Question 1:
The Framingham Heart Study (FHS) is a prospective cohort study that began in 1948. Participants have been examined biennially, and all participants are continuously followed through regular surveillance. Clinic examination data have included cardiovascular disease risk factors and markers of disease such as blood pressure, smoking history, health behaviors, blood chemistry, lung function, echocardiography, and medication use. Through regular surveillance of area hospitals, participant contact, and death certificates, the FHS reviews and adjudicates events for the occurrence of cardiovascular outcomes.
The NHLBI teaching dataset is a subset of the data from the FHS and includes data on 4,434 participants. Participant clinic data were collected during 3 examination periods, approximately 6 years apart, from roughly 1956 to 1968. Each participant was followed for up to 24 years. Although the teaching dataset contains Framingham data “as collected”, specific methods were used to ensure an anonymous dataset that protects patient confidentiality; therefore, this dataset is inappropriate for publication purposes.
This question uses the following variables from the teaching dataset:
CURSMOKE = 1 if current smoker at the 1956 exam
= 0 otherwise
PREVCHD = 1 if diagnosed with coronary heart disease (CHD) before the 1956 exam
= 0 otherwise
DIABETES = 1 if diabetic according to criteria at the 1956 exam (either treated for diabetes or casual glucose 200 mg/dL)
= 0 otherwise
DEATH = 1 if died (from any cause) during the 24 years of follow-up after the 1956 exam
= 0 otherwise
TIMEDTH = follow-up time (in years) from the 1956 exam to:
1. time of death for participants who died during the 24-year follow-up period
2. end of study (24 years) for participants who did not die during the follow-up period
ANYCHD = 1 if developed CHD during the 24 years of follow-up after the 1956 exam
= 0 otherwise
TIMECHD = follow-up time (in years) from the 1956 exam to:
1. time of developing CHD for participants who had documentation of the development CHD during the 24-year follow-up period,
2. time of death for participants who had no documentation of the development of CHD during the follow-up period but who died from another cause,
3. time of last contact for participants who had no documentation of the development of CHD by their last contact and were lost to follow-up, or
4. end of study (24 years) for participants who were followed for 24 years and did not develop CHD or die during the follow-up period.
The following table (Table 1) shows the relationship between current smoking and prevalent CHD in 1956.
Table 1.
PREVCHD
CURSMOKE 1 0 Total
1 86 2095 2181
0 108 2145 2253
Total 194 4240 4434
a. What is the prevalence of CHD at the 1956 exam among all participants?
b. What is the prevalence of CHD at the 1956 exam among current smokers? What is the prevalence among non-smokers?
c. What is the prevalence ratio for CHD, comparing current smokers to non-smokers? Give at least two plausible explanations for this value.
The following table (Table 2) shows the relationship between diabetes at the 1956 exam and mortality (death) during the 24 years of follow-up. Note that there were no losses to follow-up for the outcome of death, because mortality status was obtained for all participants through a search of the National Death Index or through the Social Security Death Index.
Table 2.
DEATH
DIABETES 1 0 Total participants
1 94 27 121
0 1456 2857 4313
Total 1550 2884 4434
The following table (Table 3) shows the total amount of follow-up time in years until death (for those who died) or until the end of the study, i.e., 24 years (for those who survived), among the 4434 participants in Table 2, according to whether they had diabetes in 1956.
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