.org
Kevin M. Sullivan Department of Epidemiology Rollins School of Public Health Emory University 1518 Clifton Road, NE Atlanta, GA 30322 USA email@example.com
Library of Congress Control Number: 2006933294 ISBN-10: 0-387-45964-2 ISBN-13: 978-0-387-45964-6 Printed on acid-free paper. C 2007 Springer Science+Business Media, LLC All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identiﬁed as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.
e-ISBN-10: 0-387-45966-9 e-ISBN-13: 978-0-387-45966-0
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Four years ago (2002), I (DGK) authored a unique educational program, ActivEpi (Springer Publishers), developed in CD-ROM format to provide a multimedia interactive “electronic textbook” on basic principles and methods of epidemiology. In 2003, the ActivEpi Companion Text, authored by myself (DGK), KM Sullivan and ND Barker and also published by Springer, was developed to provide a hardcopy of the material contained in the ActivEpi CD-ROM. The CD-ROM contains 15 chapters, with each consisting of a collection of “activities” including narrated expositions, interactive study questions, quizzes, homework questions, and web links to relevant references on the Internet. In the nearly three years since the publication of the ActivEpi CD-ROM, we have received several suggestions from instructors of introductory epidemiology courses as well as health and medical professionals to produce an abbreviated version that narrows the discussion to the most “essential” principles and methods. Instructors expressed to us their concern that the material covered by the CDROM (and likewise, the Companion Text) was too comprehensive to conveniently fit the amount of time available in an introductory course. Professionals expressed their desire for a more economically time-consuming version that would conveniently fit their “after hours” availability. To address these suggestions, we have herewith produced A Pocket Guide to Epidemiology which provides a much shorter, more “essential” version of the material covered by the ActivEpi CD-ROM and Companion Text. We realize that determining what is “essential” is not a simple task, especially since, from our point of view, the original CD-ROM was already restricted to “essential” topics. Nevertheless, to produce this text, we decided to remove from the original material a great many fine points of explanation and complicated topics/issues about epidemiologic principles and methods, with our primary goal a “quicker read”. A Pocket Guide to Epidemiology contains less than half as many pages as the ActivEpi Companion Text. We have continued to include in A Pocket Guide to Epidemiology many of the study questions and quizzes that are provided in each Lesson of the CD ROM, but we have eliminated homework exercises, computer exercises, and Internet linkages from the original CD-ROM. Nevertheless, we indicate throughout A Pocket Guide to Epidemiology how and where the interested reader can turn to the...
References: Clayton DG. Some odds ratio statistics for the analysis of ordered categorical data. Biometrika 1974;61:525-31. Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research: Principles and Quantitative Methods. John Wiley and Sons Publishers, New York, 1982. Mantel N. Chi-square tests with one degree of freedom: Extensions of the Mantel-Haenszel procedure. J Am Stat Assoc 1963;58:690-700. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22(4):719-48. Rezende NA, Blumberg HM, Metzger BS, Larsen NM, Ray SM, and McGowan JE, Jr. Risk factors for methicillin-resistance among patients with Staphylococcus aureus bacteremia at the time of hospital admission. Am J Med Sci 2002; 323(3):117-23.
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Answers Study Questions and Quizzes
Q14.1 1. For both smokers and non-smokers separately, there appears to be no association between exposure to TXC and the development of lung cancer. Never the less, it may be argued that the RR of 1.3 for smokers indicates a moderate association; however, this estimate is highly non-significant. 2. No, the two stratum-specific risk ratio estimates are essentially equal. Again, the RR of 1.3 for smokers indicates a small effect, but is highly nonsignificant. 3. No, even though the crude estimate of effects is 2.1, the correct analysis requires that smoking be controlled, from which the data show no effect of TCX exposure. An adjusted estimate over the two strata would provide an appropriate summary statistic that controls for smoking. 4. Since the adjusted point estimate is close to the null value of 1 and the Mantel-Haenszel test statistic is very non-significant, you should conclude that there is no evidence of and E-D relationship from these data Q14.2 1. Yes, the odds ratio of 11.67 is very high and the MH test is highly significant and, even though the confidence interval is wide, the interval does not include the null value. 2. The association may change when one or more variables are controlled. If this happens and the control variables are risk factors, then an adjusted estimate or estimates would be more appropriate. 3. Not necessarily. If one or more of these variables are not previously known risk factors for MRSA status, then such variables may not be controlled. 4. Some (n=5) study subjects had to having missing information on either MSRA status or on previous hospitalization information. In fact, it was on the latter variable that 5 observations were missing. 5. No, the stratum-specific odds ratios within different age groups are very close (around 11). 6. No, the P-value of .95 is very high, indicating no evidence of interaction due to age. 7. Yes, overall assessment is appropriate because there is no evidence of interaction due to age. 8. No, the crude and adjusted odds ratios are essentially equal. 9. Yes, the Mantel-Haenszel test for stratified data is highly significant (P
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