Risk in statistiETEETTETTTWEcal Terms Refers Simply To The Probability That An Event Will Occur

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Risk in statistical terms refers simply to the probability that an event will occur.

These are the definitions and relationships among various terms used to describe
risk and changes in risk.

 Absolute Risk (AR) = the number of events (good or bad) in a treated


(exposed) or control (non-exposed) group, divided by the number of
people in that group
 Absolute Risk Reduction (ARR) = the AR of events in the control
group (ARc) - the AR of events in the treatment group (ARt)
 Relative Risk (RR) = ARt / ARc = (a/(a+b)) / (c/(c+d)) from 2x2 table,
see below
 Relative Risk Reduction (RRR) = (ARc – ARt) / ARc; or RRR = 1 –
RR
 Number Needed to Treat (NNT) = 1 / ARR
 Number Needed to Harm (NNH) = 1 / (ARt – ARc)
 Odds Ratio (OR) = (odds of the event in the exposed group) / (odds
of the event in the non-exposed group) = (a/b)/(c/d) = ad/bc (from 2x2
table, see below)
 Hazard Ratio (HR) = (risk of outcome in exposed group) / (risk of
outcome in non-exposed group), occurring at a given interval of time
2x2 table for calculating risk

Examples

 RR of 0.8 means an RRR of 20% (meaning a 20% reduction in the


relative risk of the specified outcome in the treatment group
compared with the control group).
 RRR is usually constant across a range of absolute risks. But the
ARR is higher and the NNT lower in people with higher absolute
risks.
 If a person's AR of stroke, estimated from his age and other risk
factors, is 0.25 without treatment but falls to 0.20 with treatment, the
ARR is 25% – 20% = 5%. The RRR is (25% – 20%) / 25% = 20%.
The NNT is 1 / 0.05 = 20.
 In a person with an AR of stroke of only 0.025 without treatment, the
same treatment will still produce a 20% RRR, but treatment will
reduce her AR of stroke to 0.020, giving a much smaller ARR of 2.5%
– 2% = 0.5%, and an NNT of 200.
Significant difference

 If the RR, OR, or HR = 1, or the confidence interval (CI) = 1, then


there is no statistically significant difference between treatment and
control groups. 
 If the RR/OR/HR >1, and the CI does not include 1, events are
significantly more likely in the treatment than the control group.
 If the RR/OR/HR <1, and the CI does not include 1, events are
significantly less likely in the treatment than the control group.
 Therefore, if the CI includes 1 then it is uncertain whether the true
value would be above or below 1, i.e., whether events are more likely
in the treatment or control group, so overall there is no statistical
significant difference.
NOTE: When considering absolute numbers, if the CI includes 0 then there
is no significant difference. For example, considering the mean difference
in height between two groups of people, if the CIs around the point
estimate include 0, the conclusion would be that there was no significant
difference in height between groups.

Minimal Clinically Important Difference (MCID)

 Also known as clinical significance, this is the smallest change in


effect that is meaningful to the patient and/or healthcare professional.
Also called Minimal Important Difference (MID).
Useful tools

Statistical calculator

Further reading from related BMJ content

Hazard ratios
What is the number needed to treat (NNT)?

What is the number needed to harm (NNH)?

Understanding confidence intervals

Confidence intervals and statistical significance: rules of thumb

Confidence intervals: predicting uncertainty

Minimally important difference estimates and methods: a protocol

Application of minimal important differences in degenerative knee disease


outcomes: a systematic review and case study to inform BMJ Rapid
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