Review Questions-Association and Bias

Estimating Risk: Is There an Association?
Dept.Epidemiology
Ben Fu Yang
1
1. Of 2,872 persons who had received
radiation treatment in childhood because of an
enlarged thymus, cancer of the thyroid
developed in 24 and a benign thyroid tumor
developed in 52. A comparison group consisted
of 5,055 children who had received no such
treatment (brothers and sisters of the children
who had received radiation treatment). During
the follow-up period, none of the comparison
group developed thyroid cancer, but benign
thyroid tumors developed in 6. Calculate the
relative risk for benign thyroid tumors: _____

2
2. In a study of a disease in which all cases that
developed were ascertained, if the relative risk for
the association between a factor and the disease is
equal to or less than 1.0, then:
a. There is no association between the factor and
the disease
b. The factor protects against development of the
disease
c. Either matching or randomization has been
unsuccessful
d. The comparison group used was unsuitable,
and a valid comparison is not possible
e. There is either no association or a negative
association between the factor and the disease
3
Questions 3 and 4 are based on the
information given in the following
table.
In a small pilot study, 12 women with
uterine cancer and 12 with no apparent
disease were contacted and asked
whether they had ever used estrogen.
Each woman with cancer was matched
by age, race, weight, and parity to a
woman without disease. The results are
shown below:
4
Pair Women with Uterine Women without Uterine
No. Cancer Cancer
1 Estrogen user Estrogen nonuser
2 Estrogen nonuser Estrogen nonuser
3 Estrogen user Estrogen user
4 Estrogen user Estrogen user
6 Estrogen nonuser Estrogen nonuser
9 Estrogen nonuser Estrogen user
10 Estrogen nonuser Estrogen user
12 Estrogen user Estrogen nonuser 5
3
3.What is the estimated relative risk of cancer
when analyzing this study as a matched-pairs
study?
a. 0.25 b. 0.33 c. 1.00 d. 3.00 e. 4.20
4. Unmatch the pairs. What is the estimated

relative risk of cancer when analyzing this study
as an unmatched study design?
a. 0.70 b. 1.43 c. 2.80 d. 3.00 e. 4.00
6
Questions 5 through 7 are based on the following
information.
Talbot and colleagues carried out a study of sudden unexpected
death in women. Data on smoking history are shown in the
following table.
Smoking History for Cases of ASHD Sudden Death and Controls
(Current Smoker, 1+ Pack/Day) [Matched Pairs], Allegheny County, 1980
CONTROLS
Smoking 1+ Smoking <1
Cases Pack/Day Pack/Day Total
Smoking 1+ 2 36 38
pack/day
Smoking <1 8 34 42
pack/day
Total 10 70 80 7
5.Calculate the matched-pairs odds ratio for
these data. ____
6.Using data from the table, unmatch the pairs

and calculate an unmatched odds ratio. _____
7.What are the odds that the controls smoke 1+ pack/d
8
Questions 8 and 9 are based on the information given bellow.
Rates of Atherosclerotic Heart Disease (ASHD) per 10,000
Population, By Age and Sex, Framingham, Massachusetts
MEN WOMEN
Age at
Begin ASHD Yearly Follow- ASHD Yearly Follow-
ning Rates up Exams Rates up Exams
of at (Mean at (Mean
Study Initial Annual Initial Annual
(yr) Exam Incidence) Exam Incidence)
29–34 76.7 19.4 0.0 0.0
35–44 90.7 40.0 17.2 2.1
45–54 167.6 106.5 111.1 29.4
55–62 505.4 209.1 211.1 117.8
9
8.The relative risk for developing ASHD
subsequent to entering this study in men as
compared to women is:
a.Approximately equal in all age groups
b.Highest in the oldest age group

c.Lowest in the youngest and oldest age
groups, and highest at ages 35–44 and
45–54 years
d.Highest in the youngest and oldest age
groups, and lowest at ages 35–44 and 45–
54 years
e.Lowest in the oldest age group
10
9.The most likely explanation for the
differences in rates of ASHD between the
initial examination and the yearly follow-up
examinations in men is:
a.The prevalence and incidence of ASHD
increase with age in men
b.Case-fatality rates of ASHD are higher at
younger ages in men
c.A classic cohort effect explains these results
d.The case-fatality rate in ASHD is highest
in the first 24 hours following a heart
attackinitial examination measures the
e.The
prevalence of ASHD, whereas the subsequent
examinations primarily measure the incidence 11
of ASHD
1.Which of the following is an approach to
handling confounding?
a.Individual matching b.Stratification
c.Group matchingd.Adjustment e.All of the above

2.It has been suggested that physicians may
examine women who use oral contraceptives
more often or more thoroughly than women
who do not. If so, and if an association is
observed between phlebitis and oral
contraceptive use, the association may be due
to:
a.Selection biasb.Interviewer biasc.Surveillance bias
d.Nonresponse bias e.Recall bias 12

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Estimating Risk: Is There an Association?

4. Unmatch the pairs. What is the estimated

6.Using data from the table, unmatch the pairs

7.What are the odds that the controls smoke 1+ pack/d

a.Approximately equal in all age groups

b.Highest in the oldest age group

a.Individual matching b.Stratification

c.Group matchingd.Adjustment e.All of the above

d.Nonresponse bias e.Recall bias 12

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