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19 Cards in this Set

  • Front
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Risk factor?

attribute that is associated with disease after adjusting for other known risk factors

Risk marker

attribute that is associated with disease occurrence, but is merely reflecting or ‘marking’ another RF that has a causal relation to the disease

Confounder?

variable that mediates an observed association between an exposure and a disease

Adjustment?

Statistically accounting for other known risk factors for disease

RR

Relative Risk = Risk of developing disease in the exposed group divided by risk in the unexposed group.


-RR = 1 = no association


-RR < 1 = decreased risk "protective"


-RR > 1 = increased risk


(e.g., if 21% of smokers develop lung cancer vs. 1% of nonsmokers, RR = 21/1 = 21)

Attributable Risk (aka risk difference)

The difference in risk between exposed and unexposed groups, or the proportion of disease occurrences that are attributable to the exposure (e.g., if risk of lung cancer in smokers is 21% and risk in nonsmokers is 1%, then 20% (or .20) of the 21% risk of lung cancer in smokers is attributable to smoking).



Prevalence? What is it altered by?

Prevalence looks at all current cases:



proportion of people in a population who have the disease @ a specified point in time; affected by the disease incidence, and the mortality of the condition.



Altered by disease incidence and mortality (can

Incidence?

The # of new cases in a population during a time interval:



#of new cases/population at risk during time period

Population attributable risk? What does it account for?

1. Impact of exposure in population; if RF is causal then it = % of cases potentially eliminated if a causal RF not present in population


2. Accounts for prevalence and RR


What are the 8 parameters used to establish causality

1. Strength
2. Consistency
3. Temporality


4. Biologic gradient


5. Plausibility
6. Coherence
7. Experiment
8. Analogy

How do each of the following contribute to causality?



1. Strength
2. Consistency
3. Temporality


4. Biologic gradient

1. Strength = larger RR the better
2. Consistency = confirmed in other populations
3. Temporality = which came first, disease or factor


4. Biologic gradient = Is there a dose-response relationship



(fyi: dose response = increased exposure leads to a greater frequency of the outcome, then this is suggestive of a causal relationship. Heavy smokers, for example, have been shown to be at a higher risk of lung cancer than light smokers.)

How do each of the following contribute to causality?



5. Plausibility
6. Coherence
7. Experiment
8. Analogy

5. Plausibility = acceptable given current knowledge?
6. Coherence = consistent with other facts known about disease
7. Experiment = animal models/observational/RCTs consistent
8. Analogy = similar associations causal

Disadvantage of observational study?

less precise in estimating the impact of modification or treatment of CRFs, because of the nonrandomized nature of the subjects who modify their risk factors.



This form of bias has been referred to as the “healthy cohort” effect, whereby more healthy subjects nonrandomly choose to quit smoking, lose weight, exercise, take hormones and vitamins, etc.


Modifiable risk factors with STRONG evidence to support the impact of modification? (4)

1. smoking


2. HTN


3. hypercholesterolemia


4. Physical inactivity (Matt Mendes)

Modifiable risk factors with SUGGESTIVE evidence to support the impact of modification? (5)

1. Obesity


2. Diabetes


3. Hormone replacement


4. LVH


5. Stress

Non-modifiable risk factors (3)

1. Age


2. Sex


3. Family Hx

Stages of smoking cessation (5)

1. pre-contemplation


2. contemplation


3. ready for action


4. Action = not used for up to 6 months


5. Maintainance = not used for > 6 months

The 4 A's of smoking cessation or prevention

1. Ask = smoking status? motivated? previous attempts?


2. Advise = express concern + personal advice


3. Assist = develop a plan + identify triggers


4. Arrange = set up follow up visits

Weight gain a major impediment to quitting, particularly among _______



- Average weight gain ___ pounds (male/female) - Major weight gain (> 28 lbs) occurred in ____%

Weight gain a major impediment to quitting, particularly among women



- Average weight gain 6/8 pounds (male/female) - Major weight gain (> 28 lbs) occurred in < 15%