A principal aim of epidemiology is to assess the cause of disease. However, since most epidemiological studies are by nature observational rather than experimental, a number of possible explanations for an observed association need to be considered before we can infer a cause-effect relationship exists.
Morbidity has been defined as any departure, subjective or objective, from a state of physiological or psychological well-being. In practice, morbidity encompasses disease, injury, and disability.
A principal aim of epidemiology is to assess the cause of disease. However, since most epidemiological studies are by nature observational rather than experimental, a number of possible explanations for an observed association need to be considered before we can infer a cause-effect relationship exists.
Morbidity has been defined as any departure, subjective or objective, from a state of physiological or psychological well-being. In practice, morbidity encompasses disease, injury, and disability.
This PPT discusses
Basics measurements in epidemiology
Basics requirements of measurements
Tools of measurements
Measures of morbidity
Measures of disability
Measures of mortality
These annotated slides will help you interpret an OR or RR in clinical terms. Please download these slides and view them in PowerPoint so you can view the annotations describing each slide.
Succession “Losers”: What Happens to Executives Passed Over for the CEO Job?
By David F. Larcker, Stephen A. Miles, and Brian Tayan
Stanford Closer Look Series
Overview:
Shareholders pay considerable attention to the choice of executive selected as the new CEO whenever a change in leadership takes place. However, without an inside look at the leading candidates to assume the CEO role, it is difficult for shareholders to tell whether the board has made the correct choice. In this Closer Look, we examine CEO succession events among the largest 100 companies over a ten-year period to determine what happens to the executives who were not selected (i.e., the “succession losers”) and how they perform relative to those who were selected (the “succession winners”).
We ask:
• Are the executives selected for the CEO role really better than those passed over?
• What are the implications for understanding the labor market for executive talent?
• Are differences in performance due to operating conditions or quality of available talent?
• Are boards better at identifying CEO talent than other research generally suggests?
The impact of innovation on travel and tourism industries (World Travel Marke...Brian Solis
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This PPT discusses
Basics measurements in epidemiology
Basics requirements of measurements
Tools of measurements
Measures of morbidity
Measures of disability
Measures of mortality
These annotated slides will help you interpret an OR or RR in clinical terms. Please download these slides and view them in PowerPoint so you can view the annotations describing each slide.
Succession “Losers”: What Happens to Executives Passed Over for the CEO Job?
By David F. Larcker, Stephen A. Miles, and Brian Tayan
Stanford Closer Look Series
Overview:
Shareholders pay considerable attention to the choice of executive selected as the new CEO whenever a change in leadership takes place. However, without an inside look at the leading candidates to assume the CEO role, it is difficult for shareholders to tell whether the board has made the correct choice. In this Closer Look, we examine CEO succession events among the largest 100 companies over a ten-year period to determine what happens to the executives who were not selected (i.e., the “succession losers”) and how they perform relative to those who were selected (the “succession winners”).
We ask:
• Are the executives selected for the CEO role really better than those passed over?
• What are the implications for understanding the labor market for executive talent?
• Are differences in performance due to operating conditions or quality of available talent?
• Are boards better at identifying CEO talent than other research generally suggests?
The impact of innovation on travel and tourism industries (World Travel Marke...Brian Solis
From the impact of Pokemon Go on Silicon Valley to artificial intelligence, futurist Brian Solis talks to Mathew Parsons of World Travel Market about the future of travel, tourism and hospitality.
We’re all trying to find that idea or spark that will turn a good project into a great project. Creativity plays a huge role in the outcome of our work. Harnessing the power of collaboration and open source, we can make great strides towards excellence. Not just for designers, this talk can be applicable to many different roles – even development. In this talk, Seasoned Creative Director Sara Cannon is going to share some secrets about creative methodology, collaboration, and the strong role that open source can play in our work.
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Each technological age has been marked by a shift in how the industrial platform enables companies to rethink their business processes and create wealth. In the talk I argue that we are limiting our view of what this next industrial/digital age can offer because of how we read, measure and through that perceive the world (how we cherry pick data). Companies are locked in metrics and quantitative measures, data that can fit into a spreadsheet. And by that they see the digital transformation merely as an efficiency tool to the fossil fuel age. But we need to stretch further…
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Common measures of association in medical research (UPDATED) 2013Pat Barlow
This is an updated version of my Common Measures of Association presentation. I've updated it to include (1) more detail on rates, risks, and proportions, (2) Absolute Risk Reduction (ARR), Attributable Risk (AR), Number Needed to Treat (NNT) and Number Needed to Harm (NNH). Feel free to email me for a full version of the slideshow.
