ORDER A SIMILAR PAPER NOW

Discussion post: Initial Response

Nguyen et al. (2020)

Study Description

Nguyen et al., (2020), conducted a population-based case-control study based on patients that were part of the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO), the Swedish Patient Register, and Prescribed Drug Register to identify a correlation between patients diagnosed with irritable bowel disease (IBD) and the use of antibiotics a year prior to the patient being diagnosed with IBD. The researchers also included the IBD subtypes of ulcerative colitis and Crohn’s disease for this research. With the use of ESPRESSO, the researchers found nearly 24,000 IBD cases through the years 2007 to 2016, in which these cases had matched controls and unaffected siblings for comparisons. The researchers utilized logistic regression to estimate multivariable-adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Strengths and Limitations 

Nguyen et al.’s population-based case-control study had a primary strength in that it was a large, nationwide sample drawn from the Swedish population registries that looked at nearly 24,000 cases of IBD cases that had additional robust matching controls and full siblings. Such a large sample allows for the reduction in selection bias and accounts for shared genetic factors and environmental factors that could have contributed to the diagnosis of IBD. While the study had a strength in numbers, there were some limitations to the study that needed to be addressed. The primary limitation that has been identified is that the study’s observational design limits its ability to establish causation, and there is then a potential for residual confounding, such as differences in infection severity or unmeasured lifestyle factors. Not knowing the significant medical background of each patient does not allow for a full scope analysis of the causation of IBD, which could be related to socioeconomic factors and behavioral factors that can increase the prevalence of IBD. Additionally, the prevalence of IBD in Sweden is found to be elevated with lower antibiotic dispensation patterns when compared to other countries, which can be associated with another limitation of the research.

Population, Data Sources, and Epidemiological Measures 

The population that was utilized for this research included individuals who were 16 years of age or older who lived in Sweden. The patients had a compatible IBD diagnosis, including Crohn’s disease and ulcerative colitis. To allow for appropriate comparison, the researchers used two sets of controls: matched population-controls that were drawn from the general population and full siblings of the IBD cases. The authors of this study utilized the Swedish registries, including pathology/histology reports, which was from the ESPRESSO, to identify valid IBD diagnoses. The authors then identified antibiotic exposure from prescription/dispensation records that were recorded through the systemic antibiotic dispensaries. The epidemiological measures incorporated into the study included the odds ratio, which compared the odds of prior antibiotic use among IBD cases versus the controls, and they also utilized a dose-response relationship to measure the cumulative antibiotic exposure. Additionally, the authors incorporated a sensitivity analysis that looked at a two-year lead-in period, which was to ignore the antibiotic dispensation in two years before the IBD diagnosis, and the researchers found that this had similar risk estimates compared to the one-year dispensation before diagnosis.

Design Appropriateness

The study design utilized by Nguyen and associates (2020) was appropriate. The case-control study design was well-suited for examining exposure and association, in which the researchers efficiently assessed antibiotic exposure using existing registry data and diagnoses of IBD.

Researchers’ Conclusion

I would likely not support Nguyen and associates’ (2020) conclusion that antibiotics may cause IBD. I believe other factors would need to be understood before having high confidence in the prevalence of antibiotics causing IBD. An example of other factors would be socioeconomic factors, which were highlighted in the limitations of the study. Additionally, the duration during which the patients were on antibiotics was not established during the study, which should also be taken into consideration, given that some patients may be on antibiotics for one week versus one month, depending on the case.

Palència et al. (2020)

Study Description

Palencia et al. (2020) produced an ecological study of trends to identify the effects of inequalities that have been aggravated by economic recession and the mortality rates within certain diseases, with their primary focus on lung, colon, prostate, and breast cancers within nine European urban areas. The study looked at three periods, 2000-2003, 2004-2008, and 2009-2014, and observed the relationship between socio-economic deprivation and cancer mortality. The study emphasizes the effects of socioeconomic inequalities and how these inequalities shape patterns of cancer mortality across urban neighborhoods, revealing that residents of more deprived areas consistently experienced higher mortality for several cancer types and that these disparities persisted across all three time periods examined.

Strengths and Limitations

A key strength of this study is that it was quite large and included a multi-city design throughout nine European urban areas, while using small-area deprivation indices and Bayesian spatial models over multiple time periods that robustly examined the socioeconomic inequalities in cancer mortality before and after the 2008 economic crisis. The researchers also incorporated some of the major cancer types, analyzing them by patient sex, and comparing these patterns across urban contexts. A limitation to this study would be that the post-crisis data only included six years after the initial crisis and did not take into account longer-term effects from the crisis on cancer inequalities. Due to the latency periods that occur with the identified cancers within this study, additional timeframes could have been added to the study.

