Epidemiological Study Designs Essay
Epidemiology is a discipline in healthcare that seeks to understand the causes and courses of disease. It is concerned with incidence and prevalence as well as environmental, agent, and host factors surrounding the development of disease (Gulis & Fujino, 2015). In public health, there are many health conditions with a known association with specific predisposing factors. An example of this kind of epidemiological association is that between obesity and heart disease. The purpose of this paper is to look at this obesity-heart disease epidemiological association, and how it can be investigated using an observational study. Epidemiological Study Designs Essay
Identification of the Population Health Topic
The population health topic or association between a risk factor and a health outcome chosen is that of obesity and heart disease. Overweight and obesity are very well known risk factors to the development of heart disease. This includes coronary artery disease or CAD (Hammer & McPhee, 2018). Overweight and obesity is the result of accumulation of adipose tissue in the body. This fatty tissue is deposited in areas that include subcutaneous tissue, around organs, and unfortunately inside arteries too as atheromatous plaque. This is to say that overweight and obesity lead to hyperlipidemia in which there are excessive amounts of triglycerides and low-density lipoprotein (LDL) cholesterol. At the same time, there is a corresponding drop in the levels of high-density lipoprotein (HDL) cholesterol of the “good” cholesterol (Jameson et al., 2018). This is the beginning of the development of heart disease.
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Obesity leads to hypertension as a result of compression of the blood vessels as well as deposition of fatty tissue inside of arteries. With HTN, the heart has to work harder to supply the body tissues due to the resistance. This causes progressive hypertrophy of the left ventricle with eventual heart failure. Fluid will start accumulating in the lungs and without treatment the right side of the heart will also be affected. Deposition of atheromatous plaques inside coronary arteries leads to narrowing and ischemia (Jameson et al., 2018). If cardiac catheterization is not done in time to unblock the coronary artery, complete blockage occurs resulting in myocardial infarction or heart attack. Epidemiological Study Designs Essay
Research Question: What is the contribution of obesity to the development of heart disease?
The Appropriate Epidemiologic Study Design
Because it is not ethically possible to do an experimental study to see how obesity causes heart disease (due to ethical reasons), the best study design for this would be an observational study. For this reason, the best and most appropriate study design chosen to look at the epidemiological relationship between obesity and heart disease is retrospective case-control study (Song & Chung, 2010). This is one type of observational study that is usually preferred for lifestyle conditions such as heart disease.
The study design involves selecting cases of heart disease that have been already diagnosed (alive or dead), and then looking back at the situations and events leading up to the diagnosis of heart disease. A group of people with similar characteristics but who do not have heart disease will also be selected and followed backwards. These will be the controls (Song & Chung, 2010). The objective is to see if obesity will feature prominently among the factors that led to the diagnosis of heart disease. In other words, for the argument to hold that obesity is indeed a risk factor associated with heart disease, a majority of the sample population must be found to have been obese. Epidemiological Study Designs Essay
The Data Collection Activities
The data collection in this project as the name of the study design implies will be retrospective. That means it will be back-looking and not forward-looking. For this reason, data collection will involve mailing a questionnaire to the control group of participants. For the patients already diagnosed with heart disease, data collection will involve looking at their health records going back three to five years. This will involve physical perusal of the health records with permission from the healthcare organizations and providers, the patients (if still alive), and the patients’ families.
Methodologic Strategies
The methodologic strategy to be used here will be about the selection of the sample to study as well as the controls. For the sample, a stratified random sample of the healthcare organizations in the county will be done. From these, a representative sample will be generated based on organization size, complexity, location, clientele demographics, and resource availability. Selection of the participants will then be done based on the diagnosis of either heart failure of a myocardial infarction or MI. stratified random sampling will also be used to select the controls, who must represent diversity and all other factors including socioeconomic status and ethnicity. Epidemiological Study Designs Essay
The Strengths and Limitations of the Selected Approach and Ethical Considerations
The strengths of the retrospective case-control observational approach include readily available data in records, faster completion rates, and the ease of getting a sample amongst others. The weaknesses on the other hand include the possibility of mistakes having been made in data entry in the records, missing information from medical records, lack of the benefit of seeing in real time the association between what is being observed and the environmental factors.
The ethical considerations pertaining to this study include ensuring the benefits are tangible, ensuring confidentiality of participants and privacy of any healthcare data used, getting informed consent from participants or their families (in the case of health records), and declaring any conflict of interest (NIH, 2016). All these ethical parameters will be observed.
Conclusion
The epidemiological association between obesity and heart disease is known but more research is needed. One of the best study designs to do this is conducting an observational study. For this, a retrospective case-control study would be the best as has been seen above. Epidemiological Study Designs Essay
References
Gulis, G. & Fujino, Y. (2015). Epidemiology, population health, and health impact assessment. Journal of Epidemiology, 25(3), 179-180. https://doi.org/10.2188/jea.JE20140212
Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. New York, NY: McGraw-Hill Education.
Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds) (2018). Harrison’s principles of internal medicine, 20th ed. New York, NY: McGraw-Hill Education.
National Institutes of Health [NIH] (March 16, 2016). Guiding principles of ethical research: Pursuing potential research participants protections. https://www.nih.gov/health-information/nih-clinical-research-trials-you/guiding-principles-ethical-research
Song, J.W., & Chung, K.C. (2010). Observational studies: Cohort and case-control studies. Plastic and Reconstructive Surgery, 126(6), 2234–2242.
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Briefly identify the population health topic (association between a risk factor and a health outcome) you selected. Present a research question based on this topic that you would like to answer in a proposed study. (Consult the Walden “Developing Research†resource for guidance on crafting a research question.) Epidemiological Study Designs Essay
Explain the epidemiologic study design that would be most appropriate to assess and address your population health problem.
Summarize the data collection activities you would use (i.e., how you would collect data—online survey, paper/pen, mailing, etc.).
Explain any specific methodologic strategies you would use. For example, if you were conducting a case-control study, how would you select your cases and controls?
Consider the methods you would use to make these selections. What are the strengths and limitations of your selected approach?
Explain ethical considerations pertaining to your study. Epidemiological Study Designs Essay