Statistical Analysis for Organization Decision-Making in Healthcare

Evaluating the outcomes of “Healthy People 2020” in reducing the prevalence of lung cancer or all-cause-cancer across U.S. citizens
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Professor’s Name
Abstract
Lung cancer is a life-threatening disorder and a global concern across healthcare professionals, public health authorities, patients, and their family members. Tobacco use and genetics are considered some of the major factors that increase the risk of lung cancer or all-cause-cancer. As a result, the Department of Health and Human Services (DHHS) launched a mission called “Healthy People 2020” in 2010. The major goals of “Healthy People 2020” include ensure high quality and longer life-span across U.S. citizens by reducing the prevalence of preventable diseases, disabilities, injuries, or premature death, and eliminating healthcare disparities. The present study explored whether the prevalence of lung-cancer or all-cause cancer in the United States is correlated to tobacco usage and presence of underlying respiratory diseases. The findings of the study would help our healthcare organization to organize an awareness campaign across patients and their family members in abstaining from tobacco usage and for ensuring appropriate respiratory health. The data for the present study was obtained from www.health.gov website of the Department of Health and Human Services (DHHS). The present study showed that although the mortality rate for lung cancer/oral cancer and all-cause-cancer is in line with the target framed by the “ Healthy People 2020” mission, however; the objective for tobacco usage pattern and mortality due to COPD have still not been achieved.

On the other hand, the correlation and regression analysis reflected that tobacco usage and COPD is a major determinant of mortality due to lung cancer/oral cancer and all-cause-cancer in the United States.
Keywords: Healthy People 2020, tobacco usage, COPD death, all-cause cancer, lung cancer
Evaluating the outcomes of “Healthy People 2020” in reducing the prevalence of lung cancer or all-cause-cancer across U.S. citizens
Introduction
Lung cancer is a life-threatening disorder and a global concern across healthcare professionals, public health authorities, patients, and their family members (Falk & Williams, 2010). In 2012, lung cancer accounted for 1.6 million deaths and affected 1.8 million individuals (World Cancer report, 2014). Studies suggest that various factors predispose the risk of lung cancer in at-risk individuals. Tobacco use and genetics are considered some of the major factors that increase the risk of lung cancer or all-cause-cancer( Collins et al., 2007). Hence, public health authorities of different nations have launched various initiatives to reduce the prevalence of lung cancer, all-cause-cancer, and tobacco usage across concerned stakeholders. Like any other nation, the increased prevalence of lung cancer, all-cause-cancer, tobacco usage, and respiratory diseases is a matter of concern across healthcare authorities of the United States.
As a result, the Department of Health and Human Services (DHHS) launched a mission called “Healthy People 2020” in 2010. The major goals of “Healthy People 2020” include ensure high quality and longer life-span across U.S. citizens by reducing the prevalence of preventable diseases, disabilities, injuries, or premature death, eliminating healthcare disparities across U.S. citizens and ensure the provision of accessible, and affordable healthcare in a uniform manner, creating social and physical environments for promoting good health, and ensuring quality of life (QOL) parameters by promoting healthy behaviors in concerned stakeholders. The “Healthy People 2020”mission has kept different milestones to measure the success of its implementation. Although there has been a global consensus in reducing the prevalence of lung cancer or tobacco usage, however; public awareness and implementation of healthcare reforms are often unachieved. The reasons for such deviation include social, economic, political, and financial limitations.
The present study explored whether the prevalence of lung-cancer or all-cause cancer in the United States is correlated to tobacco usage and presence of underlying respiratory diseases. The study also explored whether respiratory diseases predispose the risk of lung cancer or all-cause-cancer in concerned stakeholders. The findings of the present study would help to identify whether the measures that are implemented to achieve the “Healthy People 2020” mission are exhibiting success or failure. Based on the findings of the present study, different healthcare initiatives or modifications can be undertaken by the public health authorities or allied stakeholders to ensure the success of “Healthy People 2020.”
A Reflection on Compliance with the NIH guidelines on Research with Human Subjects
I have understood the importance of ethical principles applicable to research with human subjects. The core philosophy of such ethical guidelines is to ensure safety and respect in the research participants. Investigators should develop a healthy relationship with research participants for enhancing their compliance with a proposed study. Moreover, such relationship is also essential to ensure that the subjective responses as shared by the study participants are unbiased and honest. On the other hand, researchers should also ensure confidentiality of the data that is shared or stemmed from the study participants. The NIH endorses that the pillars of such relationship are respect, honesty, and trust. Under no circumstances, such attributes should be violated while interacting with research participants. Historical data suggests that research with human subjects involved exploitation, and a violation of their interests. Such issues prompted public violence and erosion of human rights (National Institutes of health, Historical events, 2017).
