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Type II Diabetes is one of the fastest growing chronic diseases in Australia

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Type II Diabetes is one of the fastest growing chronic diseases in Australia. Table 1 below displays the numbers of type II diabetic cases and the total populations in two Queensland regional cities (City X and City Y) and the Queensland population by sex at the beginning of 2011. The two cities also recorded additional type II diabetic cases throughout the same year including 785 female and 971 male cases in City X, and 1168 female and 1252 male cases in City Y.

 

Table 1 Numbers of diabetic cases and total populations in City X and City Y

	City X		City Y		Queensland population in 2011
Sex group	Total cases at the beginning of 2011	Population in 2011	Total cases at the beginning of 2011	Population in 2011
Male	15053	83630	24255	232762	2,048,861
Female	12198	76239	25861	240509	2,042,685

 

a) Calculate the overall prevalence of type II diabetes at the beginning of 2011 in the two cities and indicate which city had higher prevalence of the disease. (2.5 marks)

b) Which specific incidence measure (cumulative incidence, incidence rate, or estimated incidence rate) can be used in this scenario? Provide reasoning to justify your answer. Compare the crude incidence (two-sex combined) of diabetes between the two cities in 2011. Please use per 1000 people as the population multiplier. (3.5 marks)

c) Calculate the sex-specific incidence (per 1000) in the two cities. How does sex affect the risk of developing diabetes in each of the two cities? (Use an appropriate measure of association to determine the effect of sex on diabetes). Based on your results, explain whether or not sex is a risk factor for type II diabetes in the two cities. (4 marks)

d) Use Queensland’s population as the standard population to calculate the direct standardised incidence rates (sex adjusted incidence) of type II diabetes in City X and in City Y. Indicate which city had higher standardised incidence. Compare the standardised results and the crude results (in Q1-b) between the two cities and interpret your findings. (5 marks)

 

 

 

Question 2     (8 marks) 

A hypothetical study was conducted to investigate the association between alcohol consumption during pregnancy and low birth weight.  A total of 105 babies born with low weight (<10^th centile in newborn population) were identified in a community. Additional 210 babies with normal weight were also selected from the same community. Mothers of the babies were interviewed to determine their alcohol drinking behaviours during pregnancy. The interview results indicated that 20 mothers of the babies with low birth weight and 18 mothers of the babies with normal weight drank alcohol regularly during pregnancy.

 

1. What type of study design is this? Please provide 2 reasons to justify your choice of study design (2 marks)
2. Does there appear to be an association between alcohol consumption during pregnancy and having a child with low birth weight and, if so, how strong is the association?  (4 marks)
3. Calculate the attributable fraction and interpret your result. (2 marks)

 

 

 

Question 3   (8 marks) 

A total of 100,000 postmenopausal women were selected in 1986 to participate in a study examining the effect of physical activity on the risk of breast cancer. After eliminating those who had cancer diagnoses at the initial survey, the remaining 96534 women were eligible for the study. The initial survey included participants’ self-reported regular physical activities and durations to determine their levels of physical activity. In 2006, the National Cancer Registry and Death Registry were used to identify the participants who developed breast cancer or died of breast cancer during the study period. Table 3 summarises the number of women who developed breast cancer and the total person-years by the level of physical activity.

 

Table 3 Level of physical activity and breast cancer among postmenopausal women

Level of physical activity	Number of Breast cancer	Total person-years
Low	1518	271,364
Intermediate	2153	536,482
High	1104	397,403

 

a) Identify the study design used in this research and provide 2 reasons to justify your answer. (2 marks)

b) How does the occurrence of breast cancer vary by level of physical activity among postmenopausal women? Interpret your results briefly.  Hint: choose an appropriate measure of association to quantify the variation. (4 marks)

c) What proportion of breast cancer can be prevented if all postmenopausal women consistently engaged in a high level of physical activity?  (2 marks)

 

 

Question 4    (9 marks)

Search data of “Mortality and Global Health Estimates” (using data in 2020, except life expectancy and healthy life expectancy data in 2019) for 3 selected countries: Australia, Ghana and Vietnam from WHO’s Global Health Observatory website (Link: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates) and complete the following table (Table 4) (Items 4-8, excluding the shaded parts). Please report data of mean estimates excluding confidence intervals (3 marks). Compare the population health data among the three selected countries and answer Question 4 (a) and (b) (6 marks).

Table 4  WHO health statistical profiles for Australia, Nigeria and Vietnam (2020)

Data in 2020	Australia	Ghana	Vietnam
Population (thousands)	25,655	33,107	97,338
Population proportion
Under 15 (%)	18.7%	37.4%	24.3%
≥ 65 (%)	16.4%	4.3%	7.6%
Crude mortality (per 1000)	6.75	6.14	6.41
Maternal mortality ratio (per 100,000 live births)
Infant mortality rate (per 1000 live births)
Under 5 mortality rate (per 1000 live births)
Life expectancy (years), 2019
At birth (Both sexes)
At age 60 (Both sexes)
Healthy life expectancy, 2019
At birth (Both sexes)
At age 60 (Both sexes)

1. Compare the population and crude mortality data (Items 1-3) of the three selected countries, and summarise your comparison results briefly. Considering the population structures presented in the table, is crude mortality rate a useful measure for comparing the overall public health status among the three countries? Why or why not?    (Word limit: 200 words).  (2 marks)
2. According to the completed Table 4, compare the population health data (Items 3-8) and the general levels of public health among the three countries. If you are managing global funds to support these countries’ plans for achieving better health, how would you prioritise the funding allocation? (Word limit: 300 words).  (4 marks)

PLEASE USE MICROSOFT WORD DOCUMENT TO TYPE YOUR ANSWERS, USING A MINIMUM FONT SIZE OF 11 AND 1.5 LINE SPACING. DO NOT SUBMIT A PDF FILE. YOU ARE REQUIRED TO SHOW WORKING OUT FOR THE CALCULATIONS (INCLUDING INTERPRETATIONS) AND PROVIDE BRIEF ANSWERS TO THE QUESTIONS IN THIS ASSIGNMENT. KEEP ONE DECIMAL PLACE IN YOUR FINAL ANSWERS OF CALCULATIONS. A TOTAL OF LESS THAN 1,500 WORDS (EXCLUDING EQUATIONS & TABLES) WILL BE SUFFICIENT TO ANSWER ALL QUESTIONS IN THIS ASSIGNMENT.