Chapter 9
Multivariable Methods
Objectives
• Define and provide examples of dependent and
independent variables in a study of a public
health problem
• Explain the principle of statistical adjustment
to a lay audience
• Organize data for regression analysis
Objectives
• Define and provide an example of confounding
• Define and provide an example of effect
modification
• Interpret coefficients in multiple linear and
multiple logistic regression analysis
Definitions
• Confounding – the distortion of the effect of a
risk factor on an outcome
• Effect Modification – a different relationship
between the risk factor and an outcome
depending on the level of another variable
Confounding
• A confounder is related to the risk factor and
also to the outcome
• Assessing confounding
– Formal tests of hypothesis
– Clinically meaningful associations
Example 9.1.
Confounding
We wish to assess the association between obesity and
incident cardiovascular disease.
Incident
CVD
No
CVD
Total
Obese 46 254 300
Not
Obese
60 640 700
Total 106 894 1000
1.78
0.086
0.153
60/700
46/300
RR
CVD
Example 9.1.
Confounding
Is age a confounder?
Age
< 50
CVD No
CVD
Total Age
50+
CVD No
CVD
Total
Obese 10 90 100 Obese 36 164 200
Not
Obese
35 465 500 Not
Obese
25 175 200
Total 45 555 600 Total 65 335 400
1.44
0.13
0.18
RR and 1.43
0.07
0.10
RR
50 Age|CVD50Age|CVD
Example 9.2.
Effect Modification
A clinical trial is run to assess the efficacy of a new drug
to increase HDL cholesterol.
N Mean Std Dev
New drug 50 40.16 4.46
Placebo 50 39.21 3.91
H0: m1m2 versus H1:m1≠m2
Z=-1.13 is not statistically significant
Example 9.2.
Effect Modification
Is there effect modification by gender?
Women N Mean Std Dev
New drug 40 38.88 3.97
Placebo 41 39.24 4.21
Men N Mean Std Dev
New drug 10 45.25 1.89
Placebo 9 39.06 2.22
Effect Modification
34
36
38
40
42
44
46
Women Men
M
e
a
n
H
D
L
Gender
Placebo
New Drug
Cochran-Mantel-Haenszel Method
• Technique to estimate association between risk
factor and outcome accounting for
confounding
• Data are organized into stratum and
associations are estimated in each stratum and
combined
Correlation and Simple Linear Regression
Analysis
• Two continuous variables
– Y= dependent, outcome variable
– X=independent, predictor variable
Relationship between age and SBP, number of
hours of exercise and percent body fat, caffeine
consumption and blood sugar level.
Correlation and Simple Linear Regression
• Correlation – nature and strength of linear
association between variables
• Regression – equation that best describes
relationship between variables
Scatter Diagram
0
5
10
15
20
25
0 5 10 15 20 25 30 35 40 45
X
Y
Correlation Coefficient
• Population correlation r
• Sample correlation r, -1 < r < +1
• Sign indicates nature of relationship (positive
or direct, negative o.
Matching Weights to Simultaneously Compare Three Treatment Groups: a Simulati...Kazuki Yoshida
Presentation at the Epidemiology Congress of Americas 2016.