Respect
Human subjects should be respected, and their dignity and confidentiality should be maintained under different stages of research. Moreover, they should be provided independence in decision-making for receiving or denying experimental interventions. Finally, study participants or respective stakeholders should provide informed consent before the initiation of a study.
Beneficence and Non-malificence
Researchers should always ensure beneficence across the study participants. This means that a proposed intervention or an analysis should clinically benefit the study participants. On the contrary, researchers should also ensure that the principle of non-malificence is also complies. Non-malificence means that under no circumstances a proposed intervention or an analysis should impose additional harm to the study participants.
Justice
However, it is necessary at times to take decisions that would ensure justice across a study population from a broader perspective. Even under situations, an intervention or an analysis should be only undertaken if the benefits of such research outweigh the risks that are associated with such research. Researchers should comply with such ethical principles while working with secondary data. As far as practicable, the identity of the patients or study participants should be concealed. However, the concerned researcher should identify the sources of quality data that would help to address the research question in an unbiased and reproducible manner.
Competence statement
I am confident that I would always be able to comply with the NIH guidelines those govern research with human subjects. In this regard, I have obtained the National certification in Protecting Human Research Participants and ensuring the confidentiality of any healthcare data from the National Institutes of Health (NIH) (Fig 1).
Fig 1: Certificate of Competence in Complying with NIH guidelines for Research with Human Subjects and Data
Data Collection
I adhered to the regulations of the NIH and Institutional Review board in collecting and disseminating the data for the present study. The data for the present study was obtained from www.health.gov website of the Department of Health and Human Services (DHHS). Since the study was conducted with secondary data, there was no risk of malificence to the study participants. The data that was presented was also anonymous as it pertained to the National Health Data of the United States. The study did not reveal the data of any State or a specific healthcare organization. Hence, the ethnic and demographic identity of the study participants was kept confidential. The data that was collected for the present study include mortality rates for lung-cancer, oral cancer, All-cause cancer, and chronic obstructive pulmonary disease from 2010 to 2015. Data was also collected on tobacco usage pattern during the same period. The data for the present study was obtained on adult U.S. citizens and is presented in table 1.
  Tobacco use COPD death Oral+Lung Cancer All cause cancer
2010 19.3 116.6 50.1 172.8
2011 19 117.7 48.5 169
2012 18.2 114.8 47.4 166.5
2013 17.9 116.5 45.8 163.2
2014 17 111.7 44.6 161.2
2015 15.3 115.1 43 158.5
Table 1: dataset for the present study (Source: www.health.gov)
Data Analysis
Different types of descriptive and inferential statistics were estimated to explore the research questions that were considered for the study. All statistical tests for the present study were performed with the SPSS (Statistical Package for Social Science) software. The descriptive statistics that were estimated include mean, median, mode, standard deviation, and range. The descriptive statistics helped to define the spread of the data (Table 2). The inferential statistics that were undertaken for the present study include one-sample t-tests, regression analysis, correlation analysis, and ANOVA. The inferential statistics helped to compare relevant datasets of different variables and for estimating the cause-and-effect relationship between such variables. All statistical tests of inference were explored at the 0.05 level of significance. Finally, hypothesis testing was implemented to report the findings of such statistical tests of inference. The hypothesis testing was undertaken based on the acceptance or rejection of the null hypothesis (Ho) or the alternative hypothesis (Ha) respectively.