Population, Data Sources, and Epidemiological Measures

For this study, the researchers utilized residents from Athens, Barcelona, Berlin-Brandenburg, Brussels, Lisbon, London, Prague, Stockholm, and Turin during three separate time frames of 2000-2003, 2004-2008, and 2009-2014. Palencia and associates (2020) focused on adult participants and analyzed adult men and women separately. The data sources for this study included census records, mortality registers, socioeconomic indicators based on the census data, and the use of a composite deprivation index that was created through principal components analysis. The study utilized epidemiological measures to include standardized mortality ratios, ecological regression models, and relative risks.

Design Appropriateness

The ecological trend design that was utilized for this study was appropriate for looking at how socioeconomic deprivations are correlated to cancer mortality.  The study examined population-level patterns, geographic inequalities, and changes that occurred following the 2008 economic crisis, in which the use of the ecological design was appropriate since it allows for a better understanding of the structural and contextual factors that cannot be properly assessed from an individual level.

Researchers’ Conclusion

While the researchers concluded that their hypothesis was not validated by the study, they concluded that there needs to be more emphasis on the socioeconomic measures and the correlation with mortality from cancer, which I agree with. The researchers emphasized that, given the information that was derived from their research, more local health programs that are targeted, equity-focused, and responsive to area-level socioeconomic disparities are needed to help reduce cancer mortality inequalities across urban communities.

References

Nguyen, L. H., Örtqvist, A. K., Cao, Y., Simon, T. G., Roelstraete, B., Song, M., Joshi, A. D., Staller, K., Chan, A. T., Khalili, H., Olén, O., & Ludvigsson, J. F. (2020). Antibiotic use and the development of inflammatory bowel disease: a national case-control study in Sweden. The lancet. Gastroenterology & hepatology, 5(11), 986–995. https://doi.org/10.1016/S2468-1253(20)30267-3Links to an external site.

Palència, L., Ferrando, J., Marí-Dell’Olmo, M., Gotsens, M., Morrison, J., Dzurova, D., Lustigova, M., Costa, C., Rodríguez-Sanz, M., Bosakova, L., Santana, P., & Borrell, C. (2020). Socio-economic inequalities on cancer mortality in nine European areas: The effect of the last economic recession. Cancer epidemiology, 69, 101827. https://doi.org/10.1016/j.canep.2020.101827Links to an external site.

Rubric: CONTRIBUTION TO THE DISCUSSION: First Response (20 possible points)

20 to >19.0 ptsExcellentDiscussion response: • Significantly contributes to the quality of the discussion/interaction and thinking and learning. • Provides rich and relevant examples and thought-provoking ideas that demonstrates new perspectives, and synthesis of ideas supported by the literature. • Scholarly sources are correctly cited and formatted. • First response is supported by 2 or more relevant examples and research/evidence from a variety of scholarly sources including course and outside readings. • Posts on separate day.
19 to >15.0 ptsGoodDiscussion response: • Contributes to the quality of the interaction/discussion and learning. • Provides relevant examples and/or thought-provoking ideas • Scholarly sources are correctly cited and formatted. • First response is supported by 2 or more relevant examples and research/evidence from a variety of scholarly sources including course and outside readings. • Posts on separate day.
15 to >12.0 ptsFairDiscussion response: • Minimally contributes to the quality of the interaction/discussion and learning. • Provides few examples to support thoughts. • Information provided lacks evidence of critical thinking or synthesis of ideas. • There is a lack of support from relevant scholarly research/evidence. • Posts on separate day.
12 to >0 ptsPoorDiscussion response: • Does not contribute to the quality of the interaction/discussion and learning. • Lacks relevant examples or ideas. • There is a lack of support from relevant scholarly research/evidence. • Posts on same day.

20 pts

This criterion is linked to a Learning OutcomeCONTRIBUTION TO THE DISCUSSION: Second Response (20 possible points)

20 to >19.0 ptsExcellentDiscussion response: • Significantly contributes to the quality of the discussion/interaction and thinking and learning. • Provides relevant examples and thought-provoking ideas that demonstrates new perspectives, and extensive synthesis of ideas supported by the literature. • Second response is supported by 2 or more relevant examples and research/evidence from a variety of scholarly sources including course and outside readings. • Scholarly sources are correctly cited and formatted. • Posts on separate day.
19 to >15.0 ptsGoodDiscussion response: • Contributes to the quality of the interaction/discussion and learning. • Provides relevant examples and/or thought-provoking ideas • Second response is supported by 2 or more relevant examples and research/evidence from a variety of scholarly sources including course and outside readings. • Scholarly sources are correctly cited and formatted. • Posts on separate day.
15 to >12.0 ptsFairDiscussion response: • Minimally contributes to the quality of the interaction/discussion and learning. • Provides few examples to support thoughts. • Information provided lacks evidence of critical thinking or synthesis of ideas. • Minimal scholarly sources provided to support post. • Posts on separate day.
12 to >0 ptsPoorDiscussion response: • Does not contribute to the quality of the interaction/discussion and learning. • Lacks relevant examples or ideas. • No sources provided. • Posts on same day.

