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The following are hypothetical data from a casecontrol study of oral contraceptives (OC) and cervical cancer. You are interested in determining the potentially confounding effect

The following are hypothetical data from a case‑control study of oral contraceptives (OC) and cervical cancer. You are interested in determining the potentially confounding effect of education, dichotomized in your data as "low" (< 12 years) and "high" (12+ years):

Table 1: Strata 1: low education level (< 12 years)

OC use

Cervical cancer

Control

Total

Yes

45

9

54

No

47

16

63

Total

92

25

117

Table 2: Strata 2: high education level (12 + years)

OC use

Cervical cancer

Control

Total

Yes

26

42

68

No

12

33

45

Total

38

75

113


A. to evaluate “education” as a confounder based on the criteria of confounder (i.e. strategy 1 in lecture(4 points)

  1. Step 1: evaluate the association between confounder (education) and exposure (OC use). Please complete the following table using the above Table 1&2 and calculate the OR between education and OC use (1 pts)

Education

OC use

Yes

No

high

low


  1. Step 2: evaluate the association between confounder (education) and disease (Cervical cancer). Please complete the following table using the above Table 1&2 and calculate the OR between education and Cervical cancer (1 pts)

Education

Cervical cancer

Yes

No

high

low


  1. If we assume that “education” is not an intermediate factor in the causal pathway of the relationship between OC use and cervical cancer, could you determine if education is a confounder based on the results from part i and ii of A? If yes, what is the direction of confounding of education (negative, positive or qualitative) based on the associations between education and OC use and between education and cervical cancer from part i and ii of A? (2 pts)

B. to evaluate “education” as a confounder based on the method of stratification

  1. Step 1: evaluate the crude association between OC use and cervical cancer (e. without stratified with education). Please complete the following table using the above Table 1&2 and calculate the OR between OC use and cervical cancer

OC use

Cervical cancer

Yes

No

Yes

No


  1. Step 2: evaluate the association between OC use and cervical cancer in each stratum of education; i.e. please calculate the OR between OC use and cervical cancer in each stratum of education respectively.

                      OR strata-low=

                        OR strata-high=

  1. Based on the results of Part i and ii of B, do you think that “education” is a confounder in study of the relationship between OC use and cervical cancer? Why or why not?

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