https://epiresearch.org/2016-meeting/submitted-abstract-sessions/pharmacoepidemiology-estimation-of-treatment/
Paper: http://journals.lww.com/epidem/Abstract/publishahead/Matching_weights_to_simultaneously_compare_three.98901.aspx (email me at kazukiyoshida@mail.harvard.edu)
Simulation code: https://github.com/kaz-yos/mw
Tutorial: http://rpubs.com/kaz_yos/matching-weights
Nuts & Bolts of Systematic Reviews, Meta-analyses & Network Meta-analysesOARSI
Director, Applied Health Research Centre (AHRC)
Li Ka Shing Knowledge Institute, St. Michael’s Hospital
Professor, Department of Medicine & IHPME, University of Toronto
Tier 1 Canada Research Chair in Clinical Epidemiology of Chronic Diseases
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2. Lecture 9 Review –
Measures of association
Measures of association
–
–
–
Risk difference
Risk ratio
Odds ratio
Calculation & interpretation
interval for each measure
of confidence
of association
3. 2×2 table - Measures of association
Outcome - binary
Measure of Effect Formula
Risk difference p1-p0
Risk ratio p1 / p0
Odds ratio (d1/h1) / (d0/h0)
4. Differences in measures of association
• When there is no association between exposure and outcome,
–
–
–
risk difference = 0
risk ratio (RR) = 1
odds ratio (OR) = 1
•
•
Risk difference can be negative or positive
RR & OR are always positive
• For rare outcomes, OR ~ RR
• OR is always further from 1 than corresponding RR
– If RR > 1 then OR > RR
– If RR < 1 the OR < RR
5. Interpretation of measures of association
• RR & OR < 1, associated with a reduced risk / odds (may
protective)
be
– RR = 0.8 (reduced risk of 20%)
• RR
–
& OR > 1, associated with an increased risk / odds
RR = 1.2 (increased risk of 20%)
• RR & OR – further the risk is from 1, stronger the association
between exposure and outcome (e.g. RR=2 versus RR=3).
6. Comparing the outcome measure of two exposure groups
(groups 1 & 0)
s.e.(log RR) = − + −e
eR
(log
e
OR )
d h d h
Outcome
variable –
data type
Population
parameter
Estimate
of
population
parameter
from
sample
Standard error of
loge(parameter)
95% Confidence interval of
loge(population parameter)
Categorical
Population
risk ratio
p1/p0 1 1 1 1
d1 n1 d0 n0
logeRR
±1.96× s.e.(log R )
Categorical Population
odds ratio
(d1/h1) /
(d0/h0) s.e. =
1
+
1
+
1
+
1
1 1 0 0
logeOR
±1.96xs.e.(log eOR)
7. Calculation of p-values for comparing two groups
1 0
z =
s.e.(lo g ( RR ))
s.e.(log (OR))
Outcome
variable –
data type
Population parameter Population parameter
under null hypothesis
Test statistic
Categorical
π1-π0
Population risk ratio
Population odds ratio
π1-π0=0
Population risk ratio=1
Population odds ratio=1
p − p
s.e.( p
1
− p
0
)
z =
loge (RR)
e
z =
loge (OR)
e
8. Comparing the outcome measure of two exposure groups
(TBM trial: dexamethasone versus placebo)
Outcome
variable –
data type
Population
parameter
under null
hypothesis
Estimate of
population
parameter
from sample
95% confidence
interval for
population
parameter
Two-sided p-value
Categorical Population
risk
difference
= 0
p1-p0
= -0.095
-0.175, -0.015 0.020
Categorical
Population
risk ratio
= 1
p1/p0
= 0.77
0.62, 0.96 0.016
Categorical Population
odds ratio
= 1
(d1/h1) / (d0/h0)
= 0.66
0.46, 0.93 0.021
9. 2×2 table – TBM trial example
Odds ratio for death = (d1/h1) / (d0/h0) = 0.465 / 0.704 = 0.66
Odds ratio for exposure to dexamethasone = (d1/d0) / (h1/h0) = 0.777 / 1.176 = 0.66
Odds ratio for not dying = (h1/d1) / (h0/d0) = 2.149 / 1.420 = 1.51 = (1/0.66)
Odds ratio for exposure to placebo = (d0/d1) / (h0/h1) = 1.287 / 0.850 = 1.51 = (1/0.66)
Death during 9 months post start
of treatment
Treatment group Yes No Total
Dexamethasone
(group 1)
87 (d1) 187 (h1) 274 (n1)
Placebo
(group 0)
112 (d0) 159 (h0) 271 (n0)
Total 199 346 545
10. Measure of association
Study Design Risk
difference
Risk
Ratio
Odds
Ratio
Randomised controlled trial
√ √ √
Cohort Study
√ √ √
Case-control Study
× × √
11. Lecture 10 – Controlling for confounding:
stratification and regression
• A description of confounding
• How to control for confounding
analysis by
– Stratification
– Regression modelling
in statistical
• A brief description of the role of multiple
linear or logistic regression in adjusting for
confounding
12. Outcome and exposure variables
(RECAP)
Outcomes are variables of interest (population
health relevance) whose patterns and
determinants we wish to learn about from data
•
• Exposures are the variables we think might
explain observed variation in the outcomes
• Statistical analysis can be used to quantify the
association between outcomes and exposures
13. What is confounding?
A confounding variable
1)
2)
3)
is associated with the outcome variable;
is associated with the exposure variable;
does not lie on the causal pathway.