Statistics
Tobacco use COPD death Oral+Lung C All cause cancer
N Valid 6 6 6 6
Missing 0 0 0 0
Mean 17.7833 115.4000 46.5667 165.2000
Std. Error of Mean .59856 .85790 1.06604 2.15081
Median 18.0500 115.8000 46.6000 164.8500
Mode 15.30a 111.70a 43.00a 158.50a
Std. Deviation 1.46617 2.10143 2.61126 5.26840
Variance 2.150 4.416 6.819 27.756
Skewness -.993 -1.153 -.025 .253
Std. Error of Skewness .845 .845 .845 .845
Kurtosis .706 1.614 -1.019 -.948
Std. Error of Kurtosis 1.741 1.741 1.741 1.741
Range 4.00 6.00 7.10 14.30
Minimum 15.30 111.70 43.00 158.50
Maximum 19.30 117.70 50.10 172.80
Sum 106.70 692.40 279.40 991.20
a. Multiple modes exist. The smallest value is shown
Table 2: Descriptive statistics
Table 2 reflects that the maximum amount of mortality registered for All-cause-cancer, COPD, and lung-cancer are 172.80, 117.70, and 50.1 respectively. Moreover, the table also reflects that the maximum incidence of tobacco usage is 19.30. On the other hand, the mean (average) of mortality for All-cause-cancer, COPD, and lung-cancer are 165.2, 115.4, and 46.5 respectively. Likewise, the mean (average) tobacco usage is estimated to 17.30. The reduction in average scores compared to maximum scores across all category of variables give preliminary insights that there was a reduction in such morbidity and mortality parameters during some period between 2010 and 2015. Such observation is aligned with the mission of “Healthy People 2020.” However, one-sample t-tests were conducted to project the statistical significance of such reductions (Table 3).
One-Sample Test
Test Value = 161.4
t df Sig. (2-tailed) Mean Difference 95% Confidence Interval of the Difference
Lower Upper
All cause cancer 1.767 5 .138 3.80000 -1.7288 9.3288
One-Sample Test
Test Value = 47.8
t df Sig. (2-tailed) Mean Difference 95% Confidence Interval of the Difference
Lower Upper
Oral+Lung C -1.157 5 .300 -1.23333 -3.9737 1.5070
One-Sample Test
Test Value = 102.6
t df Sig. (2-tailed) Mean Difference 95% Confidence Interval of the Difference
Lower Upper
COPD death 14.920 5 .000 12.80000 10.5947 15.0053
One-Sample Test
Test Value = 12
t df Sig. (2-tailed) Mean Difference 95% Confidence Interval of the Difference
Lower Upper
Tobacco use 9.662 5 .000 5.78333 4.2447 7.3220
Table 3: One sample t-tests
The one-sample t-tests were conducted with the relevant datasets from 2010 to 2015. The datasets were compared to the target milestone of “Healthy People 2020” that is considered for each of the variables (datasets). The one sample t-tests reflect that the mortality rates of all-cause-cancer and oral and lung cancer are aligned with the target milestone of “Healthy People 2020”. This is because the p-value for both the t-tests is greater than 0.05. Hence, it can be inferred that there is no significant difference between the mean mortality rates from 2010 to 2015 and the target mortality rate as per “Healthy People 2020” for All-cause-cancer and oral and lung cancer. On the contrary, the one sample t-tests reflect that there is a significant difference between the mean mortality rates from 2010 to 2015 and the target mortality rate as per “Healthy People 2020” for COPD (115.4 versus 102.6, p<0.05).
Likewise, the one sample t-tests reflect that there is a significant difference between tobacco usage rates from 2010 to 2015 and the target tobacco usage rate as per “Healthy People 2020” (17.78 versus 12, p<0.05) Hence, such findings suggest that mortality rates for COPD and tobacco usage rates are still higher than the “Healthy People 2020” objective. Hence, the study explored whether higher incidences of COPD or tobacco usage could increase the prevalence of mortality for lung/oral cancer and all-cause-cancer in the near future. Pearson’s correlation coefficient and linear regression equations were constructed to explore such relationship (Table 4).
Correlations
Tobacco use COPD death Oral+Lung C All cause cancer
Tobacco use Pearson Correlation 1 .528 .959** .938**
Sig. (2-tailed) .281 .002 .006
N 6 6 6 6
COPD death Pearson Correlation .528 1 .572 .572
Sig. (2-tailed) .281 .236 .235
N 6 6 6 6
Oral+Lung C Pearson Correlation .959** .572 1 .997**
Sig. (2-tailed) .002 .236 .000
N 6 6 6 6
All cause cancer Pearson Correlation .938** .572 .997** 1
Sig. (2-tailed) .006 .235 .000 N 6 6 6 6
**. Correlation is significant at the 0.01 level (2-tailed).
Table 4: Correlation analysis
The correlation analysis implicated that tobacco usage is significantly and positively correlated with mortality due to oral or lung cancer and all-cause-cancer (p<0.05). The correlation analysis also highlighted that tobacco usage is not a causative factor mortality due to COPD (p>0.05) and neither COPD increases the risk of oral or lung cancer and all-cause-cancer (p>0.05). However, an interaction of the different variables on the predictability of lung/oral cancer was explored by the linear regression analysis (Table 5).

