Stacy Huang

EPID600
Introduction to Epidemiology

Homework 7
DUE 11/05/18 at 1:30 pm

Effect modification

While you can discuss the homework with other students, you must submit your work individually and it should
reflect your own thinking and understanding of the questions. Do not type up the answers as a group; do it
individually, using your own wording. You may want to bring a copy of your homework to the lab discussion.

The table below shows incidence rates of gastroenteritis among children 1-4 years of age in city AA by social
class over several years.

Rate (per 1000 person-years)

Year
Low social class High social class
1985 100 49
1990 88 36
1995 74 23
2000 60 13
2005 50 3
1.
a. Calculate the rate differences and the rate ratios comparing low to high social class for each year.

IRD = rate exposed - rate unexposed

IRR = rate exposed / rate unexposed

1985:
IRD = 100 - 49 = 51 per 1000 person years
IRR = 100 / 49 = 2.04

1990:
IRD = 88 - 36 = 52 per 1000 person years
IRR = 88 / 36 = 2.44

1995:
IRD = 74 - 23 = 51 per 1000 person years
IRR = 74 / 23 = 3.21

2000:
IRD = 60 - 13 = 47 per 1000 person years
IRR = 60 / 13 = 4.62

2005:
IRD = 50 - 3 = 47 per 1000 person years
IRR = 50/3 = 16.66

b. Describe the association between social class and gastroenteritis:

i. In 1985 using rate differences

1
Stacy Huang

EPID600
Introduction to Epidemiology

There’s a positive association between social class and gastroenteritis. The incidence rate of
gastroenteritis among children 1-4 years of age in low social class is 51 per 1000 person years in
excess of the incidence rate of gastroenteritis among children ages 1-4 in high social class.

ii. In 1985 using rate ratios

There’s a positive association between social class and gastroenteritis. The incidence rate of
gastroenteritis among children 1-4 years of age in low social class is 2.04 times higher than than
among children ages 1-4 in high social class.

iii. In 2005 using rate differences

There’s a positive association between social class and gastroenteritis. The incidence rate of
gastroenteritis among children 1-4 years of age in low social class is 47 per 1000 person years in
excess of the incidence rate of gastroenteritis among children ages 1-4 in high social class.

iv. In 2005 using rate ratios

There’s a positive association between social class and gastroenteritis. The incidence rate of gastroenteritis
among children 1-4 years of age in low social class is 16.66 times higher than than among children ages 1-4 in
high social class.

c. Does year modify the association of social class with gastroenteritis? Explain in one sentence.

Yes, year appears to modify the association of social class with gastroenteritis, because as time goes by, the
IRD and IRR both change.

2. The table below shows the risk of suicide during a 1 year follow-up in black and white men and women in a
given country

Risk per thousand over 1 year

Black White
Women 0.019 0.044
Men 0.112 0.186

a. Assume both sex and race have causal effects on death from suicide. Determine whether there is an
interaction between sex and race in the additive scale by estimating and comparing the differences
between expected and observed joint effects. Consider black women as the reference (unexposed).

A=race (white=exposed, black=unexposed

Y=suicide
M=sex (M=1 male, M=0 female)

Observed CID for each cause in the absence of the other exposure:
CID for race = Pr(Y=1 | A=1, M=0) - Pr(Y=1 | A=0, M=0) = .044 - .019 = 0.025 per 1000 over 1 year
CID for sex = Pr(Y=1 | M=1, A=0) - Pr(Y=1 | M=0, A=0) = .112 - .019 = .093 per 1000 over 1 year

Expected joint CID = CID for race + CID for sex = .025 + .093 = .118 per 1000 over 1 year

Observed joint CID = Pr(Y=1 | A=1, M=1) - Pr(Y=1 | A=0, M=0) = .186 - .019 = .167 per 1000 over 1 year

2
Stacy Huang

EPID600
Introduction to Epidemiology

observed joint CID > expected joint CID → synergism

There is a synergistic interaction between race and gender in the additive scale.

b. Determine whether there is an interaction between sex and race in the multiplicative scale by
estimating and comparing the differences between expected and observed joint effects. Consider black
women as the reference (unexposed).

Observed CIR:
CIR for race = Pr(Y=1 | A=1, M=0) / Pr(Y=1 | A=0, M=0) = .044 / .019 = 2.316
CIR for sex = Pr(Y=1 | M=1, A=0) / Pr(Y=1 | M=0, A=0) = .112 / .019 = 5.895

Expected joint CIR = CIR for race x CIR for sex = 2.316 x 5.895 = 13.65

Observed joint CIR = Pr(Y=1 | A=1, M=1) / Pr(Y=1 | A=0, M=0) = .186 / .019 = 9.78

observed joint CIR < expected joint CIR → antagonism

There’s an antagonistic interaction between race and sex in the multiplicative scale.

