ASSIGNMENT 2

Assignment #2
Jaimie Short
6164818
Epidemiology
Instructor: Cathy Egan
2016-10-05

ASSIGNMENT 2

Question 1 (6 marks)
Describe the two types of association (non-causal and causal) that are possible between
exposures and health outcomes. Using your own experiences, give two examples of a noncausal association, and two examples of a causal association. (i.e. you do not need to do
research to identify scientific causal and non-causal associations, but rather describe two
associations that you are aware of in your experience.)
There are two different types of associations that are possible between exposures and health
outcomes: causal and non-causal. If we define the exposure(s) as X and the health outcome as
Y, we can better describe the two associations.
1. In a causal association, X causes Y.
2. In a non-causal association, X does not cause Y. In fact, the outcome may cause the
exposure (e.g. yellow teeth and smoking). Secondly, X and Y may be associated through
the involvement other factors or variables. There are three different types of non-causal
associations: random, artefactual and indirect.
Two examples of causal associations are:
1. Cigarette smoking (exposure) and lung cancer (health outcome). There is welldocumented evidence that show causality between cigarette smoking and lung cancer.
2. Exposure to asbestos (exposure) and developing asbestosis (health outcome).
Asbestosis are directly linked to chrysotile fibers which are one of six types of asbestos.
Two examples of non-causal associations are:
1. Intravenous drug use and acquiring Hepatitis C. Intravenous drug use (IDU) does not
directly cause Hepatitis C. However, the risky behaviours associated with IDU can lead
to a user acquiring Hepatitis C. For example, a IDU user that shares needles with other
users are at high risk of acquiring Hepatitis C.
2. Birth order and Down Syndrome. Birth order does not cause Down Syndrome but a third
factor, maternal age, comes into play. As birth order increases so does maternal age.
There is evidence that confirms that the greater the maternal age, the greater the risk of
the child developing Down Syndrome.

ASSIGNMENT 2

Question 2 (4 marks)
Set up a contingency table for the association between income and depression, based on the
following information.
A study investigated the health outcome of depression, by surveying one thousand participants
from across Ontario. Depression was measured using the Center for Epidemiologic Studies
Depression (CES-D) scale, whereby scores of 16 or higher indicated the presence of
depression. Participants also answered questions about their socioeconomic status, one of
which was their income. Income was categorized as low income, middle income and high
income.
Investigators found that 20% of the study population scored 16 or higher on the CES-D scale.
Half of the participants were categorized as having a middle income, 200 had a low income,
and the remainder of participants had a high income. Seventy-five low-income participants were
categorized as being depressed. Fifty percent of non-depressed participants had a middle
income.
Contingency Table for the Association Between Income and Depression
Income
Low
Middle
High
Total

Depressed
75
100
25
200

Non-Depressed
125
400
275
800

Total
200
500
300
1000

ASSIGNMENT 2

Question 3 (2 marks)
Graphically display the following information. Describe the association, if any. Scatter plot! Is it
positive? Is it negative?
Perso
BMI
Systolic blood
n
1
2
3
4
5
6
7
8
9
10

(kg/m2)
20.0
22.0
23.0
21.0
25.0
26.0
29.0
24.0
19.0
21.0

pressure (mmHg)
120
125
130
115
140
145
160
135
110
120

Relationship Between BMI and Systolic BP

180
160
140
120
100

Systolic Blood Pressure (mmHg)

80
60
40
20
0
18

20

22

24

26

28

30

Body Mass Index (kg/m2)

The red line helps to visualize the positive association between BMI and systolic blood
pressure. As BMI increases, systolic blood pressure also increases.

ASSIGNMENT 2

ASSIGNMENT 2

Question 4 (3 marks)
Use three of Hills criteria to evaluate the causal association between the BRCA1 (Breast
Cancer 1) gene and breast cancer.
In this question, I am making the assumption that the question is looking at the causal
association between the BRCA1 gene mutation and breast cancer. BRCA1 is a human gene. It
is found in all individuals as a tumour-suppressant but when it is expressed as a mutation, it can
cause different types of cancer.
Hills Criteria
1. Strength and association It has been estimated that 55 to 65 percent of women who
inherit BRCA1 mutation will develop breast cancer by age 70 (National Cancer Institute,
2015). Another long-term study calculated the lifetime risk for those individuals who
inherit the BRCA1 mutation between 40-80% (Petrucelli, et al., 2013). While there is
some variance, this evidence indicates a strong association between breast cancer and
the mutated BRCA1 gene.
2. Consistency A brief literature search through the Conestoga Library confirms the
causal association between breast cancer and BRCA1 mutation across a wide age
range of ages, ethnicities, and geographic areas. From this search, no published studies
with negative observations that challenge the association between breast cancer and
BRCA1 mutation were found.
3. Specificity Breast cancer can be developed in individuals who express the mutated
BRCA1 gene. However, breast cancer can still develop in the absence of the gene.
BRCA1 mutation accounts for approximately 5 to 10% of cases of breast cancer
(National Cancer Institute, 2015). The rest of the cases develop due to biological risk
factors (e.g. age, high breast tissue density, and hormones and menstrual history) or
lifestyle risk factors (e.g. body mass index, diet, alcohol consumption, smoking).
Specificity between breast cancer and BRCA1 mutated gene are low.
Of interest, the BRCA1 mutated gene is not specific to breast cancer. It can also be the
precursor to ovarian cancer.

ASSIGNMENT 2

7
References

Petrucelli, N., Daly, M.B., and Feldman, G.L. BRCA1 and BRCA2 Hereditary Breast and
Ovarian Cancer. (2013) Seattle (WA): University of Washington, Seattle; 19932016. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK1247/
Public Health Agency of Canada. (2009). Breast Cancer Your Risk. Public Health Agency of
Canada. Retrieved from: http://www.phac-aspc.gc.ca/cd-mc/pdf/Breast_Cancer_Risk-eng.pdf
U.S. Department of Human Health Services. (2015). BRCA1 and BRCA2: Cancer Risk and
Genetic Testing, National Cancer Institute. Retrieved from: https://www.cancer.gov/aboutcancer/causes-prevention/genetics/brca-fact-sheet