Strength of association between smoking and cleft lip


Prevalence, incidence and lifetime risk of atrial

fibrillation: the Rotterdam study

Jan Heeringa1, Deirdre AM. van der Kuip1, Albert Hofman‘, Jan A. Korsz, Gerard van Herpenz,

Bruno H.Ch. Stricker1, Theo Stijnen‘, Gregory Y.H. Lip3, and Jacqueline C.M. Witteman1*

1 Department of Epidemiology and Biostatistics, Erasmus Medical Center, PO Box 1738, 3000 DR Rotterdam, The Netherlands;

2 Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands; and 3Haemostasis, Thrombosis, and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK

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Question 1.

a) What justification do the authors provide for conducting this study?

b) What was the overall adjusted OR of cleft lip with or without cleft palate in those consuming ≥400μg of folic acid per day compared to no consumption of folic acid.

c) How would you interpret the finding in 4 (b)?

d) The authors state that the controls in this study are population-based controls – are they? Why or why not?

e) Reflect upon your answer in (d). The authors could have conveniently recruited controls (those without orofacial clefts, but presenting for other reasons) from the surgical centres at the same time as recruiting cases. What might be the effect of using control participants from the surgical centres on the magnitude of the reported OR between folic acid intake and facial clefts? Would the OR move closer or further away from the null value of 1.00? Explain.

Question 2:

In a study using the same design as Wilcox et al., researchers investigated cleft lip with or without cleft palate by smoking status in those participants who reported consuming folic acid supplements. In this sub-group there were 42 cases of cleft lip with or without cleft palate and 55 controls who were current smokers; and there were 72 cases of cleft lip with or without cleft palate and 190 controls who were non-smokers.

(a) Construct a 2x2 table and calculate an appropriate measure of the strength of association between smoking and cleft lip with or without cleft palate in those who consumed folic acid supplements during pregnancy.

Cleft lip with or without cleft palate
Smoking status Cases Controls Total
Current smoker 42 55 97
Non-smoker 72 190 262
Total 114 245 359

(b) How would you interpret the finding in question 2(a)?

(c) What proportion of cleft lip with or without cleft palate in the population is potentially preventable, assuming a causal association between smoking and cleft lip?

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