Outcome variableExposure variable
Confounding variable
Failing to control for confounding may result in a
biased estimate of the magnitude of the association
between exposure and outcome
14. Example of confounding
Exposure variable Outcome variable
Alcohol intake Heart disease
Confounding variables
Cigarette smoking
15. Control of confounding
Design of Study
• Randomisation
(randomised controlled trial: e.g. TBM trial)
• Restriction
(only include those with one value of confounder)
• Matching
17. Hypothetical example of a case-control study
Association between energy intake and heart disease
Odds
Odds
of heart disease in high energy intake group = 730/600 = 1.22
of heart disease in low energy intake group = 700/540 = 1.30
Odds ratio = 1.22 / 1.30 = 0.94
95% confidence interval: 0.80 up to 1.10
Heart disease
Energy intake Yes No Total
High
(group 1)
730 (d1) 600 (h1) 1330 (n1)
Low
(group 0)
700 (d0) 540 (h0) 1240 (n0)
Total 1430 1140 2570
18. Is this association confounded
by physical activity?
Exposure variable Outcome variable
Energy intake Heart disease
Confounding variables
Physical activity
19. Stratify by physical activity…..
Calculate the stratum specific odds ratios…
Energy
intake
High physical activity Low physical activity
Heart disease Heart disease
Yes No Yes No
High
(group 1)
500 510 230 90
Low
(group 0)
100 150 600 390
20. Stratify by physical activity…..
For high physical activity group:
OR (95% CI) = 1.47 (1.11, 1.95)
For low physical activity group:
OR (95% CI) = 1.66 (1.26, 2.19)
Energy
intake
High physical activity Low physical activity
Heart disease Heart disease
Yes No Yes No
High
(group 1)
500 510 230 90
Low
(group 0)
100 150 600 390
21. Is this association confounded
by physical
???
activity?
Exposure variable
Energy intake
Outcome variable
Heart disease
??????
Confounding variables
Physical activity
22. Confounding – condition 1
Association between physical activity and heart disease
** Look particularly in those who are not exposed to the factor of interest**
For low energy intake group:
OR (95% CI) = 0.43 (0.33, 0.58)
For high energy intake group:
OR (95% CI) = 0.38 (0.29, 0.50)
Physical
activity
High energy intake Low energy intake
Heart disease Heart disease
Yes No Yes No
High
(group 1)
500 510 100 150
Low
(group 0)
230 90 600 390
23. Confounding – condition 2
Association between energy intake and physical activity
• In a case-control study: examine the association in the controls
• In a cohort study: use the whole cohort
24. Confounding – condition 2
Association between energy intake and physical activity for those
without heart disease (n=1140)
Proportion in high energy intake group who report high physical activity =
510/600 = 0.85 (85%)
Proportion in low energy intake group who report high physical activity =
150/540 = 0.28 (28%)
Odds Ratio = (510/90) / (150/390) = 14.7; 95% CI: 11.0 up to 19.7
Physical activity
Energy intake High Low Total
High
(group 1)
510 90 600
Low
(group 0)
150 390 540
25. Is this association confounded
by physical
???
activity?
