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  • Number of Words: 2000


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Question 1 (17 marks)                

A study was conducted to evaluate the relationship between red meat consumption and bowel cancer. At total of 300 men and women aged 60 years and older with bowel cancer diagnosed within the past 3 months were recruited into the study. 300 population based, age and gender matched participants without bowel cancer were also recruited. Participants were interviewed in detail about their dietary habits in the 12 months prior (or 12 months prior to diagnosis). They were also asked about any major dietary changes that may have occurred in the 10 years prior. Those that consumed on average 3 or more serves of red meat a week were considered to be ‘high red meat consumers’. Those who consumed, on average, 2 or less serves of red meat each week were low red meat consumers’. Of the 300 participants with bowel cancer, 208 of them were classified as high red meat consumers. Of those without bowel cancer, 78 were classified as high read meat consumers. For this question we will consider “high red meat eaters” as ‘exposed’.

  1. What type of study was conducted? [1 mark]
  2. In conducting the study the population based participants were “age and gender matched”. What does this mean? Why did the researchers do this? [2 marks]
  3. Construct a 2×2 table showing these results [2 marks] Please do not deduct points if the totals for rows and columns are not presented as these are not needed to calculate the odds ratio.
  4. Calculate and interpret an appropriate measure of risk. Show your calculations. [2 marks]

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One of the researchers suggested that family history should be considered a confounder, so they asked participants if they had a family history of bowel cancer (1 or more first degree relative previously diagnosed with bowel cancer). 295 participants recorded that they had a family history of bowel cancer. Of those with a family history, 178 were diagnosed with bowel cancer and were high red meat consumers, 67 were diagnosed with bowel cancer and were low red meat consumers, 20 were disease free but were high red meat consumers and 30 were disease free and low red meat consumers.

  1. Construct two new 2×2 (one for those with a family history of bowel cancer, and one for those without a family history of bowel cancer) to investigate the association between meat eating and cancer in these 2 groups [4 marks].
  2. Calculate new estimates of effect for each table. Do you conclude that family history is a confounder? Explain how have you come to this conclusion? [4 marks]
  3. Provide a final estimate/conclusion for the association between red meat and bowel cancer [2 marks].

Question 2 [13 marks]

A cohort study looked at the association between HIV status and all-cause mortality among prisoners. There were 850 prisoners who were HIV positive and 21,500 who were HIV negative in the study. The data from the study are reported in Table 4 below. In this question, provide all working for your calculations.

Table 4: Deaths from all causes by HIV status in prisoners

Deaths Person-years of follow-up
HIV positive 325 8,820
HIV negative 2,460 265,000
Total 2,785 273,820


  1. Calculate the rate ratio for all-cause mortality to compare mortality by HIV status. [2 marks]
  2. What was the (absolute) difference in mortality rates by HIV status? Interpret your [2 marks]
  3. Now calculate the proportion of deaths among prisoners that would have not occurred in the absence of HIV (the attributable fraction). Give an interpretation of your answer. [3 marks]
  4. What is the overall incidence of mortality? [1 mark]
  5. What would the incidence of mortality be if there was no HIV? [1 mark]
  6. Using 4 and 5, calculate the population attributable risk. Interpret the population attributable risk. [2 marks]
  7. Now calculate and interpret the population attributable fraction. [2 marks]

Question 3 [10 marks]

A cohort study looked at the association between level of alcohol consumption and hospital admissions and deaths related to alcohol (we will call these alcohol related events). Table 5 gives the number of alcohol-related events and the level of alcohol consumption.

Table 5: Cohort study data on level of alcohol consumption and alcohol-related events

Alcohol-related events Person-years of follow-up
Heavy drinking 180 15,000
Light drinking 260 205,000
Total 440 220,000


Table 6 gives the same data but stratified by socioeconomic status (low and high socioeconomic status).

Table 6: Cohort study data on level of alcohol consumption and alcohol-related events by socioeconomic status

  • Low socioeconomic status
Alcohol-related events Person-years of follow-up
Heavy drinking 120 7,500
Light drinking 130 110,000
Total 250 117,500


  • High socioeconomic status
Alcohol-related events Person-years of follow-up
Heavy drinking 


60 7,500
Light drinking 130 95,000
Total 190 102,500


  1. Calculate the appropriate measure of effect for the association between level of alcohol consumption and alcohol-related events. [2 marks]
  2. Calculate the stratum-specific appropriate measures of effect. [4 marks]
  3. Using 1 and 2 above, discuss whether socioeconomic status is a confounder or an effect modifier. [4 marks]


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