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“I wlll try a few questions and see if we can get anywhere. If that works we will continue.”
LisaRose,
Sure.
“First of all, from your blog.
Statistical frequency of severe anemia suffered annually among Jehovah’s Witnesses in New Zealand is assumed as not greater than the same group worldwide.
“You are making an assumption here. What if the Witnesses in New Zealand did actually suffer anemia at a higher rate? The study counter opinion mentioned including the Maori population, who have higher rates of Anemia. Just a few of them, in this small study would throw everything off. So this is not a conservative assumption, quite the opposite.
“Also, where did you get the statistics for New Zealand of 1.46 per thousand, and how do you know that statistic is severe anemia equal to the severe anemia as selected for inclusion in the study? What is the definition of " severe anemia" as opposed to mild anemia?”
In the same order…
Higher rate of anemia in New Zealand?:
Other than the Maori factor (see below) I was unable to find any reason to think rates of anemia would be higher in New Zealand compared to all other nations on average. Hence I did not assume it higher in New Zealand, or anywhere else.
Otherwise, and particularly when we look at how Beliaev defined “severe anemia” (see below) and then when we layer the JW blood refusal factor onto that definition something significant emerges.
Hg =/< 8 grams dL has many causes. When it comes to JWs, they are at a higher risk versus the rest of the population because of the adherents’ unique refusal of red cells transfusion.
This creates a vicious cycle unique to JWs. Refusing red cell transfusion puts a patient at greater risk of experiencing Hg =/< 8 grams dL. Hg =/< 8 grams dL puts a patient at greater risk of mortality. Refusing red cell transfusion puts a patient with Hg =/< 8 grams dL at an even greater risk of mortality.
This unique risk of JWs experiencing Hg =/< 8 grams dL drives the incidence of JWs suffering “severe anemia” and the incidence of JWs suffering mortality the result of "severe mortality". I don’t assume a higher incident of “severe anemia” among JWs in New Zealand or anywhere else in the world. But given this unique driver it stands to reason that, if anything, incidence of “severe anemia” among JWs would be higher than the general population in any given service area of the world.
Maori factor:
If by “The study counter opinion” you mean the published criticisms of Isibister and Shander, these authors did not raise the Maori factor specifically though both made casual reference to “ethnicity”.
If by “The study counter opinion” you mean critics in this discussion, one or two did raise this specifically.
The original presentation by Beliaev et al adjusted for the Maori factor by logistic regression.
The Maori factor was effectively mitigated (if not completely removed) by the original authors.
1.46 per thousand:
I think you mean my figure of 1.43.
This figure represents the calculated per 1000 of JWs in New Zealand during the period of 1998-2007 who would have fit the profile of “severe anemia” presented by Beliaev based on published population distribution of 57% in the 2 regions from which his data was gathered. This 1.43 per thousand assumes the 103 JW patients documented in Beliaev’s study were the only JW patients in the 2 regions who suffered “severe anemia”.
In the 2 regions from which the data set was retrieved it would be naïve to think these 103 JWs were the only ones who met the criteria of “severe anemia” applied by Beliaev. Hence using these 103 JWs (as 57% of the total sum) represents a conservative assumption.
Severe anemia:
Beliaev and colleagues made no analysis of “mild anemia”. Hence any statistical mortality associated with this condition suffered by JWs is not included in my extrapolation.
Beliaev and colleagues used a simple benchmark to measure severe anemia versus not severe anemia. The threshold value was: Hg =/< 8 grams dL.
Regardless of underlying cause or condition, if a JW patient was recorded with a blood hemoglobin of =/< 8 grams dL then the patient met the threshold value of “severe anemia”.
Does this answer your questions?
Marvin Shilmer