Age Groups Population A Population C

Years Size of # of Size of # of

Population deaths Population deaths
<30 13,000 13 10,400 13
30-65 15,000 45 12,000 45
>65 4,000 120 3,200 120

When comparing overall mortality between population A and Population C in the table
above.

A. the crude death rates can be used because the population distribution by age is the
same between the two populations
B. the crude death rates can be used because the numbers of deaths by age are the
same between the two populations
C. age-adjusted rates are needed because the age-specific mortality rates differ
between the two populations.
D. Age-adjusted are needed because the population distribution by age differs
between the two populations.
E. Comparison cannot be made because an external standard population is needed

Answer: A

Crude Death rates can be looked upon as the weighted average of the age specific
mortality rates, where the weights are the proportion of population size
contributed by the age groups. So, even if the ASDRs for two populations are
same, their CDRs may turn out to be different if the population distribution by age
is different.
Since the population distribution by age is same for the two populations, CDR
can be used for comparing their mortality.

Table: Comparison of population A and Population B by age group

Age Groups Population A Population B

Years Size of # of Size of # of
Population deaths Population deaths
<30 13,000 13 4,000 3
30-65 15,000 45 15000 30
>65 4,000 120 13,000 145

A. the crude death rates differ between population A and population B

B. The age specific rates differ between population A and population B
C. The numbers of people by age differ between population A and population B
D. The numbers of deaths by age differ between population A and population B
 E. Adjustment is not necessary because the total number of people in population A is
the same as the total number in population B

Crude Death Rate is defined as the number of deaths from all causes per k
persons in the population of any give region or community during a given period.
So crude death rates are calculated as
CDR= (Total number of deaths/total size of population) X 1000.
Now from the tables, we see that the total number of death and total population
size in Population A are 178 and 32000 respectively. These figures are same in
population B. Hence the CDRs of Population A and Population B are same.
So statement A is incorrect.
Age specific death rate for a given population for the age group x to x+n is given
by
(no of deaths in the age group x to x+n in the specified population during the
given period/ size of the population in the age group x to x+n) X 1000.
By that definition ASDR for the age group <30 for Population A is
(13/13000) X 1000 = 1.
Using the formulae it can be found that ASDRs for population A are respectively
1, 3 and 30 and those for population B are 0.75, 2 and 11.15.
So the ASDRs differ the two populations and statement B is correct.
It is obvious from the table that statements C and D are correct.
For meaningful comparison of mortality in two populations, they should have
similar age-sex structure or the two populations should be adjusted for age and
sex. Having same population sizes does not provide any hep in that respect.
Therefore, statement E is incorrect.

A case control study was conducted to evaluate the relation between prior vasectomy
(surgical procedure performed on men to produce sterility) and the risk of prostate
cancer. One concern in conducting the study was that men who have a vasectomy may
go to the doctor more often because of follow-up care and underlying health-seeking
behavior.

Assuming this bias is true, what would be its effect on the results from the study?

A. The odds ration between vasectomy and prostate cancer would be artificially
increased.
B. The odds ration between vasectomy and prostate cancer would be artificially
decreased.
C. There would be no effect on the odds ratio
D. The incidence of prostate cancer would be higher among those with vasectomies.
E. The incidence of prostate cancer would be lower among the controls.

Answer : A
 In absence of the bias, the incidence of prostate cancer among both people with
and without vasectomy , that are obtained from the study are lower than the actual
rates because a person suffering from prostate cancer may not go to the doctor and
hence will not be identified.
Because of vasectomy, a higher proportion of people with vasectomy go to the doctor for
follow-up care and hence the cancer patients have a greater chance of being identified.
So, the incidence of cancer observed among people with vasectomy will be closer to the
actual rate.
Now, since there is no relation between vasectomy and cancer, the incidence rates of
cancer among the people with and without vasectomy with and without vasectomy should
be the same. But the observed incidence among those who don’t have vasectomy is lower
than the actual incidence . Hence the odds ratio between vasectomy and prostate cancer
will be artificially increased

In a study of a group migrants from country X to the United States the following
standardized mortality ratios (SMRs) were found for disease Y

Group SMR
Native of country X living in country X 100
Migrants from country X in US 490
Children of migrants from country X in US 510
United states Whites 591

These findings suggest that

A. Environmental factors are the major determinants of these SMR’s

B. Genetic factors are the major determinants of these SMR’s
C. Culture and practices of migrants from country X probably explain the findings.
D. Migrants are highly selected and are non-representative of the population in their
native country.
E. International differences in coding death certificates for disease Y are an
important determinant of these SMR’s.

Answer : A

A study of the relationship between fitness and obesity was conducted in public schools
elementary students. Physical education teachers assessed students fitness using
Fitnessgram pacer scores and school nurses measured their height and weight. The study
finding suggested a correlation between fitness and weight status.

Which of the following statements is correct?

A. The result leads to a conclusion that elementary students should undertake
exercise program so that they will not be overweight in the future.
B. The result leads to a conclusion that elementary students should lose weight so
that they will become more fit in the futre.
C. The result leads to a conclusion that elementary students should reduce calorie
consumption so that they will become more fit in the future.
D. Causal association cannot be drawn from the result because the temporal
relationship of the variables is not known.
E. Elementary schools must have exercise programs so that students will not become
overweight in the future.

Answer: C
Correlation between two variables is the measure of linear association between the
two variables, i.e. it shows whether the value of one variable increases as the value of
the other variable increases or decreases. It does not give any indication of the
presence or absence of causal relationship between the variables.