Hi everyone, homework this week has three parts (the first two parts are pretty straightforward though). You will find part 2 substantially easier after you read the Harper article for this week:
Part 1:
1.Choose a paper describing the development or validation of a measure of relevance in health disparities research (please give the full citation and/or upload the paper if that's possible).
The UCSF Cancer of the Prostate Risk Assessment (CAPRA) Score: a straightforward and reliable preoperative predictor of disease recurrence after radical prostatectomy
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948569/
2.What was the definition of the construct?
In this paper they developed a nomogram to predict the risk of recurrence after radical prostatectomy for prostate cancer. Using this nomogram, they were able to develop a point system which could then be used to create different risk strata.
3.How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
This nomogram was created using the UCSF urologic oncology clinical cohort. The CAPRA scores were correlated with other well-validated nomograms which were currently being used in the literature and reported the degree of correlation between the performance of the CAPRA score and the other nomograms.
4.How did the authors provide evidence on the reliability of the measure? Could you think of additional approaches to evaluating the reliability of the measure?
CAPRA score was then externally validated in a multi-institutional study in the US (https://www.ncbi.nlm.nih.gov/pubmed/17039503) in a multi-institutional study in Europe (https://www.ncbi.nlm.nih.gov/pubmed/17039503).
I think they covered the validation well, with the caveat that each study population were European/Caucasian men with prostate cancer.
One additional approach would be to use pooled data to assess how well the nomogram performs in a more diverse population.
5.Describe the implications of a lack of measurement validity or reliability for future research applications.
Currently there is a notion of increased risk of poor outcomes for African Americans with the assumption of an underlying biologic basis (with limited good data to support it). Previously studies have shown that management in this group of patients varies from the standard of care, and is often more aggressive than management of men of other ethnicities; in turn, increasing the risk of overtreatment.
Without a similar structured assessment of the performance of CAPRA score in AA men, the quantification of risk in AA men may be an overestimate, leading to the perpetuation of overtreatment and the morbidity/mortality associated with the various treatments.
Part 2:
1.Find a paper describing a health disparity (please give the full citation or, even better, upload the paper so everyone else can look at it too)
Understanding the Racial and Ethnic Differences in Cost and Mortality Among Advanced Stage Prostate Cancer Patients (STROBE)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616711/
2.Summarize the construct and measurement of the dimension of disparity (e.g., racial inequalities?, SES inequalities?) and the outcome measured (e.g., self-rated health).
Construct: Racial differences in treatment patterns, controlling for clinical and demographic characteristics
Outcomes measured: direct medicare cost, all cause mortality
3.What is the evidence for the validity and reliability of the measures?
The reporting of similar findings with other observational databases noting differences in treatment and disease specific mortality by age and ethnicity.
4.What is the reference category used for the disparity measure (ie, who is the comparison group)? Why does this reference category make sense (or not) for this research question?
Reference category: non-hispanic white men with prostate cancer
This makes sense in that it is the common reference group for similar studies on this topic. Also, this particular patient population is the most studied in the literature today, generating the majority of most study populations for the creation and validation of the various nomograms and outcomes algorithms.
5.How is the disparity quantified or measured? Is this an absolute or relative measure or are both provided? Describe which type of measure you would prefer for this research area, or, if both, why.
This disparity is measured using odds ratios for treatment differences and hazards ratios for assessing differences in mortality; both being measures of association which are relative to the reference group.
I would prefer both; absolute measurements which would aid in counseling patients in standard clinical practice and relative measurements to assess differences in a research capacity.
Part 3:
1. Read someone else's response to part 1 above (identifying a construct) and comment, specifically noting whether you can see any additional implications of measurement quality for future research or whether you agree with those noted by your classmate.
Reviewed Part 1 from “Week 7 HW_ Shab”
- I agree that this study show work towards improving the external validity of the measure by assessment of how well the SE score performs in other populations. It is currently limited in that it does not account for several other common factors thought of when discussing SES such as race/ethnicity, insurance type, etc.
- First, I agree with her discussion of the implications. Second, one which was implied was that this is being added to the body of literature while still an incomplete picture of the true association between SES and ccHD. Moving forward, this study may be taken as a “strong” study and used to support future work using the same incomplete model. Without taking into account the other confounding variables not assessed, this will further widen the gap between the ‘true’ associations and what is reported in the literature.