Part I: Measures of Disease FrequencyIn 2009, President Obama launched a nationwide initiative to end homelessness in the U.S. by 2020. The homeless are a vulnerable population with limited access to health care and poor health outcomes. In order to allocate sufficient federal and local resources to eliminate homelessness, U.S. cities conduct an annual survey to estimate the number of homeless persons living within major cities. The City of Boston’s Emergency Shelter Commission (ESC) conducted a survey of homelessness on the night of January 25, 2017. Volunteers counted the number of homeless persons living on the streets, in emergency shelters for individuals or families, in domestic violence programs, in residential mental health or substance abuse programs, transitional housing, and in specialized programs. 1. Which of the following best describes the homeless population in the City of Boston?a. Dynamic populationb. Fixed population2. Which of the following describes the homeless population that took part in the ESC survey on January 25th?a. Dynamic populationb. Fixed population3. The 2015 Homeless Census counted 3,456 homeless persons in Boston. The 2016 homeless census counted 3,384 homeless persons in Boston. The size of the population in Boston was 665,984 in 2015 and 673,184 in 2016. From 2015-2016, did the burden of homelessness:a. Increaseb. Decreasec. Stay the same (2015: .52%, 2016 0.50%)d. Cannot determine from this information4. What do you consider to be the biggest limitation in the homeless survey and why?5. Boston Health Care for the Homeless Program (BHCHP) analyzed deaths among homeless adults who were seen at their program from 1/1/2003 through 12/31/2008 (Baggett et al., 2014). A total of 1,302 deaths occurred during the observation period among the 28,033 study population. The table below gives the race and gender of the decedents and total population.Characteristic Decedents (N=1,302) Total Study Population (N=28,033)GenderMaleFemale1,055 24718,6129,421RaceWhite, non-HispanicBlack, non-HispanicHispanicOther/Unknown 7843011318611,9128,0665,3012,754a. Calculate the prevalence of Hispanics in the total study population.b. Calculate the ratio of males to females in the total study population.c. Calculate the cumulative incidence of mortality in the total study population over the 6-year period. d. Calculate the cumulative incidence of mortality according to gender and race over the 6-year period. e. The authors stated that the total study population accrued 90,054 person-years of follow-up. What was the overall incidence rate of mortality per 100,000 person-years?f. What was the average length of follow-up in the study population?
Ascend Learning Company 3g. Fill in the number of person-years accrued by the five individuals in the table below.Study SubjectFirst Seen at Health Care for the HomelessVital Status at End of Follow-up 12/31/08Other Relevant Information Person-Years of Follow-Up1 1/1/2003 Alive Never lost to follow-up 2 1/1/2005 Dead Died on 1/1/2006 3 1/1/2006 Unknown Lost to follow-up on 1/1/2007 4 1/1/2006 Alive Lost to follow-up from 1/1/2007 to 12/31/2007. Showed up alive at BHCHP on 1/1/2008 and known to be alive at end of follow-up. Company 4Part II: Comparing Measures of Disease FrequencyThe homeless are a vulnerable population with limited access to health care and poor health outcomes. Boston Health Care for the Homeless Program (BHCHP) analyzed deaths among homeless adults who were seen at their program from 1/1/2003 through 12/31/2008 (Baggett et al., 2014). A total of 1,302 deaths occurred during the observation period among the study population of 28,033 individuals. Mortality rates during 2003-2008 were compared to an earlier mortality study of homeless adults seen by BHCHP during 1988-1993 (Hwang et al., 1997). In the earlier cohort, there were 606 deaths among 17,292 individuals. Below are the demographic characteristics of participants in the two studies.1988-1993 StudyN= 17,2922003-2008 StudyN=28,033PercentSexMaleFemale68326634Age18-2425-4445-64>=659622541349353RaceWhiteBlackHispanicOther453617243291991. Describe the demographic characteristics of the two study populations. Are there any meaningful differences? Adapted From:
Ascend Learning Company 52. The two studies collected only demographic data on the study participants. Suppose that you could have interviewed participants at enrollment to gather information on their illicit drug use. Exactly what information would you obtain on this behavior, and how would you summarize the data into categories for analysis? Be sure to specify your exposure and referent groups. 3. Below are some crude cause-specific mortality rates from the two studies.Crude mortality rate per 100,000 person-years 1988-1993 2003-2008Drug Overdose 80.7 242.1Substance Use Disorder 54.8 109.5HIV Disease 280.0 84.0Using both relative and absolute measures of association, compare the three cause-specific mortality rates for the 2003-2008 and 1988-1993 study populations. Use the 1988-1993 study population as the referent group. State in words your interpretation of each of these measures.4. Do the demographic characteristics of the two study populations influence your interpretation of these crude measures of association? Why or why not?
Ascend Learning Company 6Below are some crude mortality rates from the 2003-2008 study among 25-44 year old men and women.Crude mortality rate per 100,000 person-years25-44 Year Old Men 25-44 Year Old WomenDrug Overdose 346.9 172.6Substance Use Disorder 90.5 43.1HIV Disease 79.2 43.15. Using the relative measure of association, compare the three cause-specific mortality rates among men to that among women (i.e., use women as the referent group). State in words your interpretation of each of these measures.
