Measures of Association
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This document summarizes key concepts in measuring disease association from an epidemiology course, including: 1) How risk and rate ratios are calculated in cohort studies by comparing disease rates in exposed and unexposed groups. 2) How odds ratios are estimated in case-control studies by comparing odds of exposure in disease and non-disease groups. 3) How the 1950 Doll and Hill study on smoking and lung cancer was one of the first to estimate odds ratios from a case-control design.
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Measures of Association
- 1. Week 3 Measures of association EPID 504D Emory Rollins School of Public Health
- 2. 2x2 table Disease No disease Exposed a b Unexposed c d
- 3. Estimating risk - cohort Disease No disease Risk/Rate Exposed a b a/(a+b) Unexposed c d c/(c+d) Table 9-1. Design of a Cohort Study Table 11-9. Calculating in a Cohort Study • Risk ratio = risk (exposed) / risk (unexposed) • Rate ratio = rate (exposed) / rate (unexposed)
- 4. Estimating risk - cohort Diarrhea No diarrhea Total Risk (attack rate) Ate egg salad 45 9 54 45/54 (83%) Did not eat egg salad 18 41 60 18/60 (30%) • Risk ratio = risk (exposed) / risk (unexposed) = 83% / 30% = 2.8 • Risk difference = 83% - 30% = 53%
- 5. Estimating “risk” – case-control • Can’t estimate risk directly – Have cases and controls – Can vary the number of controls – Estimate risk using odds
- 6. Estimating risk – case-control Disease No disease Exposed a b Unexposed c d Table 10-1. Design of a Case-control Study Table 11-5. Risk Calculations in a Cohort Study • Odds = probability/(1-probability) • Odds ratio = odds exposure (diseased) / odds exposure (non-diseased) • Odds ratio = (a/c)/(b/d) = (ad)/(bc)
- 8. Doll and Hill, 1950 • Odds of exposure (case) = 688/21 • Odds of exposure (control) = 650/59 • Odds ratio = (ad)/(bc)=~3.0 Case Control Total Smoker 688 650 1338 Non-smoker 21 59 80 Total 709 709 1418 Smoking and carcinoma of the lung. Br Med J. 1950; 2(4682): 739–748
- 9. Summary • Odds ratio generally approximates risk ratio if the disease is “rare” • If RR, OR = 1 then no association • If RR, OR > 1 then positive association • If RR, OR < 1 then negative association
- 10. Potential for prevention • Attributable risk • Population attributable risk Background risk Risk due to exposure
- 11. Attributable risk • In the exposed, how much of the disease is due to exposure? • Attributable risk = (Incidence exposed) – (Incidence unexposed) Incidence exposed
- 12. Population attributable risk • In the total population, how much disease is due to exposure? • Population attributable risk = (Incidence total popn)-(Incidence non-exposed) Incidence total popn
- 14. Readings • Chapters 11&12 • Chapter 13 (review)