Exposure variable
Energy intake
Outcome variable
Heart disease
High energy intake:
OR = 0.38 (95% CI: 0.29, 0.50)
Low energy intake:
OR = 0.43 (95% CI: 0.33, 0.58)
High energy intake
associated
with high physical
activity
Confounding variables
Physical activity
26. So physical activity is a potential confounder
Control for confounding - Stratified analyses
1) Start with stratum specific estimates
differences, rate ratios
of odds ratios, risk ratios, risk
2) Calculate a weighted average of the
‘pooled’ estimate
stratum-specific estimates
Usual method is Mantel-Haenszel method
– Weights assigned according to amount of information in each
stratum
27. Calculate a pooled OR
(600×90)/1310) = 41.2
For low physical activity:
OR = 1.66
w= (d0×h1)/n =
For high physical activity:
OR = 1.47
w= (d0×h1)/n =
(100×510)/1260) = 40.5
Energy
intake
High physical activity
(n=1260)
Low physical activity
(n=1310)
Heart disease Heart disease
Yes No Yes No
High
(group 1)
500 (d1) 510 (h1) 230 (d1) 90 (h1)
Low
(group 0)
100 (d0) 150 (h0) 600 (d0) 390 (h0)
28. Calculate a pooled OR
(600×90)/1310) = 41.2
Mantel-Haenszel estimate of pooled odds ratio:
∑(wi × ORi )
OR =MH
∑wi
Stratum ‘i’
For low physical activity:
OR = 1.66
w= (d0×h1)/n =
For high physical activity:
OR = 1.47
w= (d0×h1)/n =
(100×510)/1260) = 40.5
29. Calculate a pooled OR
(600×90)/1310) = 41.2
Mantel-Haenszel estimate of pooled odds ratio:
(40.5×1.47) + (41.2×1.66)
OR =1.57=MH
(40.5+ 41.2)
95% CI: 1.29 up to 1.91
Recall that the crude OR was 0.94 (95% CI 0.80-1.10)
Is there a difference between crude
and adjusted measures of effect?
For low physical activity:
OR = 1.66
w= (d0×h1)/n =
For high physical activity:
OR = 1.47
w= (d0×h1)/n =
(100×510)/1260) = 40.5
30. Association between energy intake & heart
disease adjusting for physical activity
ORMH = 1.57
95% CI: 1.29, 1.91
Exposure variable
Energy intake
Outcome variable
Heart disease
High energy intake:
OR = 0.38 (95% CI: 0.29, 0.50)
Low energy intake:
OR = 0.43 (95% CI: 0.33, 0.58)
High energy intake
associated
with high physical
activity
Confounding variables
Physical activity
31. Multiple logistic regression
Outcome variable (y-variable) – binary
e.g. dead or alive; treatment failure or success;
disease or no disease..
Measure of association – Odds ratio
Multiple logistic regression model –
loge(odds of outcome) = β0 + β1X1 + β2X2 + β3X3 +…. + βkXk
β1,…βk – loge(odds ratios)
X1, …..Xk – k different exposure variables (do not need to
be binary but can be categorical with more than 2 categories
or numerical)
Useful when there are many confounding variables…
32. Logistic regression
Example – Association between energy intake and heart disease
Outcome variable (y-variable) – heart disease (coded as yes-1 & no-0)
Logistic regression model –
loge(odds of outcome) = β0 + β1X1
β1 – loge(odds ratios)
X1 – energy intake (high versus low)
Exposure Odds Ratio (expβi) 95% Confidence Interval
Energy intake
(high vs low)
0.94 0.80, 1.10
33. Multiple logistic regression
Example – Association between energy intake and heart disease
Outcome variable (y-variable) – heart disease (coded as yes-1 & no-0)
Multiple logistic regression model –
loge(odds of outcome) = β0 + β1X1 + β2X2
β1, β2 – loge(odds ratios)
X1 – energy intake (high versus low)
X2 – physical activity (high versus low)
Exposure Odds Ratio (expβi) 95% Confidence Interval
Energy intake
(high vs low)
1.57 1.29, 1.91
Physical activity
(high vs low)
0.41 0.33, 0.49
34. Multiple linear regression
Outcome variable (y-variable) – numerical
e.g. blood pressure, forced expiratory volume in 1 sec (FEV1)
Linear regression model –
y = β0 + β1X1 + β2X2 + β3X3 +…. + βkXk
y – numerical outcome variable,
β1,…βk – increase in y for every unit increase in x
X1, …..Xk – k different exposure variables (can be numerical
or categorical with 2+ categories)
Useful when there are many confounding variables…
35. Lecture 10 - Objectives
• Understand confounding
• Calculate the Mantel-Haenszel estimate of
pooled odds ratio
the
• Understand the difference between linear and
logistic regression