MODEL SUMMARY
Model R R Square Adjusted R Square Std. Error of the Estimate Change Statistics
R Square Change F Change df1 df2 Sig. F Change
1 .962a .926 .877 .91458 .926 18.880 2 3 .020
ANOVAa
Model Sum of Squares df Mean Square F Sig.
1 Regression 31.584 2 15.792 18.880 .020b
Residual 2.509 3 .836 Total 34.093 5 a. Dependent Variable: Oral+Lung C
b. Predictors: (Constant), COPD death, Tobacco use
COEFFICIENTS
Model Unstandardized Coefficients Standardized Coefficients t Sig. 95.0% Confidence Interval for B
B Std. Error Beta Lower Bound Upper Bound
1 (Constant) 4.776 23.892 .200 .854 -71.259 80.810
Tobacco use 1.624 .329 .912 4.943 .016 .578 2.670
COPD death .112 .229 .090 .488 .659 -.618 .841
Table 5: Linear Regression Analysis
The regression analysis implicated that the mortality due to lung/oral cancer in the United States could be significantly predicted from the tobacco usage pattern and prevalence COPD (p <0.05). Although mortality due to COPD is not itself a significant predictor for mortality due to lung/oral cancer (p>0.05), however; it does seem to influence the risk of mortality due lung/oral cancer when considered holistically with tobacco usage pattern in the regression model (p=0.020). The coefficient of determination (R2) of the regression model was quite high (92.9% or 0.929). This means variations in oral/lung cancer death rates can be significantly explained by the regression model. Such findings suggest that the model was appropriate and reliable. Further, the y-intercept (constant) was not significantly related to the mortality rate due to lung/oral cancer. Such findings implicate that the prevalence of mortality is largely influenced by tobacco usage pattern and underlying respiratory diseases. Therefore, reducing the prevalence of tobacco usage and of underlying respiratory diseases could reduce the risk of mortality due to lung/oral cancer. The regression equation as per the model is:
Mortality due to oral/lung cancer= 4.776 + 1.62 * Tobacco usage pattern + 0.112 * COPD death
Finally, reliability analysis was undertaken to explore whether the variables that were considered for the study was reliable and viable. Hence, Cronbach’s alpha (Table 6) was estimated to present the reliability statistics.
Reliability Statistics
Cronbach’s Alpha N of Items
.846 4
Table 6: Cronbach’s alpha estimation
Since the Cronbach’s alpha was very high in this study (84.6%), it can be inferred that the variables that were considered for this study are appropriate and reliable. Hence, the findings of this study are reproducible and viable.
Recommendations and Conclusion
The present study showed that although the mortality rate for lung cancer/oral cancer and all-cause-cancer is in line with the target framed by the “Healthy People 2020” mission. However, the objective for tobacco usage pattern and mortality due to COPD has still not been achieved. On the other hand, the correlation and regression analysis reflected that tobacco usage is a major determinant for mortality due lung cancer/oral cancer and all-cause-cancer in the United States. The study further reflected that COPD could be a determining factor for mortality due to lung/oral cancer when considered in association with tobacco usage. Hence, the U.S. healthcare authorities should implement stringent initiatives for reducing the prevalence of cigarette smoking and chronic respiratory diseases across its citizens. Such initiatives might help the federal government to achieve its “Health 2020” much earlier than that planned.
References
Collins, LG; Haines C; Perkel R; & Enck RE (2007). “Lung cancer: diagnosis and management” American Family Physician. American Academy of Family Physicians. 75 (1), 56–63.
Falk, S & Williams, C (2010). “Chapter 1”. Lung Cancer—the facts (3rd ed.). Oxford University Press, 3–4.
National Center for health Statistics. (2011). Healthy People 2020, Center for Disease Control and Prevention, https://www.cdc.gov/nchs/healthy_people/hp2020.htm Accessed 4th February 2018.
National Institute of Health. (2017). Historical Events. Retrieved from Protecting Human
Research Participants: http://phrp.nihtraining.com/history/05_history.phpWorld Cancer Report (2014). World Health Organization. 2014. pp. Chapter 5.1