20 pts

This criterion is linked to a Learning OutcomeQUALITY OF WRITING (10 possible points)

10 to >9.0 ptsExcellentDiscussion postings and responses exceed doctoral level writing expectations: • Use Standard Academic English that is clear, concise, and appropriate to doctoral level writing. • Make few if any errors in spelling, grammar, that does not affect clear communication. • Uses correct APA 7 format as closely as possible given the constraints of the online platform. • Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints.
9 to >8.0 ptsGoodDiscussion postings and responses meet doctoral level writing expectations: • Use Standard Academic English that is clear and appropriate to doctoral level writing • Makes a few errors in spelling, grammar, that does not affect clear communication. • Uses correct APA 7 format as closely as possible given the constraints of the online platform. • Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints.
8 to >6.0 ptsFairDiscussion postings and responses are somewhat below doctoral level writing expectations: • Posts contains multiple spelling, grammar, and/or punctuation deviations from Standard Academic English that affect clear communication. • Numerous errors in APA 7 format • May be less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints.
6 to >0 ptsPoorDiscussion postings and responses are well below doctoral level writing expectations: • Posts contains multiple spelling, grammar, and/or punctuation deviations from Standard Academic English that affect clear communication. • Uses incorrect APA 7 format • Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints.

Instructions: Post at least two substantive responses to peers in a different group who analyzed at least one different article in their initial post. Include information from the Learning Resources in your responses as appropriate. You may expand on each peer’s posting with additional insight and resources about study designs, ask a question to further the discussion, or offer polite disagreement or critique supported with evidence. You may also make a suggestion or comment that guides or facilitates the discussion. At least one of your response posts should address the applicability of observational studies for improving population health status. Your responses to classmates should be substantial (250 words minimum), supported with scholarly evidence from your research and/or the Learning Resources, and properly cited using APA Style. Personal anecdotes are acceptable as part of a meaningful response, but cannot stand alone as a response. Your responses should enrich the initial post by supporting and/or offering a fresh viewpoint, and be constructive, thereby enhancing the learning experience for all students.

 

SOLUTION

Peer Response

Thank you for your thorough and well-articulated analysis of Nguyen et al. (2020) and Palència et al. (2020). You provided a clear overview of each study’s purpose, methodology, and findings, and I appreciate the depth of your critique regarding both strengths and limitations. I would like to expand on several points, particularly the implications of observational study designs and their value for improving population health.

Your critique of Nguyen et al. (2020) is well-taken, especially regarding the challenges of inferring causation from case-control designs. One strength worth further emphasizing is the use of sibling controls, which offers a unique way to control for genetic and early-life environmental confounding — a method not commonly seen in many population-level epidemiologic studies. However, as you noted, residual confounding remains a concern. For example, infection severity, antibiotic stewardship differences, or healthcare utilization patterns may influence both antibiotic prescriptions and the likelihood of receiving an IBD diagnosis (Rothman et al., 2021). This reinforces the importance of triangulating evidence using multiple epidemiologic designs before drawing causal conclusions.

Your analysis of Palència et al. (2020) also highlights the importance of ecological approaches in understanding population-level inequities. While ecological studies cannot link exposures to outcomes at the individual level, they play a critical role in identifying structural and contextual health determinants, such as neighborhood deprivation. These area-based measures support public health systems in allocating resources where they are most needed (Diez Roux, 2018). In fact, observational studies like this one often serve as early signals that prompt more targeted research or policy interventions aimed at reducing health inequities.

Importantly, your discussion aligns with the broader understanding that observational epidemiology is essential for improving population health. Randomized controlled trials are often infeasible for studying social determinants, long-term exposures, or rare outcomes; thus, high-quality observational designs provide meaningful evidence for prevention strategies, health system planning, and resource allocation.

Overall, your analysis demonstrates strong critical thinking and thorough engagement with the literature. The insights you provided — especially regarding confounding, study design appropriateness, and socioeconomic implications — contribute meaningfully to the discussion.

---

References

Diez Roux, A. V. (2018). Integrating social and biologic factors in health research: A systems view. Annals of Epidemiology, 28(5), 356–363. https://doi.org/10.1016/j.annepidem.2017.12.007

Rothman, K. J., Greenland, S., & Lash, T. L. (2021). Modern epidemiology (4th ed.). Wolters Kluwer.

ORDER A SIMILAR PAPER NOW