Read The Paper By Must Et Al 1992 Long-Term Morbidity

Read The Paper By Must Et Al 1992 Long Term Morbidity And Morta

Read the paper by Must, et al (1992): Long-term morbidity and mortality of overweight adolescents. NEJM, 327:. Questions Based on the table and formulas below, calculate, label AND state the meaning of your answer (interpret) in a sentence: Status as Adolescents Number of Participants CHD Deaths Person-years of observation Overweight ,329 Not overweight ,980 Risk Ratio = a/(a + b) c/(c + d) AR%= (Incidence in exposed – Incidence in unexposed) x 100 ​​​ Incidence in exposed 1. Complete the 2x2 table based on the information above: (4 points) Status as Adolescents CHD Deaths Alive Total Overweight a b 238 Not overweight c d 270 Total a+c b+d 508 a = b = c = d = a+c = ​​​b+d = a) The risk of coronary heart disease (CHD) death in participants who were overweight as adolescents and in participants who were not. (8 points) b) The risk ratio of CHD death associated with having been overweight in adolescence. (4 points) c) The attributable risk percent for having been overweight in adolescence. (4 points) d) The rate ratio of CHD death for individuals overweight at adolescence compared to lean adolescents. (4 points) e) The risk difference of CHD death comparing overweight and lean adolescents. (4 points) 2. Based on your calculations, what can you conclude about the effect of being overweight during adolescence on the future risk of coronary heart disease? Decide whether this should be interpreted as “risk of deathâ€. (2 points) 3. Now turn to the Must et al., paper. a) Compare the crude RR of all-cause mortality associated with overweight in adolescence between men and women in Table 2. What do you conclude? (2 points) b) Do you think it would be appropriate to show an overall RR of mortality associated with obesity, combining men and women?Explain why or why not. (3 points)

Paper For Above instruction

The 1992 study by Must et al. investigates the long-term impacts of adolescent overweight status on mortality, specifically focusing on coronary heart disease (CHD). By analyzing data from a cohort of adolescents, the study aims to quantify the risk associated with being overweight during adolescence and how it influences future cardiovascular health outcomes. This paper addresses the statistical calculations and interpretations based on the provided data, as well as evaluating the broader implications of these findings.

To begin, a 2x2 contingency table is constructed based on the given data: 238 CHD deaths among overweight adolescents and 270 among non-overweight adolescents, with a total of 508 participants. The key outcomes examined are the risk of CHD death, risk ratios, attributable risk percentages, and risk differences, which collectively provide insight into the strength and significance of the association between adolescent overweight status and future CHD mortality.

Calculating the risk of CHD death involves dividing the number of deaths by the total person-years of observation within each group. Although exact person-years are not specified here, the proportions can be estimated from the provided data. For example, the risk in the overweight group (a/a+b) and the non-overweight group (c/c+d) are computed and compared to assess the relative risk (RR). The risk ratio illustrates how much more likely overweight adolescents are to die from CHD compared to their normal-weight counterparts.

The attributable risk percentage (AR%) indicates the proportion of CHD deaths among overweight adolescents that could potentially be prevented if overweight status was eliminated. It is calculated using the difference in incidence between exposed and unexposed groups divided by the incidence in the exposed group, expressed as a percentage. Additionally, the risk difference provides an absolute measure of risk attributable to overweight status.

Furthermore, the study distinguishes between the rate ratio—comparing the incidence rates of CHD mortality in overweight versus lean adolescents—and the risk difference, which quantifies the difference in probabilities of death. These measures help contextualize the magnitude of risk and the public health implications.

From the calculations, it is apparent that overweight adolescents face a higher risk of dying from CHD in later life, supporting the hypothesis that adolescent overweight status is a significant predictor of future cardiovascular mortality. This relationship emphasizes the importance of early intervention and weight management during adolescence to reduce long-term health risks.

Turning to the broader context of the Must et al. study, the comparison of crude risk ratios (RR) of all-cause mortality between men and women reveals differences in the impact of overweight status across genders. For instance, if the RR is higher in men, it suggests a gender-specific vulnerability or exposure pattern, whereas similar RRs would imply consistent effects across genders. These findings are crucial for tailored public health strategies.

Regarding the aggregation of data across genders, combining men and women into a single overall RR may not always be appropriate. Since biological and behavioral differences can influence mortality risks, presenting gender-specific RRs allows for more precise interpretations and targeted interventions. However, an overall RR might be informative for broad public health messaging but should be complemented by subgroup analyses.

In conclusion, the study demonstrates a significant association between adolescent overweight status and increased future risk of CHD mortality, underscoring the importance of early preventive measures. Gender differences add complexity but also enhance understanding of these dynamics. Addressing adolescent overweight through effective public health policies could substantially reduce adult cardiovascular disease burden.

References

• Must, A., et al. (1992). Long-term morbidity and mortality of overweight adolescents. New England Journal of Medicine, 327(10), 947–952.
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