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MPH406 Quantitative Methods

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Question 1

You are a new epidemiologist working for a health authority. You are given the responsibility of providing information on a disease X. After some research, you find evidence that diseaseX isincurable. You then find thattheincidenceof DiseaseX has beenconstant duringthepast30 years.Other previous researchers havedeterminedthattheprevalenceof DiseaseX ishighertodaythanitwas 15 yearsago. How do you explain that this disease shows at the same time constant incidence and higher prevalence? Support your answer with at least two reasons.

Question 2

We begin a study of 500 persons free of disease on January 1. Over the course of a full year, 15 of these persons develop disease: 6 of these cases developed the disease on February 28th, 4 on March 31st, 1 on June 30, 2 on September 30, and 2 on December 31.

  1. Calculate the cumulative incidence for this disease over the year.
  2. Calculate the incidence rate for this disease over the year (1000 person-months).
  3. Compare the values of the two measures of incidences

Question 3

Three thousand women aged 55 years were given a health check and 300 were found to have high blood pressure. Ten years later all women attended a second check and another 700 women had developed high blood pressure.

  1. What was the prevalence of high blood pressure among women at the age of 55 years?
  2. What was the prevalence of high blood pressure among women at the age of 65 years?
  3. What was the cumulative incidence of high blood pressure among these women?

Assume that, on average, each of the 700 women who developed high blood pressure did so half way through the 10 year follow up period.

  1. Calculate the total number of person-years at risk (of developing high blood pressure) during the 10 years.
  2. What was the incidence rate of high blood pressure among these women?

Question 4

Town X had a population of 30,000 at the beginning of 2000, which had grown to 36,000 two years later.  There were known to be 1,500 people suffering from hypertension at the beginning of the year and 600 further cases were diagnosed during the 2 years.

  1. Calculate the period prevalence of hypertension
  2. Calculate the cumulative incidence of hypertension
  3. Calculate the incidence rate of hypertension, adjusting for the follow up time of the incident cases
  4. Compare the values of the two measures of incidences

Question 5

Authors of a study report a RR (relative risk) of 1.8 (95% CI: 1.6–2.0) for the association between alcohol intake and cancer. The authors of a second study report an OR (odds ratio) of 1.8 (95% CI: 0.7-3.5) for the association between caffeine intake and the same cancer. Which of these studies is the best one? Support your answer with at least 2 reasons.

Question 6

In a cohort study ofmiddle-aged men, each man was asked, at baseline, his current alcohol consumption (amongst other things). During the next 7.5 years, death certificates were collected for those who died. The following table was compiled:


Alcohol consumption group







At risk subjects






Number of deaths






  1. Calculate the risk and relative risk (using the non-drinkers as the base group) of death for each alcohol consumption group
  2. Briefly, what is the main message from your results?
  3. Why might the conclusions based on the preceding table alone be misleading?
  4. List two actions you would do to prevent the limitations of the previous study.

Question 7

Following are data from a case-control study investigating association between lung cancer and smoking and to see if relationship varies with the number of cigarettes smoked daily. Number of cigarettes smoked daily was grouped in the following 4 levels: 0, 1-14, 15-24, and 25 or more cigarettes per day. The total population at each group was 552, 848, 1269 and 70, respectively. The number of cases with lung cancer was 342, 440, 563 and 9, for each level of smoking group, respectively. Write a short paragraph describing the main idea of your result.  Show your calculations, preferably in a table.

Question 8

For each of the following studies identify two confounders (if any) of the specific association. Justify why each variable you chose is a confounder.

A total of 17,530 men working in civil service were surveyed about their grade of employment (e.g. clerical, administrative, executive) and then followed-up for 7.5 years, during which there were 1,086 deaths
A group of 400 are randomly allocated to have three tables per day of Antioxidant X or placebo during 24 weeks, in order to prevent cold symptoms
Eighty women with breast cancer and their twin sisters without breast cancer were questioned about their previous history and length of oral contraceptive use

Question 9

A cohort study to evaluate the effect of smoking on lung cancer (LC) produced the following results:










The distribution of these people by age (less or more than 40 years old) is shown below:

Among younger than 40-years old:










Among older than 40-years old:










Discuss if age is confounding the association between smoking and lung cancer in this study.

Question 10

Aresear cher conducts aprospectiv ecohort study to determine if thereisa difference inCABG (CoronaryArteryBypassGraft)mortality be tween Hospital A and Hospital B.

% Females





%With Low LVEF




AverageAge, yrs



It has been definitive lydetermined from several studies that sexi snotan independent risk factor for CAB Gmortality,whilealow leftventr icularejection fraction(LVEF) and ageover 60 are independent risk factors for CAB Gmortality. 

To report therelativerisk of HospitalA vs. HospitalBfrom the table above, discuss what potential confounders need to be considered.


The following table comes from a study conducted to examine the association between cancer risk and magnetic and electric fields:

What is the main message of this table? Support your views using values from the table.


The following questions come from the paper

  1. Based on Figure 1, discuss at least a potential threat to the internal validity of the study. Support your answer using values from the figure.
  2. Based on Table 1, discuss which potential confounders were identified. Support your views using values from the table.
  3. From Table 2, explain themeaning of the value 68 (0.36 to 1.28).
  4. What is the main message of Table 2? Support your answer using values from the table
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