lecture3
1. State your health outcome of interest. (It could be the one you used for week #2 or another one.) Pick two key behaviors that are important factors leading to your health outcome. Explain the importance of these behaviors either for etiology, prevention, or intervention. (If none of the behaviors in the readings are important for your health outcome, suggest another behavior that is.)
My health outcome of interest is renal transplantation and renal graft loss. My area of research is in how adherence to medication affects both access to transplant and eventual transplant failure. Other behaviors that may affect both transplant access and graft loss include factors which affect blood pressure control, including diet and exercise. Adherence to antirejection medications is important to prevention of renal graft loss. Additionally, both diet and exercise are important for prevention and management of hypertension. Good blood pressure control is known to delay the progression of CKD1-3 and lead to longer renal graft survival.
2. Describe how you would study the role of one of the behaviors described for question #1 and your health outcome of interest. Incorporate a social factor (e.g. race/ethnicity, social exclusion, stress) in the study approach.
I am planning to examine access to transplant and outcomes by looking at the CKiD database, which is the largest study of pediatric patients with chronic kidney disease. They collect data on adherence at each annual study visit as well as demographic information including race/ethnicity, household income, maternal education, and zip code. CKiD also collects information on renal replacement therapy including dialysis (hemo vs peritoneal) and transplant (living vs deceased donor). I will use Cox models to compare rates and mode of transplantation among patients with different levels of adherence. I will also adjust for the above demographic information. I also plan to build regression models that looks not only at adherence but also the different demographic predictors, particularly household income.
3. If key health behaviors (e.g. smoking, exercise, nutritious diet) are strongly influenced by neighborhood, income, and/or education, do we need to continue to study how these behaviors influence health outcomes? Why or why not?
Yes, we should continue to study these behaviors. In many cases, these behaviors are potentially more easily modifiable than socioeconomic factors such as neighborhood, income, and education. Additionally, understanding how certain behaviors are influenced by social factors can allow specific interventions to be focused on and targeted to high risk groups (ex: making smoking cessation resources available in clinics that serve low income populations).
1. Appel LJ, Wright Jr JT, Greene T, et al. Intensive blood-pressure control in hypertensive chronic kidney disease. New England Journal of Medicine. 2010;363(10):918-929.
2. Flynn JT, Mitsnefes M, Pierce C, et al. Blood pressure in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children study. Hypertension. 2008;52(4):631-637.
3. Group ET. Strict blood-pressure control and progression of renal failure in children. New England Journal of Medicine. 2009;361(17):1639-1650.