HLSC 415

Chapter 11 Exercises
Spring 2017

1. Suppose that we undertake a cohort study to examine the association of high salt intake and hypertension.
Our study population consists of male and female Hispanics and Caucasians. No matching or restriction is
performed. Lets assume that the following facts are true: Men consume more salt than women.
Irrespective of their salt consumption, men have a greater risk of developing hypertension than women.
Smokers consume the same amount of salt as non-smokers. Smoking is an independent risk factor for
hypertension. Hispanics consume more salt than Caucasians. Irrespective of their salt consumption,
Hispanics have the same risk of hypertension as Caucasians. Based on the above information, which of
the following are likely confounders in this study? Justify your selection(s).

A. gender
B. smoking
C. race/ethnicity

Gender is a confounder. Since men have a higher natural rate of hypertension, this could make the
observed rate of hypertension due to salt consumption much higher than it really is. Since men
consume more salt and also have higher rates of hypertension naturally, this could lead to the false
belief that since men eat more salt and have higher rates of hypertension that salt causes hypertension

2. Consider each of the following scenarios and state whether or not the variable in question is a confounder.

A study of the risk of pulmonary hypertension among women who take diet drugs to lose weight. The crude
relative risk of pulmonary hypertension comparing diet drug users to non-users is 17.0 and the age
adjusted relative risk is 5.0. Is age a confounder in this study?

Yes, age is a confouder

A cohort study of liver cancer among alcoholics. Incidence rates of liver cancer among alcoholic men are
compared to a group of non-alcoholic men. Is gender a confounder in this study?

No, gender is not a confounder since the study is only conducted on men

A case-control study of the risk of beer consumption and oral cancer among men. In this study, cigarette
smoking is associated with beer consumption and is a risk factor for oral cancer among both beer drinkers
and nondrinkers. Is cigarette smoking a confounder in this study?

Yes, cigarette smoking is a confounder because those who drink beer are more likely to smoke, which
could make the association seem stronger than it is
3. Suppose that a cohort study of body mass index and coronary heart disease (CHD) was undertaken.
Participants were classified as having either a high or normal body mass index. Because age is associated
with both body mass index and risk of CHD, age was considered a potential confounder and the age of
each participant was recorded. The following data were gathered from the study participants:

Normal Body Mass Index High Body Mass Index

DISEASE STATUS AGE DISEASE STATUS AGE
Young Old Young Old
Developed CHD 18 65 Developed CHD 20 200
Did Not Develop CHD 6982 2935 Did Not Develop CHD 3980 5800
Total 7000 3000 Total 4000 6000

A. Set up the 2X2 table to evaluate the crude association between body mass index and CHD and calculate
the crude risk ratio.

CHD
BMI Yes No Total
High
Normal

B. Set up the 2X2 tables to evaluate the relationship between body mass index and CHD stratified by age.
Calculate the relative risks separately for the young and old participants. Is age a confounder in this study?
If so, calculate the magnitude and determine the direction of confounding.

Younger group:

Older group: