VETERINARY EPIDEMIOLOGY VPP5103 2024

Measures of Association

Common epidemiological measures include: measures of disease occurrence (e.g incidence and
prevalence); measures of association (include strength of association e.g relative risk, odd ratio,
incidence rate ratio, regression coefficient); other measures of association refer to as ‘measure of effect’
include excess risk, attributable risk, population attributable risk.

Strength of Association

A sample of subjects categorized into being exposed or non-exposed to a possible causal factor. All
subjects are exposed with regards to subsequent disease. A fraction of those exposed have become ill
during the follow-up period and a fraction of those non-exposed have also become ill with the same
disorder. The data can be displayed in a 2 x 2 contigency table as below:

Association between exposure and disease

Illness Exposure Total

Non-exposed Exposed
Healthy a b a+b
Affected c d c+d
Total a+c b+d a+b+c+d=n

Among the (b + d) exposed there are ‘d’ affected subjects, this gives a risk of Re = d/(b + d).

Among the (a + c) non-exposed, the risk equals Ro = c/(a + c)

The ratio between these two risks will express the risk of the exposed relative to the non-exposed – this
ratio is called relative risk and its given as RR = d/(b + d)/c/(a + c)

Relative risk (RR) can thus be defined as the ratio between the frequency of disease in a population
exposed to the causal agent and a population not exposed to the causal agent or the ratio between the
incidences of disease among animals having the factors divided by incidence among those not having the
factors.

RR greater than one (1) indicates a positive while less than 1 indicates a negative association between
exposure to factors and effect

Odd Ratio (OR): odds are the relationship between two possibilities, namely the probability for an event
divided by the probability for the non-effect provided that there are only two possible outcomes. Let the
probability of an outcome be P and let only one alternative result emerge, e.g that the outcome will not
occur, then the probability for the non-event will be (1 - P). Odds are then the ratio between P and (1 -
P), or P/(1 - P). From the 2 x 2 contigency table, (b + d) exposed subjects were examined. Among these
exposed subjects, d will be classified as ill or affected. The odds for being ill consequently is d/(b + d)
divided by b/(b + d) or d/b, which is the same as the probability of being ill divided by the probability of
not being ill. In the group of the (a + c) non-exposed, ‘c’ are counted as ill or affected and ‘a’ as healthy.
The odds for being ill versus healthy is c/a. the odds ratio is a comparison of these two groups by dividing
the odds for both groups, giving; OR = (d/b)/(c/a) = ad/bc.
From the table also, we will see that this odds ratio is the same as multiplying the counts diagonally in
the table and thereby dividing the product, resulting in ad/bc. Thus, this product is called the cross-
product. The odds ratio is an effect measure that tells us how much longer the odds are for the exposed
to be ill than for the non-exposed, and therefore is considered as an estimate of relative risk for disease.
The table also permit the assessment of the odds for being exposed, given that the subjects are affected
or healthy. There were (c + d) affected and (a + b) healthy subjects. Among the (c + d) patients there
were ‘d’ who were exposed to the risk factor, whereas ‘c’ were non-exposed. The odds for being
exposed will be d/(c + d) divided by c/(c + d), or d/c, whereas in the healthy control group the odds for
being exposed against non-exposed were b/a. the two groups will be compared by dividing the odds for
both groups: OR = (d/c)/(b/a) = ad/bc, which is the same as we saw when assessing odds for being ill
among exposed and non-exposed.

Bias

Bias is any systematic (as opposed to random) error in the design, conduct or analysis of a study that
renders results invalid.

Types of Bias

1. Information (observational) bias: involving misclassification of animals as diseased and non-

diseased, or exposed and not exposed to a factor, when comparing groups.
2. Interviewer bias: where an interviewer’s opinions may affect accurate reporting of of data.
3. Measurement bias: involving systematic errors in measurement
4. Selection bias: where animals selected for study have systematically different characteristics
from those that are not selected for study.
5. Confounding: confounding is derived from Greek word ‘confundere’ = ‘to mix together’, and is
the effect of an extraneous variable that can wholly or partly account for an apparent association
between variables. Confounding can produce spurious association between study variables, or
can mask a real association. A variable that confound is called a confounding variable or
confounder. A confounding variable generally must – 1) be a risk factor for the disease that is
being studied; 2) be associated with the explanatory variable; 3) not be affected by exposure to
the disease or the explanatory variable.