3
Stacy Huang

EPID600
Introduction to Epidemiology

EXTRA CREDIT

1. In question 2, what proportion of the cases of suicide among white males would be potentially attributable
to an additive interaction between sex and race?

attributable proportion = additive interaction / white males

= [Pr(Y=1 | R=1, G=1) - Pr(Y=1 | R=1, G=0) - Pr(Y=1 | R=0, G=1) + Pr(Y=1 | R=0, G=0)] / Pr(Y=1 | R=1, G=0)
= (.186 - .044 - .112 + .019) / .186
= .1322

13.22% of the risk of suicide among white males is attributable to the additive interaction between sex and
race.

The following questions refer to the paper by Villamor et al. Association between maternal body mass index in
early pregnancy and incidence of cerebral palsy. JAMA 2017;317:925-36.

Let A be a dichotomous variable representing exposure to early pregnancy maternal obesity (BMI >30 kg/m2),
M be a dichotomous variable representing exposure to preterm delivery (gestational age at delivery <37
weeks), and Y be a dichotomous variable representing cerebral palsy in the offspring. Assume both A and M
have a causal effect on Y and the data in the paper represent those causal effects.

From Table 4 and using cumulative incidences per 1000 over the follow-up period under observation (ignore
the column “Missing”) calculate:

2. The effect of A on Y in the absence of M in the additive scale; use notation.

CIDA = Pr (Y=1 | A=1, M=0) – Pr (Y=1 | A=0, M=0) = (257/131586) – (1617/1079490) = 0.00046 = 0.46 cases
per
1000 over the follow up period

3. The effect of M on Y in the absence of A in the additive scale; use notation.

CIDM = Pr(Y=1 | M=1, A=0) – Pr(Y=1 | M=0, A=0) = (613/51461) – (1617/1079490) = 0.0104 = 10.4 cases per
1000 over the follow up period

4. The expected joint effect of A and M on Y under independence of effects in the additive scale
0.00046 + 0.0104 = 0.01086 = 10.86 cases per 1000 over the follow up period

5. The observed joint effect of A and M on Y in the additive scale

(97/8020) - (1617/1079490) = 0.01060 = 10.60 cases per 1000 over the follow up period

6. The average effect of A on Y in the additive scale; use notation

average CIDA = Pr(Y=1 | A=1) – Pr(Y=1 | A=0) = (354/139606) – (2230/1130951) = 0.000564 = 0.564
cases per 1000 over the follow up period.

7. The average effect of M on Y in the additive scale; use notation

average CIDM = Pr(Y=1 | M=1) – Pr(Y=1 | M=0) = (710/59481) – (1874/1211076) = 0.0104 = 10.4 cases per
1000 over the follow up period.

8. The effect of A on Y in the absence of M in the multiplicative scale; use notation.

CIRA = Pr(Y=1 | A=1, M=0) / Pr(Y=1 | A=0, M=0) = (257/131586) / (1617/1079490) = 1.3039

4
Stacy Huang

EPID600
Introduction to Epidemiology

9. The effect of M on Y in the absence of A in the multiplicative scale; use notation.

CIDM = Pr(Y=1 | M=1, A=0) / Pr(Y=1 | M=0, A=0) = (613/51461) / (1617/1079490) = 7.9523

10. The expected joint effect of A and M on Y under independence of effects in the multiplicative scale
CIR A x CIR M = 1.3039 x 7.9523 = 10.3690
11. The observed joint effect of A and M on Y in the multiplicative scale
(97/8020) / (1617/1079490) = 8.0743

12. The average effect of A on Y in the multiplicative scale; use notation

CIR A = [Y=1 | A=1] / [Y=1 | A=0] = (354/139606) / (2230/1130951) = 1.2860

13. The average effect of M on Y in the multiplicative scale; use notation

CIR M = [Y=1 | M=1] / [Y=1 | M=0] = (710/59481) / (1874/1211076) = 7.7140

Answer true or false for each statement:

14. ___F____ There is no interaction between A and M on Y in the additive scale

15. ___T____ The effect of A antagonizes the effect of M in the multiplicative scale

16. ___F____ The effect of M synergizes with the effect of A in the additive scale

17. ___F____ Preterm delivery has no effect on cerebral palsy

18. ____F___ The association between obesity and cerebral palsy is stronger when the baby is delivered at
full term than when it is delivered preterm.

19. ___F____ Preterm delivery modifies the association between maternal obesity and cerebral palsy
qualitatively in the additive scale.

20. ___T____ Maternal obesity modifies the effect of preterm delivery on cerebral palsy quantitatively in the
multiplicative scale.