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Epidemiology Critical Analysis

“Association Between Active Commuting and Incident Cardiovascular Disease, Cancer, and Mortality: Prospective Cohort Study”

Carlos, et al (2017) has conducted a cohort study on a group of people who share common characteristics. In the study, the author has performed a section of intervals through time. In the study (Carlos et al, 2017), the author is investigating the link between the active community with the incidence of cardiovascular disease, cancer, and another life-threatening disease. The study was conducted as per the ethical appeals with government organizations' opinions to make a relevant study outcome. The study has evaluated the strong evidence of historical research and analyzed their finding using statistical tools. The drawback of the study was that the author has provided limited information on its population inclusion and exclusion criteria.

Were the groups/participants free of the outcome at the start of the study (or at the moment of exposure)?

No, the group participants involved in the study were free of the outcomes during the initiation of the study. The main reason for this exemption is that at the start of the study, the participants should be free of the outcome during the initial time. Carlos, et al has conducted the study as a prospective population-based cohort study. The study (Carlos, et al, 2017) comprises 2,63,540 women participants who have recruited form twenty-two sites across the united kingdom region. The study conducted is to determine the association between active commuting strategies and their influence on the physical fitness of the deceased persons. The author wants to know the reason for death from any cause of cancer, CVD, or any other disease. The exposure rate was addressed from the kind of transport used during the study such as non active cycling, riding, walking, or mixed. The author has also addressed other factors while conducting the research, these are socio-demographic factors, smoking status, leisure time, DIY physical activity, dietary intake, sedentary behavior, and body mass index. The author has used the data and cause of death from the death certificate received from the national health services information center for the participants. The author has followed the unbiased criteria for the inclusion of participants. The disease status of these inclusive populations has been clearly stated and checked.

Were the outcomes measured in a valid and reliable way?

a) Yes, the outcomes measured in a valid and reliable way. The author has made a statistical analysis between the active community and associated health outcomes. The author has explored and analyse the cox proportional hazard models that may exclude the participants suffering from CVD, fatal disease, and cancer. The basic characteristic by community category was analyzed and was used as a medium to investigate hazard ratio.

b) The validity and reliability are assessed through the deep association between the active community and health outcomes. The health outcome includes CVD, cancer mortality, fatal disease, incident CVD, and cancer. These outcomes were explored and analyzed using the cox approach. The cox approach is highly realistic and helps in the analysis of survival data the purpose of the model is to explore the effects of several variables on one go. The model is interrelated and a proportionate that is essential for statistical analysis in medical research (Kvamme, Borgan, & Scheel, 2019). The model help in investigating the link between the survival time of patients with one or more predictor variable. The link associated between the active community and the health output were explored using the COX model excluding participants who are prevalent of CVD and cancer at the baseline from CVD and cancer models. The reference category for all the analyses was a non-active community. Analysis in the study was adjusted sex, age, comorbidities, deprivation index, body mass index, and dietary intake (Carlos, et al, 2017).

c) Yes, the method used was reliable and valid, as the author has considered different causes of mortality. This helped him to structure the data widely and effectively.

Was the follow up time reported and sufficient to be long enough for outcomes to occur?

Yes, the follow-up time was reported through the study and was sufficient to be as long as any other outcomes to occur. In the research paper, the author has made two different follow-up strategies as per the condition of the disease. The author has used the follow-up period of average of 5 years for CVD suffering patients and cancer mortal people. He/she has used the follow up of 2.1 years for the patient characterizing the incident of CVD and cancer. The follow-up period was assessed for all disease including CVD, cancer, and obesity patient depending on the severity of the disease. The five year period is used because if the death occurs earlier or within one year of the study commencement, then the mortality rate can be censored and analyzed earlier (Carlos, et al, 2017). However, for any study to accomplish, the relative representative demographic factors need to consider (Setia, 2016). The factors considered are age, ethnicity, sex deprivation, and any medical history associated with the patient. The author has managed a wide range of demographics, health, and behavior characteristic and if the error accounted during the study due to misclassification of commuting behavior, is taken into consideration.

Was follow up complete, and if not, were the reasons to loss to follow up described and explored?

a) The author has made inter-relation between commuting mode and the respective health outcomes. The community involved in the cycle and mixed commuting were made analyzed with the statistically significant risk of all different causes of mortality as compared with other noncommunity. For CVD mortality, the author has used walking and cycling that were associated with poorer risk than non-active community. The author has included 2,63,450 participants involving paid employed, or self-employed participants. These participants were analyzed based on the baseline characteristics such as cycling, walking or any other to check the physical fitness. The main outcomes involved were the deaths due to CVD, cancer, and incidental or fatal or non-fatal CVD and cancer. In the study, the exposure variable was the type of transport including cycling, bicycling, riding, walking, mixed, or any other.

b) No, the author has not report loss-to follow up

c) Yes, the author does the differences among exposure groups in a loss to follow-up. During the follow-up period, from the population of enrolment, a total of 2,430 participants died and 1,110 had an incident CVD and 3748 due to cancer. The author has summarised the main characteristics of the patients according to the community category (Carlos, et al, 2017). The author has reported physical activity done by the participants and was objectively measured. Through these strategies, it was found that cardiorespiratory fitness was one of the highest in a group comprising of cycle commuters that was followed by the mixed modal cycling commuters. As compared to others, physical activity was found to be higher among walking commuters and not in cardiovascular fitness. The large population designed study provides sufficient evidence to compare the different forms of active commuting as per the outcomes.

Were strategies to address incomplete follow up utilized?

Yes, the strategies to address the follow up was successfully utilized and monitored in the research paper. The study has enrolled 2, 63, 540 women participants of mean age 52.6 years. The exposure variable was one of the modes of transport that were used by the patients to move from work to home on a regular basis. The major outcomes analyzed from the study include the incident CVD and cancer, along with the deaths from the CVD, cancer, or any other disease cause. In the study, the author has used maximally adjusted models in which community by cycle, community by mixed models were linked with lower risk cause of mortality, the incidence of cancer, mixed-mode cycling, and cancer mortality. The community that was involved in cycling and walking was associated with a lower risk of CVD development and CVD mortality. The author has not introduced a statistically significant association for walking communities. The mixed community including walking was not associated with other measured outcomes during the study. According to Carlos, the policies or the strategies designed to affect the population level modal shifts become the more active mode of commuting. The various mode of transport including subsidies cycle purchase and city bike show the positive improvements on public health (Carlos, et al, 2017).

References for Epidemiology Critical Analysis

Carlos, et al. 2017. Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study. BMJ, 357, 1-7.

Kvamme, H., Borgan, O., Scheel, I. 2019. Time to event predictions with neural networks and cox regression. Journal of Machine Learning Research, 1-30.

Setia, M. 2016. Methodology series module 1: cohort study. Indian Journal of Dermatology. 61, 21-25

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