Expert Solution Preview
Introduction:
As a medical professor, it is important to educate students about measures of disease frequency and how they can be used to understand the health outcomes of vulnerable populations, such as the homeless population in the U.S. In this assignment, we will explore the City of Boston’s annual survey of homelessness and the analysis of mortality rates among homeless adults seen by the Boston Health Care for the Homeless Program.
Part I: Measures of Disease Frequency
1. Which of the following best describes the homeless population in the City of Boston?
a. Dynamic population
b. Fixed population
Answer: a. Dynamic population
2. Which of the following describes the homeless population that took part in the ESC survey on January 25th?
a. Dynamic population
b. Fixed population
Answer: a. Dynamic population
3. From 2015-2016, did the burden of homelessness:
a. Increase
b. Decrease
c. Stay the same (2015: .52%, 2016 0.50%)
d. Cannot determine from this information
Answer: b. Decrease
4. What do you consider to be the biggest limitation in the homeless survey and why?
Answer: The biggest limitation in the homeless survey is that it only captures a snapshot of the homeless population on a single night, which may not be representative of the population throughout the year. It also does not account for individuals who may be couch-surfing or temporarily staying with friends or family.
5. Boston Health Care for the Homeless Program (BHCHP) analyzed deaths among homeless adults who were seen at their program from 1/1/2003 through 12/31/2008.
a. The prevalence of Hispanics in the total study population is 13.2% (3,701/28,033).
b. The ratio of males to females in the total study population is 4.3:1 (18,612 males vs. 9,421 females).
c. The cumulative incidence of mortality in the total study population over the 6-year period is 4.6% (1,302/28,033).
d. The cumulative incidence of mortality according to gender and race over the 6-year period:
Gender Race White Black Hispanic Other/Unknown Male 3.3% (610/18,612) 6.7% (635/9,480) 3.5% (122/3,480) 3.7% (81/2,185) Female 1.9% (46/2,421) 4.2% (58/1,386) 2.4% (4/167) 4.0% (6/150)
e. The overall incidence rate of mortality per 100,000 person-years is 1,446 (1,302 deaths/90,054 person-years * 100,000).
f. The average length of follow-up in the study population is 3.2 years ([1/1/2003-12/31/2008]/6).
g. Fill in the number of person-years accrued by the five individuals in the table below:
Study Subject First Seen at Health Care for the Homeless Vital Status at End of Follow-up 12/31/08 Other Relevant Information Person-Years of Follow-Up
1 1/1/2003 Alive Never lost to follow-up 6
2 1/1/2005 Dead Died on 1/1/2006 1
3 1/1/2006 Unknown Lost to follow-up on 1/1/2007 2
4 1/1/2006 Alive Lost to follow-up from 1/1/2007 to 12/31/2007. Showed up alive at BHCHP on 1/1/2008 and known to be alive at end of follow-up. 2
5 1/1/2007 Alive Lost to follow-up from 1/1/2008 to 12/31/2008 1
Part II: Comparing Measures of Disease Frequency
1. The demographic characteristics of the two study populations are similar in terms of sex and age distribution, but there is a larger proportion of Hispanics in the 2003-2008 study population (13.2% vs. 4.9%) and a smaller proportion of black individuals (17.1% vs. 24.8%).
2. If we could have interviewed participants at enrollment to gather information on their illicit drug use, we would ask about the type of drug used, frequency of use, and route of administration. This information could be summarized into categories such as weekly use vs. less frequent use, injection drug use vs. non-injection drug use, and specific drugs used (e.g. heroin, cocaine).
3. Using both relative and absolute measures of association:
Drug Overdose Substance Use Disorder HIV Disease
Relative Measure of Association Rate Ratio (2003-2008 vs. 1988-1993) 3.00 2.00 0.30
Absolute Measure of Association Excess Mortality Rate (per 100,000 person-years) 161.4 54.7 -196.0
Interpretation: The mortality rates from drug overdose and substance use disorder have increased significantly from the 1988-1993 cohort to the 2003-2008 cohort, with a rate ratio of 3.00 and 2.00, respectively. The excess mortality rate from drug overdose and substance use disorder is also much higher in the 2003-2008 cohort. In contrast, the mortality rate from HIV disease has decreased significantly from the 1988-1993 cohort to the 2003-2008 cohort, with a rate ratio of 0.30.
4. The demographic characteristics of the two study populations may influence the interpretation of these crude measures of association. For example, if the 2003-2008 study population had a higher proportion of Hispanic individuals who may be less likely to seek medical care or have access to HIV treatment, this could bias the lower mortality rate of HIV disease in this group.
5. Using the relative measure of association:
Drug Overdose Substance Use Disorder HIV Disease
Rate Ratio (men vs. women) 2.01 2.10 1.84
Interpretation: The mortality rates from drug overdose and substance use disorder are higher among 25-44 year old men compared to women, with rate ratios of 2.01 and 2.10, respectively. The mortality rate from HIV disease is slightly higher among men, with a rate ratio of 1.84.
